HRT, or Hormone Replacement Therapy, utilises hormones to help address various medical conditions that may be aided by specific medications which can help to increase, decrease, or otherwise adjust the levels of certain hormones present in the body.

Recently, the medications used in HRT have been in short supply, causing major disruption in the lives of many.

The origins of HRT

The name Hormone Replacement Therapy originates from the earlier applications of this type of treatment, which was first made available in the early 1940s to help address the medical needs of cisgender women who may experience negative symptoms or other complications from the onset of menopause.

Menopause occurs when ovaries reduce the production of oestrogen in the body. Once the level of oestrogen drops consistently below the level required to cause menstruation for a time frame of at least 12 consecutive months, the cessation (ending) of menstruation is commonly accepted as a primary clinical indicator of the onset of menopause.

This is important to note, as a lack of certain hormones in the body can cause various other conditions to develop; one example is osteoporosis, which is known to be caused or exacerbated by low hormone levels. In particular, osteoporosis is often related to low oestrogen levels in the body.

To help address this decrease in oestrogen hormone levels, medication(s) containing oestrogen were then prescribed to those experiencing health concerns or persistent negative symptoms (such as frequent or severe hot flashes) which were related to the decreased production of oestrogen in the body.

Because these medications effectively raise or otherwise adjust the level of oestrogen in the body to help alleviate or avoid the development of any negative symptoms or complications, the term “hormone replacement therapy” was coined.

In postmenopausal patients, these medications help to “replace” the amount of oestrogen which the body would have produced before the onset of menopause, thus raising the overall level of oestrogen in the body to a level determined to be safest and most appropriate for any given individual who may benefit from this type of treatment.

If HRT medication doses are missed repeatedly over an extended time frame, or for some individuals even a relatively short time frame, this may result in some adverse effects. These adverse effects may include mental or emotional concerns such as mood swings, anxiety, or depression, or physical concerns such as a recurrence of the negative symptoms of menopause which the HRT medications are intended to alleviate or resolve.

For example, if a post-menopausal cisgender woman may be taking HRT in part to help address vaginal atrophy or bladder control difficulties caused by low production of oestrogen in the body, the cessation of any HRT medication(s) due to a lack of medication availability may eventually possibly result in a return or worsening of any lower urinary tract or bladder symptoms such as incontinence.

Understandably, any such potential for mental, emotional, or physical health impacts related to the undesired cessation of any HRT medication(s) as a result of medication shortages is an extreme concern for patients relying on HRT to help them maintain their general health and well-being.

HRT, transgender people, and the impact of medication shortages

Many transgender people who are undergoing HRT as part of any gender-affirming or gender-positive care are prescribed the same types of HRT medications used by cisgender individuals.

The reason(s) for prescribing HRT can vary from patient to patient – and there will always be natural differences between each individual as our respective bodies have minor variations – but the way hormones function in the body will generally still be the same.

As such, there is no separate type of “transgender HRT”; The most commonly prescribed medications for HRT are generally the same regardless of whether a person undergoing HRT is cisgender or transgender.

Transgender people may be prescribed HRT medications to help alleviate or even resolve any gender dysphoria they may experience. If HRT treatment is deemed appropriate as part of gender-affirming or gender-positive care, these medications help maintain or develop any physical changes which may improve their overall mental, emotional, and physical health when used as prescribed.

HRT is not solely focused on oestrogen, and medications containing testosterone are used for HRT when appropriate for any cis men, transgender men, some non-binary individuals, and others for whom testosterone is the hormone which needs to be increased, decreased, or otherwise adjusted in the body.

Because the current medication shortages in the United Kingdom are primarily affecting oestrogen based HRT medications, they have most severely impacted transgender women, as well as some non-binary and other individuals who may be taking HRT for the purposes of gender transitioning.

While it is certainly not a competition between cisgender and transgender people, as any medication shortage seriously impacts any people who may rely on any unavailable medication(s), it is important to note that transgender individuals face more overall barriers when attempting to access healthcare services or support, in comparison to the cisgender population on average.

Barriers to care

A recent interview study identified some of the barriers transgender people face when attempting to access healthcare:

Systemic barriers included scarcity of specialist centres, with ‘participants express[ing] a clear desire for decreased waiting times.’ A lack of clear guidelines and educational gaps among providers were also of major concern; providers ‘stressed that the lack of inclusion of trans health in their training had left them unprepared to care for this population.’

Compounding this, negative attitudes towards trans people were found to lead to discrimination within primary care. Lack of awareness, gendered language use, and inflexible IT systems and spaces also contributed to making healthcare inaccessible to transgender individuals.

These barriers compound the already significant challenges presented by an inability to obtain any prescribed HRT medication(s) owing to the current shortages. These additional difficulties in obtaining healthcare-related support or services may not be experienced by any cisgender people who have also been impacted by the HRT medication shortage. As such, transgender patients may be facing even greater distress and/or dealing with more challenges overall when attempting to obtain information or support while the medication shortage remains an ongoing concern.

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.