“No legal prescription”: How trans women in Cameroon are accessing hormones

Image description: An illustration of the Cameroonian flag with a stethoscope in the first column against a green background, the medical snake symbol atop of which is the trans equality sign in the second red column, and a syringe in the last yellow column.

Yaoundé, Cameroon (Minority Africa) — When she was 21 years old, Chanelle Kouankep, a Cameroonian trans woman, was sent away from home by her father. Kouankep was forced to move in with a friend in an uncompleted wooden house, but she describes the experience as the price she had to pay for her liberty. 

Today, after over ten failed suicide attempts, Kouankep, now 26, serves as president of an independent network Réseau Indépendant TransAfricain (RITA), and heads TRANSAMICAL in Yaoundé, where she fights for the rights of trans people in Cameroon, battling for access to adequate health care and safe Hormone Replacement Therapy (HRT). 

“I receive complaints from members of the trans community every single day,” Kouankep tells Minority Africa. “What they go through makes them even question their existence on earth.” 

Kouankep, like many other trans people in Cameroon, has created an informal network and is now adopting approaches to Hormone Replacement Therapy which they have pulled from other countries across Western Africa, such as Benin and Ivory Coast.   

This involves them identifying select pharmacies which can provide hormones to trans people across Cameroon and equally communicating these networks to each other via social media. 

The problem? This is done clandestinely without any regulations or specific medical prescriptions. 

In recent years, there has been a growing clampdown on the rights of LGBTQ+ people in Cameroon, which continues to create an unfavorable environment for HRT, establishing the need for community-driven solutions such as Kouankep’s. 

Last year, Cameroon sentenced two transgender women to prison on charges of ‘attempted homosexuality,’ in a country where same-sex activities are illegal. 

“Hormone replacement therapy in Cameroon is not recognized,” says Kouankep. “We find hormones in pharmacies, but these are meant for women in menopause. It is [these] hormones that trans people take because this medication is similar to theirs.”

Miss Porshia, a 35-year-old trans woman in Cameroon and transgender human rights activist, admits that “having access to treatment as a trans person is not easy.”

She adds, “I have many times been [a] victim of stigmatization and discrimination based on my gender identity.”

Porshia is one of many trans people in Cameroon who are now getting their hormones through specific secret channels, whether through registered pharmacies or street drug vendors. In her case, she gets them from a friend who works in a pharmacy. 

“I have no legal prescription as it should. So, I am aware that it can possibly cause some troubles with time,” she says. “And [I] know that self-medication can be dangerous.” 

Trans people who intend to undergo hormone replacement therapy should see an endocrinologist, but this is not the case in Cameroon’s informal network. However, Kouankep believes that deriving and consequently sharing learnings with trans people in other African countries can be crucial to mitigating the potential of harm in the industry. 

“We have benefited from [advice on] choice of medicine and accessibility,” she says. “They share their experience, knowledge, and names of certain drugs they can easily get.” 

Hormone shortages, outright inaccessibility for transphobia, and widespread misconceptions about transgender identity are shared across the African continent. 

In South Africa, a Covid-19-induced hormone shortage saw trans men turning to the black market and recording unusual side effects. Similarly, trans people in Burkina Faso reported self-medicating despite potentially leading to complications such as hypertension and cardiac arrest. 

Yet many trans people say it is an easier choice to make than the violence they experience in the country’s healthcare system. 

“I used to go to the hospital when I was sick, but honestly now I have stopped,” Porshia says. “First of all, because I was not welcomed, and secondly, I realized that the services were incomplete for me.”

Her perspective is re-echoed by a medical practitioner in Yaoundé who spoke to Minority Africa on condition of anonymity about the prevalence of discrimination against transgender people in the country’s healthcare system. 

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“To combat this, trans people have created centers where they manage their problems,” the practitioner says. “Some of them are well organized and equipped. They are well received here. But they have a setback. This is because they are restricted to certain treatments. This means that trans people are still forced to move to other public hospitals for treatment. That’s where the problem lies.”

In the last five years, strides have been made to remedy many of the challenges trans people face in Cameroon. This is significant because before now, trans people were lumped in the same group as gay men or men who have sex with men (MSM), explains Nickel Kamen Liwandi, an activist and executive director of the Cameroonian Foundation for AIDS (CAMFAIDS). 

“We were able to distinguish between trans [people] and [men who have sex with men], which the ministry of health recognized in 2018. Now [trans people] are recognized as an independent group,” Liwandi discloses. “Thanks to this distinction, we can be able to fight for some specific services for the transgender community. In Cameroon, that is the lone approach that we can use because there is no law on that yet.”

“We are trying to see how other countries adopted hormonal replacement therapy,” Liwandi tells Minority Africa. “We are working with friendly doctors to talk them into enabling a follow-up from backstage [and[ we are trying to build an informal network to help trans people while waiting for a legal way out.”

It has been three years since Kouankep started taking hormones, and she has noted many changes. She admits that “hormone replacement therapy, like any other medicine, has its side effects.” 

“I have stretch marks. Physically, my body is more feminine than it used to be. Hormone replacement therapy has a lot of effects on nerves. You have frequent mood swings, hot flashes, and excess anger,” Kouankep explains.

She mentions being part of a France-based support group as instrumental to her navigating these challenges. Kouankep is particular about holding space for other trans persons in Cameroon in a similar fashion. 

For Porshia, not minding the workarounds, the discrimination and exclusion from healthcare services still have far-reaching emotional consequences. 

“It hurts when you are not understood and when there is no dedicated service for you,” she says. “When everybody is rejecting you or doesn’t understand you, you develop psychological trauma, depression, sadness, madness, and sometimes it [can lead to] death.”

Edited by: Caleb Okereke, PK Cross, and Uzoma Ihejirika.