Transition and access to hormones

Author: Ali Malikov

Translation: Minority Azerbaijan

In Azerbaijan, access to transition, hormonal support, and medical services in general is putting trans people to a new test, as alternative routes in the region are also narrowing. The absence of a functional administrative or legal mechanism for legal gender recognition in our country forces trans citizens who want to begin this process to find solutions on their own.

Until a few years ago, it was possible through certain support groups or individuals with financial means to obtain hormones at cheaper prices from accessible countries like Turkey. For this reason, Turkey played the role of a relatively accessible "exit door" for Azerbaijani trans people.

However, the tightening legislative initiatives against the LGBTQI+ community in the neighboring country and the administrative restrictions applied in the healthcare field indicate that this door is also about to close. Late last year, together with activists and community members living in France, I participated in an informal hormone and binder campaign organized to support trans people in Turkey. Through this initiative, we tried to send hormone medications and other essential supplies from abroad to Turkey. According to Turkish activists, as a result of decisions by institutions affiliated with the Ministry of Health, restrictions are being applied to the circulation of certain medications used in hormone therapy. This means that cheap access routes in the region are transitioning into an unsustainable form.

In many pharmacies in Baku, it is possible to find hormonal medications, but from what I have seen myself, although these drugs are sold for other medical purposes, many establishments selectively refuse to sell these medications to trans people.

To understand the difference, it is enough to look at how transition is received in France. There, transition has been integrated into the healthcare system to a certain extent, and trans people can obtain ALD 31 status to cover conditions requiring long-term and continuous medical supervision. With this document, hormone therapy, many medical procedures, and even in some cases laser hair removal and chest surgeries are covered by the state. In other words, healthcare that includes transition is recognized as part of the social protection system. I obtained this document in about 1 month, but you don't need to have this status to get free hormones — even without insurance, you can obtain medications uninterruptedly with a prescription from a family doctor or endocrinologist.

In a conversation with Alasgar*, a 25-year-old trans man currently living in Baku, he says that even in the country's largest and most "central" city, medical transition is built on personal connections and coincidental opportunities.

"I've been taking testosterone for 3 years, and I haven't been able to see a doctor either when I started transition or now. There's just one doctor known to dozens of trans people around me. I went to that doctor for the first appointment, but because I had my tests done at another hospital, he refused to examine me. I'm forced to ask my questions to doctor acquaintances, and I try to handle the side effects caused by hormones on my own. What else can I do?" Alasgar says.

According to Alasgar, most specialists hesitate to work with trans patients regarding medical transition because there is no legal regulation. The few doctors who provide support discreetly only agree to see patients based on close acquaintance. Not being able to get a medical check-up also means not being able to easily obtain the necessary medications from pharmacies.

Such a gap pushes transition into an unregulated area — that is, the black market. Here, the issue is not only whether the medication can be found or not. It is also about to whom, under what conditions, and at what price that medication is given. Some medical workers and intermediaries know very well that trans people have no alternatives. If a person has already started this process, they understand that the person will not leave hormone intake unfinished, and they take advantage of this. As a result, the same medications are sold 3-4 times more expensive than the real price. For example, in 2024, 50 mg Androcur, which was bought from Turkey for approximately 55 manat, was offered in Baku for almost the same price — but only as half a pack.

According to Alasgar, finding hormone medications in these pharmacies is also somewhat a matter of luck. "The pharmacies' warehouses need to have leftover medications so they're interested in selling them under the table. Now controls are also getting stricter — it's unclear whether it will be as easy as before."

Nazli*, a 21-year-old trans woman, shows another side of the doctor shortage problem. According to her, this process is emotionally and financially heavy, especially for young people without family support.

"I started hormones on my own 7 months ago to reduce my gender dysphoria, and my only source of guidance is reading the advice of other trans people on sites like Reddit. I do my blood tests myself and try to adjust the dosage of medications I take based on my body's reactions. Although I went to an endocrinologist for the first time in Baku, the doctor told me he had no information on this topic and also had no authority to monitor this process."

According to Nazli, the medications she takes have risks such as swelling in the legs, blood clotting, and other serious complications. Although she is aware of these risks, she does not know what to do as an alternative. "I pay about 150 manat monthly just for medications. This price is a lot for a student. My only way to reduce the risks is to do research online."

When talking about the consequences of taking medications without medical supervision, my goal is not to create emotional impact. Without proper dosing and medical monitoring, liver damage, thrombosis, hormonal balance disorders, and other serious complications can occur. Information about such outcomes also circulates within the local community, but the majority of these cases are not officially documented.

I remember that in 2022, while attending Avaz Hafizli's funeral, a Quran was also being read at the same gathering in memory of a trans woman who had lost her life as a result of medication overdose. More recently, information was spread about another trans woman who suffered liver problems and lost her life because of taking hormones without supervision. The lack of medical supervision, not knowing the correct dosage, and medications obtained through unofficial channels directly put human life at risk. A situation that actually comes at the cost of human life and is repeated time and again is not a coincidence. It is institutional, and it is the result of trans people's needs not being recognized as a legitimate medical issue.

*Respondents' names have been changed for security.

A few translation notes: "manat" is Azerbaijan's currency. "ALD 31" is a French healthcare classification for long-term conditions. Avaz Hafizli was an Azerbaijani LGBTQ+ activist and journalist.

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