Transgender South Africans risk their lives for (self-)affirmation

Lack of access to gender affirming treatment is pushing transgender South Africans to dangerous and illegal measures to self-medicate, experts have warned.

Gender affirming treatment, which consists of hormone therapy and in some cases surgery, was considered an essential part of treating gender dysphoria, a distress experienced by some transgender people as a result of an in-congruence between their gender identity and the sex they were assigned at birth.

But according to Dr Tlaleng Mofokeng Commissioner at the Commission for Gender Equality, the risk of complications from hormone treatment was a heightened concern with transgender people because they often ended up self-medicating.

“With google and all of that stuff, it’s easy for people to find information but you can’t make a clinical assessment. A lot of the times you need blood tests before and monitoring… You may find some people taking very high doses of oestrogen if they are transgender women thinking that the higher the dose, the more that they will get the feminising effect, and that is actually more dangerous to your liver and other bodily organs.

“So, it is very important to advocate for access to good formulations at the right doses, that are easy for patients to maintain.”

Some people would begin treatment only to discontinue as a result of a lack of income, or be pushed to seeking cheaper options, which were not necessarily the best nor particularly suited for the patient, added Mokokeng.

The black market for such treatments, be they injections, pills or creams, was often predatory and either expensive or dangerous for patients.

Ayanda Nino Maphosa, a photographer and trans-man began hormone treatment a year ago, after toiling to save up money. While he opted to use a private clinic for treatment, where patients could be expected to spend at least R800 a month for a topical testosterone cream, he was aware of the illegal trade of testosterone treatments.

“I never ran out of cream, unlike (those who use injections.) There was a time in the country when they ran out of the testosterone injections and a lot of trans men suffered and for me, I am just using the cream. The cream is kind of expensive. It’s starts from R800 to R1000. I remember when the testosterone injections ran out in the country, a lot of trans men went into dodgy places to a testosterone (treatment) called ‘dop’. I don’t know much about it but I saw people buying that and my own information about ‘dop’ is that it’s really bad testosterone that can literally kill your organs.”

The only public facilities offering trans-specific healthcare services in South Africa are:
– Chris Hani Baragwanath Hospital (Johannesburg)
– Steve Biko Hospital (Pretoria)
– Groote Schuur Hospital (Cape Town)
– Helen Joseph Hospital (Johannesburg)

Thomas Shamurariya, a trans rights activist and founder of trans rights group, Fruit Basket said while South Africa attracted transgender patients from more countries with more transphobic environments across the continent, things were not much better here.

“When I started the project, my target was transgender migrants from other African countries here in SA. But as I did the project, as I advertised the workshops, I realised and I noticed that transgender South Africans face the exact same problems. Hormone replacement therapy is not easily accessible, because we talk about Bara being one of the only places that offer it for free. So, you can imagine that there are people in other provinces and in other areas that are so far and that have no (transport) to come to Bara.”

He added that in some communities, people took advantage of desperate trans people by selling them products used for gender affirmation, and people would buy and use these products without being told what steps they needed to follow.

Compounding the human rights violations of sexual minorities,training for the specialised healthcare needs of the LGBTI+ community was also lacking and there was a poverty of institutional knowledge in the country, said Mofokeng.

“If you want to have any comprehensive speciality training in queer health, transgender health for lesbian women, you kind of have to go overseas and how many people can afford, as healthcare workers and doctors to stop running their practices and then to go overseas for two to three months? It makes it even harder for a post-graduate to then keep up with their education so it’s important that some of this ends up in under-graduate training for all pharmacists, nurses doctors and lack of access is definitely a human rights violation in this regard.”

In November last year Wits University’s Reproductive Health and HIV Institute (RHI) and global aid group USAID opened the country’s first healthcare facility which specifically catered for transgender people, now offering gender affirming healthcare, including hormone therapy. Another facility was opened a month later in Cape Town, catering for transgender women.

Democratic Alliance (DA) shadow health minister Siviwe Gwarube said there was a need for public education on trans rights in all communities. This should especially extend to cover healthcare workers in our public facilities, she added.

“The second issue is the availability of medical care and hormonal treatment at public health facilities. This is crucial. It cannot be that you need to have access to private healthcare in order for you to be able to get the treatment you need. While the issue is very much resource-dependent, it is also a human rights matter which the Department of Health must take seriously and progressively realize.”

Simnikiweh@citizen.co.za

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