Trans women are not causing HRT shortages for menopausal women. The two groups use different formulations, doses, and delivery methods, and the supply chain problems affecting oestrogen products have causes rooted in manufacturing, demand forecasting, and pharmaceutical logistics, not in trans healthcare.
Where did this claim come from?
Over the past few years, shortages of hormone replacement therapy products have caused real distress for menopausal and perimenopausal women across the UK and beyond. The frustration is completely understandable: these are medicines that make an enormous difference to quality of life, and running out of them is not a small thing. Into that frustration stepped a familiar villain. Trans women, it was claimed in newspaper columns, social media threads, and letters to MPs, were draining the supply, snapping up oestrogen products and leaving menopausal women without.
I have seen this claim circulate widely enough that it deserves a clear, detailed rebuttal. Not because I want to score points in a culture war, but because factual errors cause harm. They cause harm to menopausal women who deserve an accurate account of why they cannot get their prescription. And they cause harm to trans women who are blamed for a crisis they did not create.
Do trans women and menopausal women use the same products?
This is where the claim falls apart most quickly. The short answer is: mostly no, and where there is some overlap, the numbers do not come close to explaining a systemic shortage.
Menopausal hormone therapy typically involves low doses of oestrogen, often combined with a progestogen, delivered in forms calibrated for the relatively modest top-up a perimenopausal or postmenopausal body needs. The most commonly prescribed formulations include low-dose oestradiol patches, gels, and sprays, combined tablet preparations, and topical vaginal oestrogens.
Trans women undergoing feminising hormone therapy use oestradiol too, but the doses are significantly higher, and the clinical objective is different: not topping up a natural supply that has declined, but achieving and maintaining feminising oestradiol levels in a body that would not otherwise produce them. The doses used in gender-affirming hormone therapy are typically several times higher than those used in menopausal HRT. Some trans women use patches or gels; many use injectable oestradiol valerate or cypionate, or sublingual oestradiol, forms that are far less commonly used in standard menopausal practice.
So the idea of trans women and menopausal women queuing for the same products at the same counter, in quantities that could tip a national shortage, does not hold up to even basic scrutiny.
How many trans women are there, relative to menopausal women?
Even setting aside the product differences, the sheer numbers matter. Estimates of the trans population in the UK suggest somewhere in the region of 200,000 to 500,000 trans people in total, of whom trans women on hormone therapy represent a subset. Menopausal and perimenopausal women in the UK number in the millions: figures consistently cited put the number of women experiencing menopause symptoms in the UK at over 13 million at any one time.
The idea that a relatively small number of trans women, many of whom are not even using the products most commonly prescribed for menopause, are depleting national supplies for millions of women requires a mathematical leap that the data simply cannot support.
So what is actually causing HRT shortages?
The real causes are documented and rather less emotionally satisfying than a scapegoat. They include:
- A surge in prescribing following long overdue cultural change. After decades in which menopause was under-discussed and HRT was under-prescribed partly because of concerns that have since been substantially revised, awareness campaigns and changes in clinical guidance led to a significant increase in demand. Pharmaceutical supply chains that had not anticipated this growth struggled to keep up.
- Manufacturing and distribution bottlenecks. Many hormone products are made by a small number of manufacturers. When a production line has problems, or a manufacturer exits a market, there is little slack in the system. This is a structural problem across many medication categories, not unique to HRT.
- Global supply chain pressures. The period of sharpest shortages overlapped with broader disruptions to pharmaceutical logistics that affected medicine availability across many categories.
- Regulatory and licensing factors. Some formulations that clinicians wanted to prescribe did not have licences in all markets, or faced import restrictions, limiting the ability to source products flexibly.
These are the causes that public health bodies, pharmacy networks, and clinicians have identified. Trans women do not appear in that list, because they are not a significant factor.
Why does this false claim keep circulating?
I think it is worth naming this directly, because it is not random. Trans women have been subjected to sustained, organised hostility in UK public discourse, particularly over the last several years. When a grievance emerges, and the grievance around HRT shortages is a real one, trans women are a ready-made target. The logic does not have to be sound; the emotional move just has to feel plausible to people who are already primed to view trans women with suspicion.
What troubles me most is not that a claim circulates online. Claims always circulate. What troubles me is when the claim is amplified by journalists, politicians, and commentators who have access to the prescribing data and the supply chain reports, and choose not to look at them. That is not an accident. That is a choice to prioritise a particular narrative over accurate information.
And that choice has a cost. For menopausal women, it misdirects their frustration away from the people and systems actually responsible, meaning pharmaceutical companies, supply chain failures, and years of under-investment in women's health services. For trans women, it adds another layer of stigma to lives that are already harder than they need to be.
What about the genuine pressures trans women face in getting HRT?
Here is something that tends to get lost in these conversations: trans women face significant barriers to accessing hormone therapy themselves. NHS waiting lists for gender services in the UK run to years. Private care, where it exists, is expensive and not universally available. Many trans women have struggled, sometimes for very long periods, to access the hormones they need for their own wellbeing and their own health.
The picture being painted, of trans women as a privileged group with easy access to oestrogen who are depleting a finite resource, is the inverse of reality. Trans women are not at the front of the queue; in many cases they are still waiting to reach one.
What should menopausal women know?
If you are a menopausal woman who has struggled to access HRT, your frustration is valid and your need is real. You deserve honest answers about why the system failed you. Those honest answers point to pharmaceutical supply chains, prescribing surges that outpaced production, and years in which menopause was not taken seriously enough as a health issue. They do not point to trans women.
I would rather you direct your energy and your advocacy towards the people and systems that actually let you down: the manufacturers, the regulators, the commissioners, and the governments that underfunded women's health services for decades. Those are the conversations that will change things.
What should trans women know?
You are not responsible for this. You did not cause this shortage, and you deserve to say so clearly and confidently when the claim is made. You also deserve access to the hormones that support your health and your life, and the barriers you face in getting them are a separate, serious problem that needs urgent attention.
The attempt to set trans women and menopausal women against each other is not an accident. It serves a particular political agenda. The reality is that both groups are navigating a healthcare system that has often failed women's hormonal health, and both deserve better from it.
If there is a topic that you would like me to cover, just let Sammy know.
Dr Helen Webberley is a gender specialist, medical educator, and advocate. She is the founder of GenderGP and writes about gender diversity, trans healthcare, and the lives around them.
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