Under-Insured Transgender Americans Turn to Riskier, Non-Licensed Sources for Gender-Affirming Hormones

Transgender people who lack access to insurance coverage for gender-affirming hormone therapy are more likely to use hormones from sources other than a licensed prescriber, compared to those with insurance coverage. Analysis of the most recent United States Transgender Survey shows that about 9 percent of transgender adults – which comes to about 170,000 transgender adults in the U.S. today – access hormones from non-licensed sources like friends or online. The study found an association between the use of non-prescribed hormones and lack of health insurance or denial of insurance coverage for gender-affirming medical care. Survey respondents also identified insurance coverage as a prevailing barrier; it was ranked as a top issue affecting transgender people in the United States, ranked second only to direct violence.

The authors note that hormones accessed from an unlicensed source may pose health and safety risks, as medications may be unmonitored for content, quality, formulation and dosing. Additionally, use of non-prescription hormones likely entails decreased monitoring of hormone levels and less opportunity for mitigating risks or other forms of harm reduction and preventive care.

Insurance Coverage and Use of Hormones Among Transgender Respondents to a National Survey

Daphna Stroumsa, MD, MPH, et al

University of Michigan, Ann Arbor, Michigan