A manufacturing delay that has created a shortage of the injectable testosterone drug Delatestryl has left many trans men scrambling to find alternatives.
A registered nurse with the Sherbourne Health Centre’s LGBT Primary Care program says users should not wait for the drug to reappear.
“They should be coming in to see their physicians or nurse practitioners because they can be switched to a different compound,” says Mary Potter. “The issue is when they don’t come to see us . . . they’re told by the pharmacy that they just don’t have it and people are waiting without the medication.”
Potter says waiting, rather than finding an alternative drug, can result in a lapse of the medication’s effects.
She says this is the second shortage this year.
Xtra spoke with five Toronto pharmacies which all had Delatestryl on back order.
However, another injectable testosterone, Depo-Testosterone (testosterone cypionate), is available. The concentration of the active ingredient is lower in Depo-Testosterone, so injections may be more uncomfortable.
A topical gel and patch are also available, although they are significantly more expensive, says Adam Silvertown, pharmacy manager at Pace Pharmacy. He says the transdermal patch, known as Androderm, can cost users as much as $160 a month.
A month’s supply of Delatestryl is cheaper, around $60.
Theramed, the former manufacturer of Delatestryl, recently sold product rights to Valeant International, another drug distributor.
Carine Remolien, a pharmacological coordinator for Valeant Canada, says the product is unavailable because of a “manufacturing delay.”
“The product might be available January 15,” she says.
Jeff Morrison, director of government relations and public affairs for the Canadian Pharmacists Association, says, “there’s no requirement on the part of manufacturers or industries to disclose why a particular drug is in short supply.”
He says a new reporting system for shortages will allow pharmacists to anticipate problems in advance.
Morrison thinks government should pressure drug manufacturers to maintain a steady supply of their products. “Provincial governments . . . are big purchasers of drugs for their public drug plans. A lot of the contracts provinces have with manufacturers, there are clauses that mandate [drug companies to] maintain certain supply levels,” he explains. “The problem is a lot of provinces just don’t enforce those.”
A 2010 Canadian Pharmacists Association report found that 91 percent of pharmacists said drug shortages “inconvenienced” their patients, while 70 percent said patients’ health outcomes were “adversely affected” by shortages.
“In a lot of cases, patients are the ones sort of having to run back and forth between their doctor’s office and their pharmacy to get a new prescription and they’re saying it’s a huge inconvenience,” Morrison says.
Benjamin Vandorpe was lucky. He filled his prescription before learning the medication was on back order in Toronto. The Nova Scotia native says he first heard about the shortage from friends in that province. When he learned many Toronto pharmacies were also out of stock—and could be for about another month—he decided to call the suppliers to ask what was causing the hold-up.
Vandorpe thinks Valeant and Theramed should have notified users of the drug about the hiccup. “Even just a note on the website explaining the situation would have been great, especially since there is only one person who deals with inquiries about medications, and she's out of the office until January,” he says.
“A lot of people depend on this medication for physiological, mental, and emotional well-being,” he adds. “There are so few doctors who are willing to prescribe it to trans-identified individuals that it's a serious inconvenience to have to seek out another medication.”
Potter agrees. “It is quite disruptive,” she says. “Trans people have to fight so hard just to get that medication in the first place . . . putting people through these gaps or making them struggle to get a medication is just kind of unreasonable.”