For two years, I took injectable estrogen once every two weeks.

I’d carefully expose the needle and draw out the thick liquid, filling the syringe, and tap out the bubbles. Then I’d enlist a friend to help inject it. It symbolized to me that gender transition is a combination of strength from within and community support.

I will never forget my sister’s try. She pushed too fast, separating the barrel from the needle, leaving half in my arm and the estrogen across my face. Otherwise, she’s a terrific registered nurse.

Shortage of estrogen drugs in US worries trans women: 'It's my peace of mind' Read more

But last year, my pharmacy was suddenly unable to fill my prescription, which I depend on the same way those with diabetes, thyroid failure, HIV or countless other now-treatable conditions depend on theirs. It was on backorder, I was told, with no further explanation. This was over a year before Out magazine reported on the national shortage last week.

My pharmacy offered to request a replacement prescription from my doctor for a double dose at a lower concentration. This would require weekly shots, each of which left my arm or thigh sore for a few days, so I opted instead for daily pills which dissolve under my tongue.



Switching to pills was an easier decision for me than for others. Pills must be taken daily, which is easy to forget. Their contents reach the bloodstream indirectly, instead passing medicine through the liver, which can be dangerous over time. Many trans women, myself included, feel that shots and the cyclic nature of the estrogen levels rising and falling across bi-weekly doses feels more natural, and more effective, than the continuous levels from daily pills.



In whatever form we take them, hormones are molecules that signal cells in the body to do specific things, like lines of software code. The more often they appear, the more that command is accessed. Hormones like testosterone and estrogen control our sex characteristics, especially in the womb and through puberty.



Amazingly, everyone’s body has an ability to respond to both “male” and “female” instructions, depending on which hormones are present. Nobody fully understands what makes a person identify as a different gender than their body has developed. But for those needing them, prescription hormones change the software our bodies run on. We are “hacking” our bodies to match how we feel on the inside.

This helps trans people to not only survive, but thrive. But it only works if the drugs are reliably available and affordable.

My pharmacists were likely aware last year that high-dose estrogen injections would be scarce for the 18 months and counting. Reportedly, Par Pharmaceuticals, its manufacturer, must wait on new Food and Drug Administration approvals following changes in material suppliers. The reasoning feels almost irrelevant to those whose lives are affected.

Making myself more feminine stops me from feeling disgusted by my body. I always was a woman, simply one with a deficiency of a certain signalling hormone, which my body so comfortably responds to now. It is about being seen as my truest self, and recognizing the effort it has taken to realize her.

Missing hormones, on the other hand, while not directly lethal, will lead to anxiety, depression and the return of certain male features such as spontaneous erections, which trans women find uncomfortable and terrifying. But taking female hormones treats the dysphoria above all, as if tweaking my brain’s coding alongside feminizing my body. It lifts many of us from the clutches of self-harm or darker thoughts.

Trans people have teetered long enough on the fringes of medicine that this shortage feels like yet another stumbling block against getting acceptable care. The FDA continually reveals itself to be a body of bias over basis, as it doubled down on enforcing obsolete restrictions upon gay male blood donations and in effect considers trans women to likewise be men who have sex with men.



This regulatory issue pertains to US distribution only, so some girls may seek estrogen through other channels or countries. There are reputable US compounding pharmacies that fill prescriptions by mail, but going overseas or to black markets makes it harder to be sure what you are buying. Plus, you have to pay out of pocket.

For decades, it was difficult to find doctors willing to discuss trans medicine, let alone insurance willing to cover it. It is endlessly frustrating to receive a drug I will take forever by monthly dole, remembering to place refill orders quarterly, and sorting out the inevitable glitches therein, such as doctors who accidentally write “dispense 30” when they mean 30 days’ worth.

The FDA could do well to fast-track this bureaucratic debacle and help us trans women get on with our wonderful lives. Until then, we’re stuck in an uncomfortable holding pattern, never certain if we’ll be able to feel like ourselves, a state most people have the luxury of taking for granted.