Trans Patients’ Testosterone Access Eased by Online Prescribing

Transgender patients who are prescribed testosterone online are signaling cautious optimism after federal health officials decided controlled substances may be prescribed via telemedicine through late 2024.

Testosterone, Adderall, and Xanax are among the controlled medications that clinicians have been able to prescribe online under Covid-era policies that eased access to telehealth when lockdowns made office visits difficult. The Drug Enforcement Administration had planned to reinstate pre-pandemic restrictions but now is backing away from that proposal, under a temporary rule published Wednesday in the Federal Register.

Transgender people who have been prescribed testosterone online say they’re relieved they won’t need to be seen by doctors at in-person clinics, which are rare in rural areas and often have wait times of several months. Clinicians, researchers, and health policy experts said requiring in-person exams would add roadblocks to care, and that could prove to be devastating for vulnerable transgender people.

Meg Quint, a transgender health researcher at Brigham and Women’s Hospital in Boston, said telehealth has increased access to care for transgender patients.

“Telehealth companies have been able to alleviate some of the burden both on providers, who are trying to fit in as many people as possible, and on our communities, by not forcing us to travel hours and hours, potentially missing work,” they said. “Telehealth has exponentially increased access to care for everyone but especially for trans people in terms of gender-affirming care.”

38,000 Comments

The DEA and the Department of Health and Human Services received 38,000 comments on their original plan to reinstate pre-pandemic restrictions on telehealth prescriptions of controlled substances.

Matthew Wetschler, CEO of Plume, a trans-specific telehealth company, described the extension of telehealth policies as a win.

“Many of our patients are in care deserts, and for them, our services are a lifeline,” he said. “This is a sign that the DEA knows it has a lot more to consider before making a permanent choice.”

Under the temporary rule published Wednesday, controlled substances may be prescribed online through Nov. 11. Practitioners who have relationships with patients by then can continue to prescribe the drugs online until Nov. 11, 2024.

Testosterone was categorized as a Schedule III medication for its history of abuse as a steroid, prevalence on the black market, and its risks, including increased likelihood of heart disease.

Em Dickinson, a transgender person in New York, said they had been attempting to access testosterone for several months before finding Folx Health, a telehealth company designed to provide care for LGBTQ patients. Dickinson said it only took about a month from signing up for Folx online to receiving testosterone in the mail.

“It would have taken me a much longer time to get on T if I hadn’t discovered Folx and telehealth, just because of that fear of medical spaces in general being a nonconforming person,” Dickinson said. “Not having T for me, at this point, is just not an option.”

Time to Make Plans

A 2015 study by the National LGBTQ Task Force said 28% of respondents reported experiencing harassment in clinical settings, and 19% said they had been refused care outright by a provider for being trans.

Riley Johnson, a trans man in Florida, has been on testosterone for 20 years and is receiving his care through a telehealth provider in Michigan. The proposed rules would have required him to find in-state care in Florida, which is eyeing restrictions on gender-affirming care for adults.

“If we have to stay in Florida, and I can’t get the care I need in Florida, I don’t know what I’m going to do other than like vacation care or something where I have to go across state lines,” Johnson said. “But I have no idea what that looks like.”

The DEA announcement this week relieved some anxiety for Johnson, but he said he still has concerns for the future.

“They seem to be expecting that patients and providers will take this time to make plans, but it doesn’t give people any idea of what they should be planning for because they don’t say whether they’re going to shift from their proposal,” Johnson said. “But I think this could be a good sign. It shows that they’re at least taking the public feedback into consideration.”