Moving from UK to US - Medication?

[FoxBird]

Hi everyone,

This is my first post on this very useful forum.

I'm in my mid-twenties and in the UK. I'm non-operative and post-transition (so I have no real access to trans healthcare outside of my doctor, hence this question). I can see that we can't post dosages here, so I'll keep it vague. I'm on a high dosage of both estradiol valerate and cyproterone acetate. I've been on these dosages since I was 18 and I'm quite happy with them. (I don't have any faith that my blood test results are being monitored properly, but that's another problem.)

It's looking possible that I might relocate to the US (either with my job or for study, not sure which yet) and the fact that cyproterone acetate isn't FDA approved is a huge concern to me. If I were to move to the US, what would happen there? Would a doctor be able to prescribe cyproterone acetate on the basis that it's necessary or would I have to move to spiro? And if I did move to spiro, is that fairly straight forward?

My main concern is because I am on such a high dosage of cyproterone, whether or not I would be able to take enough spiro to equal the current effects. I'm quite paranoid about testosterone (I was hit with male pattern baldness at 15 and just enough hair grew back under the anti-androgen to save me needing a wig for life) so I'm wary of messing around with my physiology if there's any huge risks involved.

My long-term partner is also in the same situation as me, although she's on Zoladex (Goserelin acetate).

I realise nobody here can speak as experts. I'm just trying to figure out whether this is something I should be concerned about, as I wouldn't want to move and then get hit with a dealbreaking problem, or whether it's a simple switch and I shouldn't worry about it. I'd happily have an orchiectomy, but the warnings about it potentially preventing subsequent SRS makes me want to avoid it. But if it's a problem, perhaps I should look at this.

What happens if you appear in the US as a post-transition trans woman? Is it a case of finding a doctor who'll take your UK history and convert your prescriptions? I also have visions of doctors wanting to "re-assess" me psychiatrically before prescribing anything, leaving me without medication for months, which would be a huge no for me. Although it can't be that different from moving within the US.

If I, say, took out a university health insurance policy, would that mean the university becomes aware of my medical records if I used that policy? I'm stealth at the moment, so something like this would be a factor, too. I'm not that knowledgeable about health insurance yet, apart from that you have to pay for it.

Also, in the previous times that I've visited the US as a tourist, and taken my medication with me, have I been unknowingly breaking the law by importing a non-FDA approved drug? Never had a customs inspection but if they seized it I'd have a problem.

[KayXo]

You could switch to bicalutamide (Casodex) which is quite a strong anti-androgen, stronger than cyproterone acetate, as much as 6 x stronger based on the studies I've read on prostate cancer patients. Only thing is it doesn't reduce your sex drive (or spontaneous erections) like cypro but if you continue taking estradiol, this will! Bicalutamide will keep your hair thick and prevent any remasculinization.

There are always analogues too like Synarel or Zoladex that you can take. Injections or nasal sprays.

Both options are expensive but if you have insurance, then it's fine. Bicalutamide, at low doses, is quite effective too, can even be taken every 2-3 days due to its long half-life (between 5-6 days). So, this would cut costs substantially.

Not sure Spiro would cut it for you since you are on high doses of cypro and remember than when you do end up discontinuing cypro, it's best to do it gradually as it can potentially affect adrenal output, similar to corticosteroids.

Best of luck.

[Hikari]

This is the FDAs personal use import guidelines if you really want Androcur.
http://www.fda.gov/ForIndustry/ImportProgram/ucm173743.htm

My understanding of this is that exception number 4 certainly applies to you since you started treatment in a different country. Now if you want cover legally you will need a physician to sign off on you continuing your treatment. In practice customs rarely seizes anything unless it is on the controlled substances list.

Note I am not a lawyer and this isn't legal advice.
There are a wide variety of well tolerated powerful antiandrogens that are FDA approved. It doesn't have to be Spironolactone, even if for some reason it seems really popular.

[ath]

Hey, what if you're going from the US back to Europe? I'm on Spiro and E, average dosage. I don't really know whether they even do Spiro over there, but I know cypro is more common. Would they probably switch me to that, and would that cause any problems? I'd be moving back to Germany.

[FoxBird]

Thanks so much for your replies. I thought spiro was the only option in the US from the reading I was doing, so it's great to see there are other options. Looks like it's something I shouldn't be too worried about then

Ath, I can't speak for Germany, but in the UK (at least, when I was going through the process a few years ago) the anti-androgen they wanted to put patients on is Zoladex. They're very reluctant to prescribe cyproterone acetate due to the potential for it to cause depression in trans women. I had to specifically request cyproterone and they prescribed it because I met certain criteria and on the condition I was closely monitored. So if you're uneasy about cyproterone and can't get spiro, you do have other options.

[KayXo]

It also seems to me that analogues are the preferred anti-androgen treatment in Germany based on recent studies on transsexual women published by German authors.

Horm Metab Res. 2006 Mar;38(3):183-7.
Effects on the male endocrine system of long-term treatment with gonadotropin-releasing hormone agonists and estrogens in male-to-female transsexuals.

Mueller A, Binder H, Cupisti S, Hoffmann I, Beckmann MW, Dittrich R.

Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany. andreas.mueller@gyn.imed.uni-erlangen.de


"We studied hormonal changes resulting from long-term treatment with gonadotropin-releasing hormone agonist and 17beta estradiol valerate in 40 healthy middle-aged male-to-female transsexuals over a period of two years." The agonist is goserelin acetate.

Exp Clin Endocrinol Diabetes. 2005 Dec;113(10):586-92.
Endocrine treatment of male-to-female transsexuals using gonadotropin-releasing hormone agonist.

Dittrich R, Binder H, Cupisti S, Hoffmann I, Beckmann MW, Mueller A.
Department of Obstetrics and Gynaecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054 Erlangen, Germany

"Sixty male-to-female transsexuals were treated with injections of gonadotropin-releasing hormone agonist (GnRHa) and oral oestradiol-17beta valerate for 2 years to achieve feminisation until SRS."

I think that before, cyproterone acetate was used and has now been replaced with agonists, similar to the UK, perhaps for the same reason. In my opinion, I also think that agonists are better.

[Randi]

After seven years on your regimen, I doubt you could produce any testosterone under any circumstances.  Estradiol alone can shut down testosterone production.

In any case no US doctor can prescribe nor any pharmacy provide a drug that is not FDA approved.

As for quick access to HRT there are many "informed consent" clinics and providers in the US.  You can learn more here:  https://www.susans.org/wiki/Informed_consent.  Even if you have to travel to NYC, Philadelphia, Chicago or San Francisco these clinics may put you on the fast track to prescriptions. 

If you absolutely feel you need cyproterone acetate, US customs would not seize drugs imported from Mumbai or Vanuatu for your personal use.

Randi

Randi

[Rachel]

Anyone in the USA can order non-narcotics through the mail from foreign countries. It is perfectly legal. There are some downfalls which is allowing time to clear customs and the potential the medication is not as specified or out of date. With that said, I have purchased medications through the internet (India) with success. 

If you know where you are moving then call a LGBT Center in the area and get some HRT Doctor leads. Call and set appointments ahead of time. Tell them your issues and get the ball rolling.

If not insured inquire about sliding scale with the Doctor (pay as a function of income), Wal-Mart had good pharmacy prices.

My Primary Care is a LGBT primary Care. They will help you fill out the forms to get access to the affordable Care Act insurance it you make less than $45,000 per year. They also have a Pharmacy next door and offer HRT and Cialis at cost. There is nothing like being in a community of gender variant persons!

Good luck and welcome to the USA, hugs.

[Hikari]

Anyone in the USA can order non-narcotics through the mail from foreign countries. It is perfectly legal. There are some downfalls which is allowing time to clear customs and the potential the medication is not as specified or out of date. With that said, I have purchased medications through the internet (India) with success. 

There are illegal items on the controled substances act that are non-narcotics, testosterone for example. Most things have no issue at customs but controlled substances are always illegal according to the federal government (though Marijuana is a controlled substance, some states chose to ignore the illegality).

[Rachel]

I just checked and you are correct testosterone is on the banned list. I never would have thought to check testosterone. The link below

http://www.deadiversion.usdoj.gov/schedules/#list