OStann Fransisco and his family were driving home from Connecticut to New Mexico on a Saturday night in 2012. Crossing Texas, they just reached Stratford. They realized they were too tired to continue driving and pulled off the highway to rest. They saw flashing police lights as they climbed into the back seat to meet their service dog. Officers approached the vehicle.
“One officer said, ‘It smells like you’ve been having a party in here. Is that right?’” Fransisco, a white nonbinary person in their 30s, told Filter. “He said, ‘Well, if you haven’t been having a party, you won’t mind if we check your car.’”
Fransisco was violently handcuffed by the officers. They also took their keys and called animal control for their dog to be confiscated. They then searched the vehicle.
“One yelled, ‘Show me your track marks, you fucking junkie! We found your needles and drugs,’” Fransisco said. The cop pulled out their testosterone prescription. “I said, ‘Those aren’t drugs, that’s my medication. I’m trans.’”
“The second it went out of my mouth, I think ‘Oh, fuck’ … I’m sitting there in a sundress and they see male hormones after they’ve been waiting to get me alone because they think I’m a girl.”
Fransisco was jailed overnight, with two cisgender women who’d also been detained for drug use, but was fortunate enough to have friends and family able to help release them the next day on a $2,500 bond.
Fransisco doesn’t inject drugs nor does he use any psychoactive substances other than weed. But their experience — of someone outside the gender binary being harassed by police and accused of drug use because they inject hormones — is a common one.
It is also why syringe service programs (SSP) often keep 21 to 25-gauge needles in stock even though they’re too large for almost anyone injecting drugs to request — they’re for gender variant participants who need them for hormone injection. Whether or not these participants also use drugs, SSP are often the safest way for them to access syringes — a marker of how, in police harassment and disenfranchisement from lifesaving, humanizing medical care, gender variant people and drug users often share a common struggle.
Transgender health care and testosterone
Testosterone is an anabolic-androgenic steroid, meaning it’s composed of synthetic variations of the sex hormone testosterone. “Anabolic” refers to muscle building; “androgenic” to increased male sex characteristics.
For nearly a century, synthetic hormones have been used by transsexuals and gender variants. The first known prescription for a trans man was given by Michael DillionIn 1939. It was popularized by professional athletes such as weightlifters around the middle of 20th century. In the 1980s, young cisgender men were using it to bulk up.
In 1990, the Anabolic Steroids Control ActTestosterone was classified as a federally controlled Schedule III drug. This places it in the exact same category as buprenorphineAnd ketamine. Lawmakers intended for this to curb steroid “abuse” among young cisgender men. Its deeper impact was to criminalize health care services for trans men, intersex and other gender variant people. testosterone replacement therapyThey are already disenfranchised from care in a cisheteronormative organization. (Estrogen replacement therapy is not a federally-scheduled substance, but people who use it still face transmisogyny-related health care barriers.
Two-fold approach is the current US approach to transgender healthcare. Originally, the only route available to people seeking transgender care was what’s colloquially referred to as the “gatekeep model” — a mental health evaluation or referral required on the basis that trans people are mentally ill or “confused.” This model still applies to anyone under 18.
In the 2000s, another alternative began to gain traction. informed consent model, which permits access to gender-affirming care, including surgeries and hormone treatments, without a mental health professional’s authorization. For those under 18 years of age require consentParent or guardian. This model, while imperfect, allows patients greater autonomy.
But “unless you go to Planned Parenthood, it’s difficult to access a provider who does informed consent-based prescriptions, especially without insurance,” TJ Burton, a transmasculine health care clinic coordinator in Kansas City, told Filter. “Even after I went to PP and got prescribed on informed consent, it’s still a time consuming and costly process.” Often that process involves lab fees — which aren’t always covered by insurance even for those who have coverage — and inflexible time windows in which people can refill their prescriptions.
Pharmacies, like all other health care settings, typically aren’t well versed in serving LGBTQ people. Many people with gender differences, including myself have experienced discrimination or hostility from pharmacists.
“Criminalization has made it easy for pharmacists to deny my [testosterone] prescription, which has happened to me many times,” Artemis McGettigan, a trans student in Dearborn, Michigan, told Filter. “[Pharmacists] have told me in the past that ‘It’s corporate policy, they’re not allowed to fill that type of prescription … but I knew that was false because other CVS locations, for example, were able to fill it.” A CVS media representative told Filter that its policies “do not prohibit our pharmacies from filling testosterone prescriptions.”
Prescription drug monitoring programs (PDMP) are electronic databases through which medical professionals and law enforcement can track someone’s prescription history. Initially designed to combat “diversion” of controlled substances with potential for addiction, they are often used to monitor testosterone prescriptions and the people who receive them. Many in the trans and gender variant community, especially those who aren’t fully public about their gender identity, fear being listed on PDMP — they could be outed by anyone with access to the database.
L. Lanzillotta is a trans man from Virginia. Filter contributor, recalled meeting with a psychiatrist who didn’t know he was trans and to whom he had no plans to out himself. But that decision was made for him as soon as the psychiatrist pulled up what he strongly suspects was the state’s PDMP.
“She knew I was on testosterone after checking something on her computer, even though I hadn’t said anything,” Lanzillotta told Filter. “Naturally, she quickly deduced why.”
While not everyone on testosterone is transgender, it’s certainly a clue, especially for those who still have a female gender marker on legal documents. Such surveillance costs gender variant autonomy, to out people without their consent.
In July, Phillip Cooper*, a trans man from Santa Fe, New Mexico, was required to sign a patient agreement form regarding controlled substances. “[I] was told it’s a clinic policy for all controlled substances,” he told Filter. “I’ve been getting T from this clinic for almost two years now and this had never been asked of me before.”
Cooper doesn’t use any banned drugs by the state, so he was shocked. “To be clear, the thing I found intrusive wasn’t having to sign the form. It was the requirement to go through a drug screening [and] submit a urine sample as though using testosterone, which doesn’t get you high and isn’t addictive, and is only a controlled substance because of sports doping, made me more likely to be using illegal drugs!” He added, “It’s nothing to do with monitoring safe T levels, which has to be done via blood test.”
Gender variants, as well as those with marginalized identities, have different experiences disproportionate rates of substance use disorder. This isn’t a moral failure — of an individual or a community — but rather a systemic one. It’s a symptom of the trauma associated with living in an ostracizing, capitalist society rooted in (among other things) the gender binary, patriarchy and colonial gender roles.
“It was humiliating and infuriating,” Cooper He claimed that he was presumed to have used illicit drugs because of his gender identity. “I don’t think either the clinic or my provider was being deliberately transphobic — rather, T being a controlled substance, and the policy being inflexible, led to a transphobic result.”
Ending this Injustice
There are several options to get testosterone criminalization out of the way. It could be federally rescheduled into the IV or V category. It could be removed from the CSA completely, but it would still be subjected to some form of government regulation.
If rescheduled, T could be accessed similarly to other over-the-counter medications — like birth control, which is also a fundamental human right. While descheduling would allow transgender and gender variant people greater access to and agency, it is likely to be perceived as an attempt to limit their access. as too “radical” by much of our transphobic society, which already micromanages our everyday lives even down to the bathrooms we’re permitted to use.
And while descheduling would mean gender variant people are less likely to be criminalized for accessing T, it still wouldn’t solve the larger problem: that we do not receive equitable health care.
The use of testosterone without medical supervision, including regular blood level monitoring, can potentially lead to health complications (such as high blood pressure or overproduction of red blood cells) that are otherwise easily avoided — and among people already unlikely to have access to decent care. Transgender care is not available in the US for people of any gender who are wealthy or have white privileges.
Descheduling wouldn’t fix health care, but it would remove barriers for gender variant people already receiving care, and theoretically protect them from experiences like what Fransisco endured in 2019. And making testosterone illegal isn’t any more effectiveTo curb recreational use of psychoactive drugs by cis men, criminalizing them is not the best way to reduce their use.
“In my opinion, any medication you’re put on should be monitored by a doctor, but that gets into how crappy our healthcare is in the US,” Burton said. “I would imagine there are bigger fish to fry [since] testosterone doesn’t get you high. It doesn’t have any immediate gratification effects. It is absurd to classify this in the way that we do. It’s an unnecessary, gate-keepy thing to do, especially when the majority of patients I see scheduling HRT are elderly and need it or are trans and need it.”
Any person who is not a woman faces discrimination and antagonism from the medical industry. We are frequently mistreatedproviders, who are subject to verbal harassment, misgendering, denial of hormone therapy, and denial of treatment unrelatedly to gender. They also have to educate providers about their identity and needs. People of additional marginalized identities and experiences — like race, disability, mental illness, higher weight or drug use — face compounding barriers to care.
Gender-variant people should not only be acknowledged in drug policy reform, but should be prioritized.
*Name changed at source’s request.
This article was originally published in FilterOnline magazine focusing on drug policy, drug use, and human rights with a harm reduction lens. Follow Filter FacebookAnd TwitterSubscribe to our email newsletters, either daily or weekly here.