Trans Women are Taking Hormones Without Medical Supervision in Uganda

A man reads newspapers reporting about Uganda’s upcoming elections at a kiosk in Kampala. Photo: SUMY SADURNI/AFP via Getty Images

One night in Kampala, Vinka Silk, 20, a trans woman and sex worker, was in a bar when a friend she had come with told the bouncers that she was a man dressed as a woman.

“My friend got jealous because I was getting rich men [that night],” Silk says.

Silk was taken to the police station where she was frisked and undressed so the police officers could check her genitals. She was held till the next morning.

“That was the [worst] moment of my life,” she says. Following the incident at the bar, Silk decided she wanted to transition and start hormone replacement therapy. She didn’t know anything about the process so she turned to the trans community, both in Uganda and outside of it, for help, advice and support.

“I asked someone about hormones and that someone is in Canada, so she told me, you can go to these pharmacies [in Uganda] and you can buy them,” she says.

Since she started taking hormones in July 2020, Silk has relied on a group of fellow trans sex workers for support.

The group is run by Anna Xwexx Morana, 24, another trans woman and sex worker in Uganda who, frustrated by how alone she felt at the start of her own transitioning journey, decided to create a support system, especially for trans sex workers to find community before, during and after they transition.

“It was like something was missing, like some part of me was missing,” Silk says about her life before discovering the group. “At first, I thought I was born alone, like me alone in this world. But coming to the community, I realised I am not alone, that we are many, [and that made me feel] good.”

Ideally, trans people looking to undergo hormone replacement therapy have to see an endocrinologist and then get a prescription unique to them.

This is not an opportunity many trans women in Uganda have, primarily for the transphobia ubiquitous in Uganda’s healthcare system but also for how expensive endocrinologists are outside of that. Uganda has little to no services available to support transitions. Transgender people are not included in studies, they say, and so data about them is not readily obtainable. Many trans people like Silk and Morana report experiencing often violent transphobia when aiming to access medical services within the country and without the financial capability to look elsewhere, some of their needs are left unaddressed.

Informal networks like the kind Morana is fostering have stood in the gap.

“It’s a privilege for me,” Morana says about creating a community for women like her. “It’s like I have a child and I am giving my child everything they’ve never had: a family, good health, anything.”

 

The support groups are held under the auspices of Morana’s Anna Foundation – an NGO that uses innovative advocacy methods to address the problems faced by trans women who are sex workers in Uganda.

 

Outside of the support sessions though, Anna Foundation has organised trainings, conducted routine testing for sexually transmitted diseases, and provided safe housing for dozens of trans sex workers.

 

“I can’t say that it has been an easy road, but there’s light at the end of the tunnel,” Morana says. “And [as] for me, I’m not waiting for the light at the end of the tunnel, I am creating my own light to get me to the end of the tunnel.”

 

True to her word, the foundation has over 200 registered members, some of whom self-administer hormones.

 

“Since I have started to take hormones, I am me,” says JujuBee, 29, a trans woman and sex worker who started taking hormones in September 2019. “I can go on the road and people start to call me a woman, and that makes me feel good. When someone tells me ‘nyabo, you are a girl, you are beautiful’, that makes me feel good.”

 

Jujubee is originally from Burundi but has lived in Uganda since 2015 when she fled repeated harassment in her country for being trans.

 

“I was arrested four times,” she says. “So I [decided] that I have to go, there is nothing [in Burundi] for me.”

 

Now over a year into her transitioning journey, Jujubee is in a much better place mentally.

 

However, self-administering hormones, like self-administering any drugs, comes with considerable risks, according to Dr Alma Perez, an endocrinologist based in Mexico City who works with transgender patients.

 

Silk, for instance, takes two tablets each day, one in the morning and another in the evening, it is a prescription she arrived at by herself.

 

“Many times when [trans people] are [self-administering], they are taking medications that are really not the best ones,” Dr. Perez says. “Second of all, they are taking higher doses, and with higher doses there are more risks of complications.”

 

In this case, complications include the possibility of liver diseases, thrombosis and even heart attacks.

 

“That’s the point of really doing it with knowledge, not just like, what I heard, what my friend said, or what I read in a blog,” she says. “That is why it’s so important to really go to the expert.”

 

Nonetheless, Dr Perez is not oblivious to the systemic challenges that prevent this from being the case both in Uganda and in Mexico.

 

“We can really help all those [transitioning] to get the knowledge of what is happening and what really could happen if they self administer higher doses,” she says.

 

One day after taking her hormones, Morana says she became unconscious.  “I passed out. I was in my bed, I just felt dizzy. I felt like I couldn’t raise my hand and I think I was in that bed unconscious for almost 40 minutes,” she says.

 

While Morana describes it as her worst experience with hormones, she is unable to afford to consult with an endocrinologist and still doesn’t know why it happened.

 

She has also had to struggle with gender dysphoria and feeling like the changes are not happening fast enough. “You get up in the morning and get to look at your body having a penis in it. That is another type of trauma on its own,” Morana says. “Looking at your body and you’re expecting to have bigger rounded hips and they are not coming but you’re having a bigger ass. And you’re like, ‘Okay, what is this ass doing?’”

 

Her experience is not uncommon though, according to Dr Perez, who says it’s something she sees happen often in her work with trans women.

 

“We wish [the changes] would happen faster, but even if you are taking higher doses, it won’t happen earlier, it will still happen in the time it will, “ she says. “That is why it’s called a transition, it’s not just everything in one day.”

 

To combat this, Dr Perez says she encourages patients at her clinic who start hormone replacement therapy to take selfies every day.

 

“[With these photos], they can see how they have evolved, how they have transitioned, because you see yourself and you hear yourself every day and you really don’t see the evolution, the transition or how big the change has been.”

 

Posted by Contributor