Many transgender people in Zimbabwe are forced to turn to the black market for hormonal medication due to a lack of services in local healthcare facilities.
Paul*, a transgender man, is transitioning without the support of local health facilities.
He relies on black-market medication imported from South Africa and YouTube tutorials for self-injection.
Being born a woman, Paul says he felt he was trapped in a female body so decided to take the bold move of transitioning into a man.
However, due to a lack of services that cater for his transitioning process, he approached people who have undergone the procedure and researched on internet platforms to get the information he felt he needed to embark on this journey on his own.
“I sat down with people who have undergone this process ahead of me. I also got information through the Internet. As risky as it may sound, I was determined to undergo the process,” he narrated.
“I got hold of sources who could get me the hormonal medicine that I need. I got the drugs, which were to be administered through injection. Because I was doing this on my own, I had to watch some videos on YouTube which demonstrated how to identify the correct body parts to inject. I followed the procedure and that was how I got started.”
Paul says despite the struggle of attaining the medicine, there are other challenges that one encounters during the transition process.
“There are various challenges that come with the transition process. There is the issue of counselling. Before going through this process, you need proper counselling because it comes with many changes physical and otherwise. You must be psychologically and emotionally prepared,” he said.
“You will experience mood swings; your body will start changing. It is like encountering the second stage of puberty. Your voice deepens, you sweat a lot, you develop a male body odour, you may notice differences in your genitalia. For some, the toll may make them emotional, angry or so happy. People around you may not understand the changes in your behaviour or moods and sometimes you may struggle to understand yourself as well.
“When this happens you need to be strong as an individual, or to at least have a solidarity circle that will encourage you to soldier on. Sometimes it may come with health conditions such as high blood pressure, liver infections or heart diseases. It is therefore important to eat healthy, cut down on alcohol intake and exercise a lot. But without proper access to professional health assistance, some may not know.”
Another transwoman, Melissa* says she started the journey when she was in the country but in the middle of the process she relocated to South Africa to get better medical attention and guidance.
“I was born male, but I always felt like a woman. I decided to transition into my preferred gender. I started taking the oral contraception pill. They were easy to access because I could get them over the counter,” she explained.
“The more I took them, I started developing breasts. For me, this was a big win because for transwomen, people always usually look out for breasts. Even if they are to question your gender, they give you the benefit of the doubt when they see that you have breasts.”
Melissa said the process weighed on her psychologically and the lack of access to professional counselling services affected her.
“I was going through a lot of changes, and I became quite emotional. I felt I needed someone to talk to. My friend who was based in South Africa told me there was a clinic close to where they lived and they offered services for free.”
Melissa said she stayed in South Africa for several years until she felt she had well transitioned.
“In South Africa, I got counselling. They check if you are psychologically ready and whether you qualify to transition. They have mechanisms in place for establishing these things. You get screened for HIV and other sexually transmitted illnesses. With such professionalism, you feel at ease and confident of the process,” she said.
“The challenge for me started when I came back and tried to get a job. Our society is not welcoming to transgender people so it was hard to keep a job. I ended up taking the route of learning a skill and being self-employed.”
A local medical practitioner, who spoke on condition of anonymity, acknowledged the challenges encountered by transgender people, citing that it is not easy to administer hormonal medicines to them.
The doctor said lack of professional help endangers their lives, leaving them prone to various diseases.
“It’s not like we do not have the mediation that they need for the process, but there is no clarity on how much we can go as far as helping them, especially in public health institutions,” the doctor said.
“In our society, homosexuality is “unacceptable”. I have been a medical practitioner for the past ten years, but I can’t say there is clarity on how to handle these patients. Of course, there is doctor-patient confidentiality but we need more than just that.
“The process would be easier for those needing the procedure if there is clear acceptance from the government. Everything starts at the top. If the government agrees openly then the whole society can also accept.”
The doctor said the challenge with getting medication on the black market is that there is no assurance that one is getting authentic drugs.
“When taking these hormonal medicines, it is not a once-off process, one has to take them time and again. For transwomen, it may take one to two years to fully transition and for transmen, it may take two to three years to get the desired results,” the doctor said.
“This procedure may take a psychological toll on the individual and the immediate family. They need counselling to prepare them. Some pre-evaluations must be done, certain tests to ascertain if the individual is suitable, if their body will respond positively to the procedure.
“Doing this procedure in a proper health facility helps one to monitor the hormonal dosage at a given time. They should not be too high or too little. Without professional monitoring, one may not fully transition.
The doctor added “The procedure would be better if it is conducted at an early stage, say when the individual is at puberty stage. But our society does not really accept this, so it is almost impossible to do that. However, I would advise against black market dealings because these are very sensitive procedures where one must be well monitored.
“It has also been medically proven that breast cancer cases are more prevalent among transgender women hence the emphasis on the need to have anyone who wishes to undergo the procedure to go about it the proper way and get professional medical assistance.”
*The names have been changed to protect their identity
