Markey, Warren ask Biden administration to expand access to gender-affirming medical care

Massachusetts Sens. Elizabeth Warren (D) and Ed Markey (D) are calling on the Biden administration to lift certain barriers that make it difficult for transgender people to access gender-affirming medical care.

In a letter sent last week to top administration officials including Attorney General Merrick Garland, Health Secretary Xavier Becerra and U.S. Drug Enforcement Administration (DEA) Administrator Anne Milgram, Warren and Markey argued that testosterone – currently a Schedule III controlled substance – should be rescheduled to make it more accessible to transgender men and nonbinary transmasculine people.

“Testosterone’s Schedule III status adds barriers to medically necessary, gender-affirming care while leaving transgender people vulnerable to harassment, discrimination, and surveillance,” the letter reads.

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Testosterone’s Schedule III status means the hormone is subject to stringent restrictions on the length, quantity and method of prescription under rules set by the federal government. Prescriptions for Schedule III substances, for instance, cannot be filled or refilled six months after the prescription was issued. They also cannot be refilled more than five times.

State and private health insurance companies are able to erect additional barriers. For transgender people that use Medicaid or are covered by private insurance, for example, a prescription for testosterone can only be filled for 30 days at a time.

“These limitations force transgender people to interact more frequently with medical providers and pharmacists, potentially resulting in exposure to unnecessary stigma and negative experiences,” Warren and Markey wrote in the letter. “These negative experiences lead transgender people to avoid interacting with medical providers, and therefore limit their access to gender-affirming care, including testosterone.”

The pair in their letter cited data from the National Center for Transgender Equality’s 2015 U.S. Transgender Survey, which found that nearly half of transgender people have experienced verbal harassment, physical abuse and denial of care while accessing health care. A large percentage also reported having to educate their health care providers about transgender people in order to receive adequate medical care.

Warren and Markey’s letter calls for testosterone to be descheduled – no longer federally regulated – or rescheduled to a Schedule V substance, which has a lower potential for abuse.

The letter also poses a series of questions for Biden administration officials to answer by Oct. 7, including inquiries into steps the Department of Justice (DOJ), the Health Department (HHS) and the DEA have taken to reconsider testosterone’s Schedule III status and whether the departments have met with members of the transgender community about barriers to testosterone access.

Leading medical organizations including the Endocrine Society, the American Medical Association and the American Association of Family Physicians have endorsed gender-affirming hormone therapy as safe, effective and medically necessary.

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