Trans women want SA public health sector to stop prescribing ‘toxic’ drug

Transgender activist Kattia Lemar Williams has launched a petition against the “highly dangerous” drug, Premarin, issued to trans and cis-gendered women in South African health care institutions.

Premarin is a medically prescribed drug that contains oestrogen hormones, meant to help treat symptoms of menopause, osteoporosis and vaginal dryness.

The medication is also prescribed as South Africa’s primary transgender hormone replacement therapy (HRT) in many public health care facilities. Some research has, however, shown that Premarin may have serious side effects, including , heart attacks, weight and bone loss, nausea, stroke and seizures.

The drug (a contraction of “pregnant mares’ urine”) was first introduced in 1942 and is mainly distilled from the urine of pregnant horses. The mares are said to be cruelly forced to stand for about five months in congested concrete floor stalls fitted with a rubber collection cup joined to a hose which extracts the urine.

“Sometimes, to increase profits, the mare’s urine is concentrated by water restriction, potentially leading to disease in the animals which could be transmitted to humans. There is also some evidence that the equine estrogen contained in Premarin may cause cancer,” Williams claims.

These are among the reasons why the Durban nurse and Miss Transgender South Africa 2017 launched a petition earlier this month, with her friend, Sarah, to stop the health department from continuing to prescribe this drug.

“It’s been way too long that we have been given [this] toxic treatment,” Williams says in the petition.”Why is it that South Africa is still prescribing this treatment to transgender people? Are we just some kind of experiment?”

According to the Williams, Premarin only helps trans women with breast growth  for the first ten months and stops working thereafter. “Doctors always say its bad hormone replacement therapy, but they still tend to treat us with it. Why? Because they say there are no protocols. What do we need to do in order to be heard? I will stand up for my community,” Williams said.

Not only is Premarin said to be very dangerous, it is also quite costly for those who need it. The approximate cost for the starting dose in the private sector is R118 per month for 0.625 mg.

According to medical doctor, trans activist and author, Dr Anastacia Tomson, Premarin is an “outdated and dangerous product” that should not be used, but due to the country’s public healthcare sector being under resourced, the cost of buying Premarin from manufacturers is much cheaper than buying other hormone therapies (although it is costlier when bought by users).

“It is a bad medicine. It has far worse side effects than any other oestrogen and trans women are particularly vulnerable because they have to take it at a higher dosage than it’s used,” Tomson told Mambaonline. “So trans women are at a higher risks of strokes and cardiovascular illness.”

Dr Tomson said that there are numerous other hormone replacement therapies which are safer and less costly for users than Premarin. For instance, Estrofem, which is a hormone replacement therapy that replaces oestrogen when the body fails to do so. The cost of Estrofem is roughly about R62 per month for 2mg. “Access to these [hormones] should be prioritised. Trans women need access to safe and effective care,” Tomson insisted.

Williams has called on the LGBTI community and its allies “to help us take a stand”.  She added: “It is our human right to have access to the new correct and less harmful form of HRT.”

To sign Williams’ petition, addressed to the South African Medical Association and the KwaZulu-Natal Department of Health, click here.