With little to no entry to medical care, trans individuals in Azerbaijan face a stark selection between residing with the ache of gender dysphoria or present process hormonal remedy on their very own.
‘My menstruation stopped, hair began to develop on my face, my mom figured it out and the household used bodily violence due to this. I needed to escape to Baku through the night time’, recollects Devran Ibrahimsoy, a 25-year-old trans man from Shamkir.
Devran has been on hormonal remedy for two years now and suffers from critical unwanted side effects that put him by way of a number of ache. He will get insufferable complications through the time he would have gotten his interval.
He says that the hormones have noticeable unwanted side effects on their our bodies; some add oiliness or a particular scent to the pores and skin, layers of fats within the breasts, buttocks, and thigh areas change their locations.
‘One in every of my buddies was affected by an extreme scent, one other was terribly dropping their hair. I obtained a hyoid bone on the third month of the remedy’, he displays.
Devran additionally worries in regards to the results hormonal remedy may have on his inside organs, together with damaging his liver.
Devran, like most of those that select to transition in Azerbaijan, is doing so with out medical supervision.
Black market medication
Turana Nuri, an LGBTQ+ activist from Azerbaijan who works with the trans neighborhood each within the nation and outdoors of it, advised OC Media that there are a number of medical doctors keen to work with trans individuals in Azerbaijan, however they’ve to cover it.
‘Endocrinologists in Azerbaijan normally don’t need to work with trans people’, she stated, including that it was a lot simpler to go to one in Turkey or Iran however that this was not reasonably priced for most individuals.
Nuri says that a lot of the trans individuals she had spoken to began hormonal remedy on their very own.
‘Hormones are normally obtained from the black market as a result of there is no such thing as a endocrinologist who would prescribe the fitting dose, due to this fact there’s a excessive chance of utilizing the unsuitable dosage’, she concludes.
There are two such drugs bought in pharmacies in Azerbaijan, Testosterone Enanthate and Propionate. Propionate is comparatively low cost for the reason that proportion of testosterone in it’s small, however it’s bought solely with a prescription.
The price of Testosterone Enanthate varies between ₼15–₼20 ($9–$12) for a single does, which is injected each week.
When Devran can not discover the previous, he buys 5 doses of Propionate and injects all of it in a single syringe.
‘I’m fortunate to have a good friend who sells these to me over-the-counter. But many individuals need to carry medication from overseas’, he says.
The product description on these drugs consists of data on the identified unwanted side effects, that are nausea, vomiting, complications, pores and skin color modifications, elevated/decreased libido, oily pores and skin, hair loss, pimples, acceleration of the event of subclinical most cancers, the formation of benign and malignant liver tumours, liver or renal failure, coronary heart failure, blood clotting issues and extra.
This, advocates say, has opened house for a gray marketplace for leftover medication in worldwide warehouses.
‘Tough to seek out physicians able to prescribe hormonal therapy’
Shota Janjgava, an endocrinologist and andrologist at Georgia’s Nationwide Institute of Endocrinology in Tbilisi advised OC Media that earlier than present process hormonal remedy, somebody ought to bear psychological well being examinations and have their hormone ranges checked.
He stated that many individuals are looking forward to hormonal modifications to happen quickly, but it is very important keep in mind that the extent of, and the speed at which, modifications happen will depend on many components like genetics and the age at which they begin taking hormones.
In response to Janjgava, the danger of issues like blood clots, coronary heart assaults, strokes, diabetes, and most cancers on account of hormone remedy have been minimal, however could be elevated for these with co-existing well being circumstances or beginning hormone remedy after age 50.
‘Typically, the extent of the danger for these in good well being is small, and could also be offset by enhancements in high quality of life and reductions in stress ranges as soon as the hormone remedy has begun’, he stated.
Janjgava considers entry to hormonal therapy a staple of trans healthcare. ‘For many who want to take hormones — not each trans particular person does — entry has a optimistic impression on wellbeing.’
‘This impression could be cashed out by way of decrease charges of hysteria, melancholy, and suicidality, however there’s extra to it than pleasure minus ache’, stated Janjgava.
He stated there’s an intangible factor in accessing transition-related care, a component that pertains to bodily autonomy and self-actualisation.
‘Though it has turn into ubiquitous in trans well being literature and amongst specialised healthcare suppliers, it’s nonetheless troublesome to seek out physicians able to prescribe hormonal therapy on an knowledgeable consent foundation.’
‘Hormonal remedy isn’t short-term, it’s endlessly’
For Deveran, nevertheless, the issues transcend not discovering a physician to supervise his transition.
His look means it’s troublesome for him to go to lots of the medical doctors he wants.
‘After I go for an X-ray, for example, they will see my ovaries and I by no means understand how the physician will react.’
‘Typically I don’t know what to reply to their questions. I do blood exams they usually see that I’ve extreme estrogen in my blood. Then they ship me to an andrologist, and once more I don’t know how you can react once they inform me to take off my pants’, he says.
Having had many disagreeable conversations with medical doctors — a number of have even rejected seeing him outright — he not visits a gynaecologist.
Devran compares the state of affairs to neighbouring Turkey, the place trans individuals are in a position to get employment and insurance coverage firms cowl their operations and drugs.
‘Earlier than the pandemic, I didn’t have any issues, all the things was nice. Then I didn’t have any earnings and I needed to cease the remedy, I couldn’t do exams, this constrained me’, Devran says.
For somebody transitioning, hormonal remedy isn’t short-term, it lasts endlessly. If somebody is compelled to cease out of the blue, on account of monetary or well being causes, the hormonal ranges within the physique change and this may have a critical impression on their well being.
When Devran stopped taking his hormones, he stated this brought on issues along with his liver and coronary heart.
‘My psychological well being has collapsed and I don’t even recognise myself anymore. However I nonetheless hope I’ll be capable to get out of it.’
[Read more about Devran’s story: Voice | ‘I was kidnapped by my family’]