[Good news for transgenders] Hormone drug Nebido is included in public hospitals, and the cost of generic drugs is reduced by 100 times, and outpatient injections are available

Written by: Claudia

Text Editor: Cindy

Website Editor: CL

Earlier this year, the Hospital Authority listed Nebido, a male hormone drug over HK$2,000 per box that was not subsidized by the government, as a generic drug, so that transgender people who have been "expensive" for many years can now use standard drug prices in public hospitals ( The 16-week dose is only HK$15) to get the medicine, and can go to general outpatient clinics in various districts for injections with the "injection paper" issued by the doctor, which greatly reduces the financial burden of transgender people. Zephyrus, vice-chairman of Trans Youth Moment, who is a doctor, pointed out that Nebido has a longer efficacy and does not require frequent injections. Many transgender friends have expressed their desire to switch to this drug, and they are happy to see the HA provide another one for the transgender community. Affordable drug options.

Hormone needle Nebido is stable and long-acting for a price of 2,000 yuan

In Hong Kong, the commonly used male hormone injections are mainly divided into two types: Sustanon and Nebido. Nebido has a stable drug potency and a long effect, and many transgender people hope to switch to this drug. Zephyrus, vice president of Trans Youth Moment, a doctor who works as a doctor, explained that Sustanon is a mixed testosterone preparation that maintains its effect in the body for a certain period of time through the different effect times of the four male hormones. However, around the fourth week of injection of Sustanon (commonly known as the needle tail), due to the drop in testosterone levels, when it is lower than the male physiological range, problems such as lack of energy and irritability may occur. And Sustanon is short-acting, and needs to be injected every three to four weeks.

On the contrary, the efficacy of Nebido is relatively stable, and the drug potency can still be maintained within the required range after the 12th week of injection. It does not require frequent injections in disguise, and it can be injected once every three to four months. Hormone levels also affect blood sugar, so for transgender friends with diabetes and other diseases, a more stable hormone level can help control the disease.

Zephyrus said that many friends wanted to inject Nebido after consulting doctors, and he himself has been buying Nebido as a self-pay drug for the past two years. However, compared with Sustanon provided by public hospitals at a low price, Nebido is priced at about HK$2,000 per box on the market, with only one needle per box. They even have to go to the community pharmacy with a doctor's prescription to buy medicines. Nebido's high drug prices discourage some people, so they can only continue to use the subsidized drugs.

After the government subsidizes, the cost of medicine is reduced by 100 times, and you can go to the outpatient clinic of the public hospital for injections

In February this year, the HA finally included Nebido as a government-subsidized generic drug, and transgender people can now take the medicine with a doctor’s prescription and go to the HA pharmacy at a standard price of only HK$15 per unit (each prescription drug costs $15 per prescription). A maximum of 16 weeks is a unit, and each time you take the medicine, you usually only take the amount of medicine that can be used for the next follow-up. economic burden.

Zephyrus added that transgender people can go to hospitals or private clinics to get injections by medical staff. Regardless of whether you choose Sustanon or Nebido, with the "injection paper" issued by the doctor, you can go to the general outpatient clinic of the hospital authority in each district to receive injections. The fee is only HK$19 each time, which is affordable. This move by the HA provides transgender people with an additional subsidized drug option, allowing them to choose a more suitable drug according to their individual needs.

Transgender upper body surgery suspension organization under epidemic calls on public hospitals not to "one size fits all"

In addition to hormonal drugs, Trans Youth Hour also focuses on other medical services related to the trans community. Zephyrus noticed that the shortage of medical resources under the epidemic has limited the scope of services for gender-affirming surgery. For example, surgery for transgender women currently only provides lower body surgery, excluding Adam’s apple smoothing and breast augmentation. According to a large-scale study conducted by CUHK in 2021 on the transgender community in Hong Kong , transgender people have different choices about whether to have surgery or what kind of surgery to have. ), but 20% to 30% of adults also expressed “unsure” or “do not want to perform” different surgeries or medical procedures. Therefore, Zephyrus hopes that surgical services will resume gradually after the epidemic is relieved. He also believes that the HA should adopt a "patient-oriented" approach and maintain services according to the needs of different people, rather than "one size fits all" and only provide one option.

Zephyrus has also attended HA meetings in the past to give opinions on the services of the gender identity clinic at Prince of Wales Hospital, and successfully joined forces with other organizations to promote the clinic from "Gender Identity Disorders Clinic" to "Gender Identity Clinic". Gender incongruence depathological. However, the hospital's clinical medical management information system (CMS) still uses incorrect or outdated terms, such as transsexualism, to describe gender inconsistency. In addition, at present, only adults can be referred to gender identity clinics, while young people need to go to the paediatric and adolescent departments of each hospital cluster until they reach adulthood. The organization therefore urges the authorities to lower the minimum age for consultation at gender identity clinics and expand the scope of services to minors.

Sexual organ surgery requires mental and psychological assessment for real life experience

In Hong Kong, transgender people can go to the Gender Identity Clinic of Prince of Wales Hospital after being referred by a doctor, and receive evaluation from various specialists such as psychiatry and endocrinology . Considering the cost and risks of surgery, many transgender people choose not to undergo or not to undergo medical procedures such as surgery. However, if transgender people intend to undergo gender-affirming surgery related to genital organs, in addition to receiving hormone therapy, they will also live with their self-identified gender and undergo a period of mental and psychological evaluation. During the real-life experience stage, the transgender person will be issued a letter from a doctor who will follow up and assess whether the person is determined and adjusted to live with that gender in the future.

As for hormone therapy, injectable or oral hormones are prescribed for transgender people. Taking transgender men as an example, by increasing the level of testosterone hormones in the body, masculine characteristics can be produced, such as stopping menstruation, lowering voice, increasing sebum secretion, etc.; transgender women can use estrogen and anti-androgens to make breasts. Growth, decrease in body hair, increase in hair, etc. When a transgender person completes a series of procedures and evaluations, they are referred to a surgeon to determine whether gender-affirming surgery is suitable, and then one or more surgeries are scheduled.

Although Hong Kong law still requires transgender people to complete the operation of removing sex organs and constructing new sex organs before they can change the gender of their ID cards, due to the high risk of these surgeries, transgender people will choose whether to undergo surgery, What surgery to do, whether to use non-surgical procedures, or even no medical procedures at all.

Further reading: [Transgender] Towards the Light: The Gender Affirmation Journey of Hong Kong’s Transsexuals

Further reading: Six gender-friendly bathroom door signs create a bathroom that belongs to everyone without distinction between men and women

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