While the HRT medication shortage continues to impact patients, it is important to provide those affected by the shortages with the opportunity to share their lived experiences of the challenges caused by ongoing or potential disruptions to their healthcare routines and prescribed treatment.

Francine (not her real name), a 34-year-old transgender woman living in England, has personally had her Hormone Replacement Therapy impacted by the ongoing medication shortages.

She has been affected negatively by difficulties obtaining her prescribed HRT medications, stating:

‘In the short term, I have a practical anxiety about ensuring I have enough of my medications to last me for the next several weeks. I am comparatively early in my medical transition, so disrupted supply feels like a big threat to my progress and wellbeing. My fear is that withdrawal of HRT might reverse some of the changes which I have been experiencing and feeling the benefits of.

In the longer term, I have been confronted with some uncomfortable realisations about the importance of these medications and the likelihood of further disruptions to the supply chain. Conflict, climate change, Brexit, and a shaky economy are all current pressing trends that will only get worse in the coming decades. I am going to need (some of) these drugs forever. This realisation raises a kind of existential anxiety about being vulnerable to disruption in a way that I have had the great privilege to never really worry about before.’

It is not currently publicly known if the medication shortages may be a result of any supply chain issues, medication production issues, or if any other potential contributing factors may or may not be involved in the shortages.

However, whatever the reason(s) may be for the current shortages, the lack of HRT medications is placing significant stress on all individuals affected. A particularly heavy burden is being felt by many transgender individuals owing in part to the ongoing challenges being faced by the transgender community as a whole in regards to accessing and obtaining gender-affirming or gender-positive care.

A lack of access to healthcare information and/or lack of access to any relevant healthcare professionals or services are persistent difficulties for the transgender patient population in general, and Francine’s current experiences reflect this as well:

‘I do not feel like any useful information or support has been provided in this period. My GP doesn’t have time to talk through these concerns, my private clinic needs appointments to be booked months in advance, and my pharmacies can only give a best guess as to when they will acquire new supplies.’

Francine’s current experiences highlight some of the well-known challenges faced by transgender patients when seeking healthcare support or information regarding their own care; a study titled “Barriers to quality health care for the transgender population” noted the following:

‘While public awareness of trans issues has been heightened, clinicians, public health researchers, and officials are becoming increasingly aware that trans persons represent one of the most marginalised and underserved populations in medicine. …the level of proficiency of health care providers in caring for trans patients is very limited.’

Extended waiting times before a GP or other healthcare professional can be made available to discuss any concerns can be an issue for any patient, but transgender patients are noted as facing some of the longest waiting times out of any patient cohort.

The difficulties faced when attempting to arrange a timely appointment with a healthcare professional or care provider, in addition to multiple identified barriers experienced by transgender individuals while seeking care in general, may further compound any stress or anxiety which might be experienced by any transgender patient as a result of the current medication shortages.

The notably long waiting times that must be endured before access to any gender-affirming or gender-positive care can be obtained has resulted in many transgender patients in the United Kingdom resorting to private healthcare services in order to obtain the necessary care in a more timely fashion.

Waiting list hell

In January 2020, the BBC published an article titled ‘Transgender people face NHS waiting list “hell”’, which illustrated some of the notably extended waiting periods being faced by transgender people in need of healthcare services. ‘More than 13,500 transgender and non-binary adults are on waiting lists for NHS gender identity clinics in England’ with some having ‘to wait three years for their first appointment at a clinic’.

‘Currently the NHS is falling drastically short when it comes to supporting trans and non-binary people; NHS Guidelines say 18 weeks is the limit from referral to treatment. In reality the average waiting time for a first appointment with a gender identity clinic is 18 months.’

With a significant increase in workload on GPs caused in part by the pandemic and the resulting backlog of patient appointments, it is now even more difficult for transgender patients to access even non-gender-specific health services or reach healthcare professionals to discuss their concerns.

In April 2022 the Department of Health and Social Care published a press release announcing that a quantity limit on HRT medication has been introduced to help ensure that only a maximum three month supply of any HRT medication(s) can be dispensed at one time to any individual patient.

However, it is worth noting that this was not inclusive of the many transgender patients who also rely on these medications as part of their prescribed gender-affirming care, and currently does not specify any transgender-inclusive language.

The British Menopause Society has also published an information page regarding the current HRT medication shortages. However, it also does not currently specify any transgender-inclusive language.

As such, most information which is publicly available regarding the ongoing HRT medication shortages may not provide any transgender individuals affected by the shortages with information relevant to their healthcare needs and concerns.

When asked if she was able to obtain any information from her pharmacist at all, Francine stated:

‘I was given virtually no information other than that there are supply issues. No explanation was provided, and no estimated date of being able to fill the prescription was given.’

This is likely because the pharmacists and pharmacy services may not have any information or updates to provide at the moment, creating a less than ideal situation for both pharmacists and patients alike. In the meantime, a full list of medications affected by the shortage can be found here.

A large number of the patients affected by the HRT medication shortages may already be under a significant amount of stress owing to concerns around any potential prolonged disruption to their care.
Any such stress is then potentially further compounded by the current inability to obtain any additional clarification or any estimated date for when their medication(s) may be back in stock at their local pharmacies.

Without access to further details or other information regarding their medication(s), many patients affected by the shortages may then also struggle to find any available opportunity to discuss any concerns with a GP or other healthcare professional– And this may contribute to any potential additional delay in receiving any relevant guidance, support, or clarification that may become available.

The HRT medication shortages may continue for some time, as there is no current estimated end to the medication supply concerns.

When Francine was asked what she might feel would help her the most while awaiting any further information or assistance from any healthcare or government services in regards to the HRT medication shortages, her reply was succinct:

‘Frankly, I have no idea. It’s hard to imagine any improvement on this issue within the current framework of care provision in the UK.’

At the moment, it seems that those affected by the HRT medication shortages, both cisgender and transgender, are going to have to wait and see.

About the author: Clark Meeder is a contributing writer with a BA (Hons) in Visual Communications, alongside professional experience working in local government and healthcare.