Phurpa Lhamo | Punakha

Transwomen, who depend on a daily supply of hormone pills, could not avail the pills because of the Covid-19 pandemic.

This has forced some to take contraceptive pills such as the Ipill.

Transwoman are born male but with their gender identity as female. They depend on hormonal pills to transition to their desired identity.

Lhak-Sam’s outreach worker, Uyen Yangchen Lhamo, 30, said she got her hormone pills from Jaigon, India.

“I had stocked hormone pills and it would last me for another two months but others have run out of it,” she said.

She said they have to take the pills continuously, and if they keep one or two days gap, features such as facial hair growth would resurface.

Generally, to transition, transwomen use estrogens, which helps in the development of female secondary sex characteristics including breast growth, softer skin and decreased muscle mass. Transmen use testosterone to help them develop male secondary sex characteristics such as deepening of voice, increase in facial and body hair growth, and thickened facial bone structures.

In Bhutan, only the transwomen take hormones as hormones for transmen, which are usually injected, aren’t available. Consumption of hormone pills among transwomen popularised around two years ago in the country.

Uyen Yangchen Lhamo said hormone pills helped her get feminine features she wanted. “Although trans, I am a woman. Some say I have to be who I am but only if I take hormones, my skin changes and I get satisfaction to identify as a female.”

Rainbow Bhutan’s outreach worker, Sonam Choden, helped transwomen get their daily supply of hormones from Phuentsholing in the past.

She said pharmacies in Thimphu do not sell the hormones. “I fear that many would have resumed taking Ipills.”

While Ipills contains a small amount of estrogen, which helps in development of female secondary sex characteristics, continuous consumption of the pill isn’t healthy.

Tashi Tsheten, who works closely with the lesbian, gay, bisexual and transgender (LGBTQ+) community in Bhutan said that if transwomen require about 100 percent supply of estrogen, the contraceptive pill provides around 10 percent of the required amount.

He added that although the contraceptive pill helps initially, the development stops after some time as the estrogen supply is too less to help the transition. “It is risky because there are other additives and substances.”

While regular health check-ups are recommended, many deny visiting hospital due to stigmatisation and lack of designated service providers for the community.

Uyen Yangchen Lhamo said that the pills also pose risks to liver and kidney. “People who consume know the risk of iPills but they don’t have an option.”

She also said that if the hormone pills are stopped for a few days, the female secondary sex feature disappears and the male features resurface. “We have to consume hormone pills for a lifetime.”

Meanwhile, with the various challenges and health risks surrounding the consumption of hormone pills, Rainbow Bhutan, a self-help group working with the LGBTQ+ community is requesting the hormone pills be made available in Bhutan.

Rainbow Bhutan’s interim director, Tenzin Gyeltshen, said that the authorities were unaware of hormones and bringing such medicine might be problematic.

In Bhutan, many transwomen consume Diane-35, an acne drug, which also contains estrogen and progestogen. “There was also a case of death due to Diana-35,” Tenzin Gyeltshen said.

All transwomen consuming hormone pills consume the pills at their own risks without a prescription. “Even globally, most people take increasing amount of risk. It’s a desperate situation,” Tashi Tsheten said.

Tashi Tsheten added that there was no service provider directed for transgender population in the country today. “If the hormone pills aren’t in the Drug Regulatory Authority list, the medicine cannot be imported. Even if it is in the list, choosing the product is difficult, because we don’t have reliable sources.”

Ogo Dorji, a transman, said that there were plans to introduce hormones for transmen. However, many were reluctant to using the hormones. “If we have specialists or doctors, many would use it. But without a prescription, it is difficult.”

Rainbow Bhutan has more than 200 registered members across Bhutan. With over 100 members, Thimphu has the highest registered members, followed by Chukha dzongkhag.