Shortage of Estrogen Drugs in US Worries Trans Women

A shortage of the two most popular estrogen hormone injections has U.S. transgender women in a panic, with no guarantee of when the supplies will return.

First reported by Out, the drugs Delestrogen and its generic counterpart, Estradiol Valerate, have been increasingly difficult to get at the 20 mg dosage. About a year and a half ago, the 40 mg dosage -- the most popular and most prescribed among transwomen -- went on shortage and never returned to the market.

Doctors are making do with the 20 mg injectables, and while the 10 mg remains available, most doctors won't prescribe it, as it entails injecting a large volume into patient's muscles every one or two weeks, to the point of extreme pain.

"All the girls are freaking out," said performer Charlene Incarnate, a patient at Callen-Lorde in New York City. "The doctors and pharmacists swear up and down that [pills and patches] are the exact same thing with the exact results. But everyone knows that if you go from pills to injections, that's when you really start noticing changes. Everyone more or less prefers the injectables."

The shortage affects about 900 patients at Callen-Lorde alone. For now, doctors are prescribing them estrogen pills or patches. Estrogen in pill form is relatively inexpensive, but patients must remember to take the pill every day. It also has a risk of blood clots.

According to Heather Zoumas Lubeski, a spokesperson for Par Pharmaceuticals, which manufactures Delestrogen, the company was forced to find a new manufacturer after its original supplier stopped producing the material. They are awaiting FDA approval on the new drugs.

"They have batches manufactured (10mg, 20mg and 40mg) but cannot distribute until they receive FDA approval. Once that happens, they can begin to ship immediately," she told Out. There is no guarantee of when that will happen.

The UK Guardian notes that the estrogen helps develop and maintain a feminized body, enhancing breast growth and redistributing fat. A sudden loss of the hormone can result in emotional changes; a long-term loss will cause those physical changes to slow down or reverse. Health experts and trans women alike have called the injections "life-saving."

In the meantime, the drug remains out of reach. Medical professionals are worried that women will seek injectable estrogen from unregulated sources; many online pharmacies ship the drug from overseas, where the content may not be as highly regulated.