Testosterone's Controlled Status: "Protect the Kids & Sports" vs Gender Affirming Care

Pharma / TRT
1

Well this makes for an entertaining development. Election year!

How will Biden play this…protect “the kids” and the “integrity of sport” or provide equitable and cost effective access for gender affirming care.

@TC_Luoma: paging John Romano. You would have a good article to dust this up again.

Testosterone is classified as a controlled substance with a moderate to low potential for physical and psychological dependence. Congress classified the drug that way as part of the Anabolic Steroids Control Act of 1990, after male cisgender athletes and non-athletes abused anabolic steroids. As such, testosterone prescriptions generally cannot be filled or refilled six months after the prescription was issued or refilled more than five times.

Descheduling the drug would cut the number of doctor’s visits needed to maintain care and lower fees for trans people, many of whom already tend to live in poverty, advocates say. It would also prevent trans people from having to interact as frequently with a health care system that often stigmatizes and mistreats them.

In their letter, Markey and Warren ask the Health and Human Services Department, plus the Justice Department and Drug Enforcement Administration, what steps, if any, they have taken to reclassify testosterone’s status as a controlled substance — and point out that doing so would align with the Biden administration’s goals to further LGBTQ+ rights and transgender Americans’ access to gender-affirming care.

The senators also urge U.S. Attorney General Merrick Garland to consider using his authority to adjust testosterone’s status within the Controlled Substances Act or remove it altogether.

Still waiting for the Bodybuilder Affirming Care Act (BACA). Let’s make it happen in 2022.

In case you think I am joking…

2 Likes
2

In addition to urging the officials to deschedule testosterone or reschedule the hormone as a Schedule V controlled substance, the Senators requested answers to the following questions by October 7th:

  • What steps, if any, have the DOJ, HHS, and DEA taken to begin reconsideration of testosterone’s Schedule III status?
    • Has DOJ, HHS, or DEA met with any representatives of the transgender community about testosterone access issues related to its Schedule III status? If so, who and when? If not, why not?
    • Has DOJ, HHS, or DEA met with any representatives of the medical community, about testosterone access issues related to its Schedule III status? If so, who and when? If not, why not?
  • What consideration has the Administration given to rescheduling or descheduling testosterone as part of its efforts to promote LGBTQ equality as reflected in the June 15th Executive Order?
    • If the Administration has not already considered rescheduling or descheduling testosterone, will it now include testosterone access in future considerations and recommendations? If not, why not?
  • Has the DEA taken any steps to protect the health, safety, and privacy of transgender men whose prescriptions for testosterone are reported to a Prescription Drug Monitoring Programs (PDMP)? If so, what steps has DEA taken? If not, why not?
3

I am so far removed from LGBTQ… that I say let them deal with the same problems athletes wanting to excel with the aid of controlled PED’s.

Why would I believe they are special? Why would anyone believe they are special? Except some low life politician looking for votes.

Maybe T Nation needs a separate sub-forum for “girls” needing testosterone.

4

IIRC, Biden was a big part of the Anabolic Steroids Control Act.

I don’t think society seems to want more bodybuilders. I made a post / reply about exogenous Testosterone on Reddit once. The original post was about male birth control, and I said Test could work for some men with sperm testing (to ensure no fertility), and perhaps you could get jacked (I also said I wouldn’t use some of the proposed drugs that basically feminize a guy). I thought it was a fair post with risks and rewards. I got a bunch of toxic masculinity replies lol.

I am afraid that the BACA will likely not be happening anytime soon. If it does occur, I think it would come as a package deal with other drugs. That’s wishful thinking though IMO, they would probably legalize heroin before AAS. This LGBT thing might be the ticket though haha.

2 Likes
5

But what happens when the FTM patient becomes toxically masculine? Slippery slope ahead for the 1990 ASCA crowd.

Biden was all over all the ASCA work.

2 Likes
6

I’ve heard that it pretty common for FTM individuals to be surprised by life as a man. From what I remember, it is a feeling of now being mostly invisible, of women being much more defensive (compared to when they were women), to not be valued. I have to imagine that switching from being a woman to probably a short / narrowly built man would be quite the shock. I would think that experience might turn some people toxic.

2 Likes
7

Don’t leave out the guys who feel like girls that need testosterone or the guys and girls who feel they more more anabolic potential.

What about the girl who feels she needs oxandrolone instead of testosterone? She identifies as an oxandrolone-based female.

Law of unintended consequences coming home to roost for the prohibition crowd? Let us see what happens.

2 Likes
8

Hear, Hear. I propose we start a movement that all females wanting to transition to male must start testosterone treatment before puberty. To start later is cruel.

The parents should be liable for failing to allow their daughter to start transitioning to male before puberty.

1 Like
9

I think it would be tough going either way TBH. It is a conundrum. Being trans I have to imagine one wants to look either masculine or feminine (what they are not), however, transitioning doesn’t guarantee that. Starting HRT before puberty would help, but obviously we shouldn’t trust kids to make that decision, and we should not do it. So then you are left with transitioning as an adult. I have masculine traits, so I’d be an ugly ugly woman haha. I wouldn’t want that.

10

Would be nice if Pocahontas would just shut the fuck up once in a while.

1 Like
11

As a presumed muscle-body dysmorphia/hormone ally, in this particular case it appears you haven"t thought this through.

Unscheduling testosterone would be a win for all and right an error that has festered for over 30 years.

12

@BrickHead

no way… FDA wants to clamp down on legitimate applications regarding HRT for postmenopausal women, FDA wants to clamp down on compounded testosterone creams, pellets, solutions for injection.

FDA wants to clamp down on compounded generic hormones like oxandrolone, stanozolol, nandrolone etc

FDA wants to clamp down on peptides

But testosterone for DiSeNfRaNcHiSeD trans people? We need to deschedule testosterone immediately!

Why are we pampering and bending over backwards for this demographic that is hardly oppressed in western society to begin with? In Australia the laws on testosterone are so, so harsh. In QLD/NT it’s the equivalent of what you’d call a schedule I substance in the USA, possession without a prescription can net 20 years in jail. BECAUSE testosterone is a bioweapon… In other states they’ve the equivalent of schedule II substances, used to be equitable to schedule V (otherwise known as S4 here) but all androgens were reclassified as schedule 4 appendix D meaning extensive restrictions regarding who can prescribe exist.

It’s also difficult to get a pharmacy to fill a script for testosterone unless you know the pharmacy very well. If you have a script for injectable testosterone, the pharmacy commonly won’t have it in stock. Androgel is the most commonly used TRT product here despite costing 3-5x more than a private script for injectable testosterone.

There’s no way Aus would follow suit by descheduling testosterone. They might make specific exceptions for trans people which would be absolutely fucking ridiculous considering how prevalent hypogonadism is within today’s society. However, it’s very hard to acquire treatment, I’ve had a psychiatrist (in Belgium, family member) tell me men with Klinefelter’s syndrome don’t need testosterone because they can survive without it.

Tell me, on paper… who is going to suffer more. A woman who wants to be a guy but can’t get on testosterone with ease… or someone with klinefelters syndrome who can’t get on testosterone?

So an epidemic of ever decreasing testosterone levels and fertility rates within men? Fine, we do nothing about that.

A tiny fraction of the population identifies as trans and wants testosterone? We need to deschedule testosterone immediately!

Far out if this is actually the straw that breaks the camel’s back resulting in reform over the erroneously harsh scheduling of T

2 Likes
13

LMAO. I was wondering when you were going to get to this.

:+1:

I posted this also at ExcelMale and it got promptly deleted. We are truly in strange times.

Has not been expressed yet as such but logical follow up after Phase 1 complete.

14

Now that is sad.

15

We can phrase this even more distinctly

18-year-old with hypogonadism who is truly suffering but can’t receive treatment because his testosterone level of 250ng/dl is “normal”

vs

girl who wants to be a man

Who should be prioritised? Why have we ignored the former when this scenario is becoming unfortunately all the more commonplace… But the latter, which is very uncommon represents an issue we clearly need to alter the status quo over at the drop of a hat because… trans people are subject to inequality or whatever…

I agree with descheduling testosterone. Even if it can be abused we need to look at the drugs testosterone has been lumped in with. In Queensland/The Northern Territory in Aus testosterone/all AAS are lumped in with heroin, methamphetamine, crack cocaine. They’re essentially schedule I substances with a very narrow set of circumstances that allow them to be treated like schedule II substances (using American equivalents)

Elsewhere in Aus they’re lumped in with the likes of benzodiazepines, barbiturates, cocaine, ketamine (schedule 4 appendix D is more/less the same as schedule 8), fentanyl, morphine, amphetamines. I.e drugs that actually cause physical dependency and most of the above can be lethal within an acute context.

In America testosterone is lumped in with barbiturates, ketamine, benzodiazepine analogues, some benzodiazepines (most benzos are schedule IV), some opiates like buprenorphine and various formulations of low dose morphine, dihydrocodeine, LSA etc.

For the most part, there isn’t an equivalence. Testosterone is dangerous when abused, but in a manner that differs from contemporary drugs of abuse.

If one looks at why/how the USA schedules-controlled substances, you’ll see testosterone shouldn’t be schedule III, schedule V or unscheduled but RX only is more appropriate.

USA schedules drugs based on the potential for abuse, how prone a drug is to induce physical and psychological dependence and how wide (or narrow) the therapeutic margin for a substance is.

It’s actually a sticky one, because the abuse of anabolic steroids has become more commonplace over the past few decades. The prevalence of anabolic steroid use is likely higher than the prevalence of say… heroin or ketamine abuse, so this would warrant a SCH III classification from this regard.

However testosterone is incapable of inducing outright physical dependence akin to the withdrawal syndrome drugs like benzodiazepines induce, hence schedule III is heinous overkill. Psychological dependence is possible, but testosterone in itself isn’t abused as extensively as the synthetic derivatives that are largely responsible for eliciting that ‘look’ bodybuilders tend to have.

When prescribed appropriately, testosterone has virtually no penchant for inducing dependence. When prescribed appropriately, testosterone will not induce physical or psychological dependence akin to the way benzodiazepines, or opiates have the potential to induce.

I can tell you withdrawal from painkillers feels so much worse than dipping because you haven’t taken a shot in 14 days.

1 Like
16

Yes. I’m in need of gender-affirming care to the tune of 750mg/wk.

1 Like
17

No judgment. I am learning to come from a place of wonder not judgment. Set that intention and shoot for the stars young man.

18
1 Like
19

Good point. In fact, if a man identifies as a male athlete (gender masculinus athleticus) then might they be able to receive gender affirming levels of androgens that make them more athletic? What if I identify as gender swole?

3 Likes
20

Up until about 5 years ago, anyone who identified as having transitioned, and who later de-transitioned or desisted was classified as a case of detransitioning. At that point, and according to those standards, 70% of individuals who transitioned in the teen years eventually desisted by age 30, 80% of teens assigned female at birth desisted by age 30. The American Endocrine Society, and also APA I believe then changed the standard of detransitioning to only include people who transitioned after receiving a psychological diagnosis of gender dysphoria and chose to transition after 18 months of counselling, however individuals were still regarded as transgender persistent if they simply identified as transgender even if they had not received a diagnosis of gender dysphoria or received prescribed counselling. So those agencies refuse to accept most people who identify as having transitioned and desisted without counselling, but retained as transgender all those who transitioned without counselling but who had maintained their transgender identificaiton. So now the numbers show only around 20-25% desistence rate of transgender identification. At one point I also saw that 2/3 of individuals presenting as trans were NOT eventually given a diagnosis of gender dysphoria. This was reported by MDs who were specialists in transgender support.

I realize that pre-teen transition cases are often quite different, but I know a few kids who did not consider themselves to be transgender prior to the teen years, (all were assigned female at birth and transitioned to living as male in their mid teens). If someone in their teens transitions without a diagnosis of gender dysphoria, there is a very high probability that it will end up causing trauma.

3 Likes