In the medical community's ongoing efforts to quell the coronavirus pandemic, an unexpected potential treatment for some patients has emerged: Scientists have begun giving cis men with COVID-19 estrogen patches and progesterone shots in an attempt to ease their symptoms. But that decision is generating controversy, stemming from the fact that it’s often notoriously difficult for transgender people to gain access to hormone-replacement therapy.
A growing body of research is showing that cis men may be more likely to contract and die from COVID-19. A study from Italy found that 60% of people who contract the virus, and 70% of people who have died from it, are men, reports The Washington Post. Experts don’t know why cis men seem to be more at risk. But one working theory is that cis women's higher levels of sex hormones like estrogen and progesterone may have protective benefits for their health.
So, last week, doctors from Stony Brook University in Long Island, New York began giving estrogen patches to men and older women — who also have lower levels of these hormones — with COVID-19 to see if their symptoms improved. At Cedars-Sinai Medical Center in Los Angeles, a similar trial using progesterone will begin next week, according to The New York Times.
While everyone is eager to find a cure, the fact that these trials began so quickly raised eyebrows. Trans people face significant barriers to getting HRT. Anti-trans bias makes it difficult to find a doctor who will prescribe the hormones. If you can find one — and they have an available appointment — the cost can be prohibitive, especially for those without health insurance. Right now, with the coronavirus pandemic affecting the U.S. Postal Service and restricting doctor's visits, trans people are experiencing even more setbacks to getting the right hormone therapy.
2/2— Riley 🧡 (@emnesoi) April 27, 2020
cis guy: "hey i think maybe having estrogen would maybe make me slightly less receptive to this disease, idk maybe tho. im not that hot for it so if not that's ok"
doctors: "OH MY GOD YOU BEAUTIFUL HUMAN BEING!!!!!! TAKE MY ENTIRE STOCK!!!!"
"I’m struggling trying to get appointments so I can get on [estrogen] and progesterone, and the assholes are just handing that shit out?!?!" one Reddit user wrote in response to a post about the study.
"Estrogen has immune modulatory properties — don’t get me wrong. You could get a beneficial effect in both men and women," said Sabra Klein — a scientist who is not involved with either trial and who studies sex differences in viral infections and vaccination responses at the Johns Hopkins Bloomberg School of Public Health — to The New York Times. But, she added, since older women have much lower levels of these hormones, and since current evidence indicates that older men are still more affected by COVID-19 than older women, the gender disparity is likely due to genetic or other factors, rather than hormonal ones.
"If they find that estrogen helps men survive coronavirus trans women will once again be left in the dirt, with no consideration and no help because all our hormones will be used by hospitals to help men," Lina Qutainah, 20, wrote on Twitter.
In an interview with Refinery29, Qutainah elaborated that she's had to switch from her usual estrogen pills to self-administered injections from other suppliers, due to delivery problems caused by coronavirus. "The virus is causing shortages in the places I usually buy my medications from, as well as shipping delays," she says. "I feel extremely personally affected [by the pandemic]. I'm in the high-risk population that's extremely susceptible to supply shocks."
If researchers do prove that there's a benefit to giving cis men with COVID-19 estrogen or progesterone, "it'll mean immediate access to medication that takes people like me months or years to gain access to legitimately," Quntainah says. "It's just a demonstration that any concerns about estrogen were always fake, and it's the result of institutionalized transphobia."
Many people have echoed these concerns on social media.
As Joshua Rush tweeted: "If this treatment proves to be lifesaving, it’s incredible. But access to hormone therapy in the US is so sparse that a black market exists for testosterone and estrogen, and trans people struggle to get the doses they need — where is this when trans people seek hormone therapy?"