Markey and Warren call on the Biden administration to expand access to gender-affirming medical care

Markey and Warren call on the Biden administration to expand access to gender-affirming medical care

The story at a glance


  • Mass. Sens. Elizabeth Warren (D) and Ed Markey (D) in a letter sent to senior administration officials argue that testosterone, which is currently a Schedule III controlled substance, should be postponed or de-scheduled to improve access to the hormone for transgender people who rely on him.

  • Testosterone’s Schedule III status means that it is subject to strict restrictions on the duration, amount and method of prescription.

  • Markey and Warren, in their letter, asked administration leaders to respond by Oct. 7.

Mass. Sens. Elizabeth Warren (R) and Ed Markey (R) are calling on the Biden administration to remove some barriers that prevent transgender people from accessing gender-affirming medical care.

In a letter sent last week to senior administration officials, including Attorney General Merrick Garland, Health Secretary Xavier Becerra and U.S. Drug Enforcement Administration (DEA) Administrator Anne Milgram, Warren and Markey argued that testosterone — currently a Schedule III controlled substance — should be deferred to make it more accessible to transgender men and non-binary transmasculine people.

“Testosterone’s Schedule III status adds barriers to medically necessary and gender-affirming care while leaving transgender people vulnerable to harassment, discrimination, and surveillance,” the letter read.


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Testosterone’s Schedule III status means that the hormone is subject to strict restrictions on how long, how much, and how it can be prescribed under rules set by the federal government. Prescriptions for Schedule III substances, for example, cannot be filled or renewed six months after the prescription is issued. They also cannot be filled more than five times.

Public and private health insurance funds are able to erect additional barriers. For transgender people who use Medicaid or are covered by private insurance, for example, a testosterone prescription can only be filled for 30 days at a time.

“These limitations force transgender people to interact more frequently with medical providers and pharmacists, which may expose them to unnecessary stigma and negative experiences,” Warren and Markey wrote in the letter. “These negative experiences lead transgender people to avoid interacting with medical care providers and therefore limit their access to gender-affirming care, including testosterone.”

The pair in their letter cited data from the National Center for Transgender Equality’s 2015 U.S. Transgender Survey, which found that nearly half of transgender people have experienced verbal harassment, physical violence and denial of care when accessing health care. A large percentage also said they had to educate their health care providers about transgender people in order to receive adequate medical care.

Warren and Markey’s letter calls for testosterone to be de-scheduled — which is no longer federally regulated — or deferred to a Schedule V substance, which has less potential for abuse.

The letter also poses a series of questions for Biden administration officials to answer by Oct. 7, including inquiries into actions the Department of Justice (DOJ), Department of Health (HHS) and the DEA have taken to reconsider the Schedule III status of testosterone and whether the departments have met with members of the transgender community about barriers to testosterone access.

Leading medical organizations including the Endocrine Society, American Medical Association, and American Association of Family Physicians have endorsed gender-affirming hormone therapy as safe, effective, and medically necessary.


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