Answer to a question from a reader

Iā€™m a trans person living in a small town in the WC and have struggled to access hormonal replacement therapy. Where can I go for help?

The short answer

You can ask your GP to refer you to Groote Schuur Hospital's Transgender Unit or contact the Desmond Tutu LGBT+ Health Division at the hospital.

The whole question

Dear Athalie

I am a transgender person living in a small town outside of Cape Town. I’ve been trying for a long time to access hormone replacement therapy (HRT), but in small towns and rural areas, there’s very limited availability, and every time I try, I hit a dead end. Is there an organisation or someone I can contact for help with getting HRT?

The long answer

You may have heard that the four Wits RHI (Reproductive Health and HIV Institute) Trans Health Centres in South Africa were forced to close down on 28 January  2025 when they got a notice from their funder, USAID, to stop. Trump became US President on 20 January, and on 28 January, USAID was stopped. The Wits RHI clinics had provided sexual health and hormone care for the transgender community. One of the RHI clinics was in Bellville.

The sudden withdrawal of USAID has also closed the Anova Health Ivan Toms Centre in Cape Town, which had offered HIV services to gay, bisexual, and other marginalised groups since 2009.

Roberto Igual in a MambaOnline article commented that “These clinics have also served as vital community hubs and safe spaces, which are now at risk of disappearing altogether.”

But thankfully, the main public resource for transgender healthcare, including hormone replacement therapy, is the Transgender Unit at Groote Schuur Hospital, and it continues. It is regarded as the best public facility for transgender healthcare in South Africa. 

This Transgender Unit, part of the University of Cape Town's Department of Psychiatry, provides referrals and services for transgender individuals, including mental health assessments, gender-affirming hormone therapy, and potential referrals for gender-affirming surgery.

You could get started by getting a referral to the Transgender Clinic. The doctor can make the referral by completing the referral form and sending it to GSH.PsychOPD@westerncape.gov.za.

Your first appointment at the Transgender Clinic would be at the Psychiatry Outpatient Department (OPD), where clinical psychologists and psychiatrists would see you for a comprehensive assessment. Depending on their assessment of your need for gender-affirming interventions, you would likely be referred to the Endocrine and Plastic Surgery department.

Gender DynamiX says that the South African Trans Health Initiative, in partnership with the Groote Schuur Hospital Transgender Unit, has developed a system of technical support and tools to assist general practitioners who may be approached by a transgender patient for hormonal therapy. 

They say that it is now possible for a transgender person to get hormone therapy from a general practitioner in a primary care setting. This means that an increasing number of patients are receiving therapy much closer to home and at reduced cost.

These are the contact details for Gender DynamiX:

The Desmond Tutu LGBT+ Health Division, based at Groote Schuur Hospital, is also still operational. It was established in 2008 and focuses on promoting equitable access to affirming healthcare for LGBTQI+ populations through research, community engagement, and advocacy. These are their contact details: 

Cape Town, South Africa

Wishing you the best,
Athalie

Answered on May 29, 2025, 4:06 p.m.

LGBTI Withdrawal of US aid

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