LUSAKA, ZAMBIA — Moments after she delivered her baby, Adesi took a close look at the infant but she couldn’t easily determine her child’s sex. The infant’s genitalia didn’t provide a clear answer.
Even so, doctors told Adesi that she needed to decide right away whether the baby was a boy or a girl. There were no other options.
Adesi, who asked that only her first name be published because of social stigma associated with intersex issues, decided to raise her child as a girl. She named her Gift.
That was more than three decades ago. Gift is now 32 years old and identifies as a man, but people tend to be confused when they first meet him. They wonder, he says, whether he’s a man or woman.
When he first spoke with Global Press Journal in 2017, Gift, who also requested that only his first name be used to protect his privacy, was undergoing medical tests to check his hormone levels.
Once the tests were complete, he hoped to begin testosterone therapy, a type of hormonal treatment typically given to men with low testosterone levels. The treatment, which requires careful monitoring from a doctor, helps boost energy levels and regulate hormonal imbalances. Gift, whose internal reproductive organs are that of a male, says regular doses of testosterone will increase his muscle mass and help him grow more body hair.
Now, Gift injects himself with testosterone once a week. There’s just one problem: His doctor doesn’t know about the injections. Gift never completed the tests that would clear him for the treatment.
“The hospital process was just too cumbersome,” he says. “I kept going back and forth for medical examinations for two years, and it was costly, as well as time-consuming.”
The World Health Organization defines intersex people as those born with physical or biological sex characteristics that do not fit traditional definitions of male or female. In Zambia, there is no third gender classification on legal documents, and there is little awareness about intersex people. Some intersex people, including Gift, use hormones without a doctor’s prescription.
Transgender Zambians, whose gender identity does not match the sex assigned to them at birth, have also found ways to get hormones.
Doctors warn against this form of self-administered treatment, but people who use hormones say lengthy, costly medical tests and procedures leave them with no choice.
Up to 2 percent of the world’s population is born intersex, according to the Office of the United Nations High Commissioner for Human Rights. The exact number of intersex people in Zambia is unknown. James Chipeta, an associate professor of pediatrics and clinical immunology at the University Teaching Hospital in Lusaka, told Global Press Journal in 2017 that doctors at his hospital have seen 90 intersex babies since 2007.
Not all intersex conditions require treatment, but hormone therapy is necessary for survival in some cases. In other cases, the treatment compensates for sex hormones that a person’s body may not produce.
In a 2015 report, the World Health Organization found that gender-variant people around the world have trouble obtaining hormones because of expensive health services and discrimination.
Many Zambians believe that being intersex, transgender or gay are all the same, Gift says, adding that he’s been mistaken as gay more than once. All three groups face discrimination. People in those groups say they worry that police will arbitrarily arrest them because it’s a crime here to be gay.
Gift says he’s tried for years to gather medical evidence to prove that he’s intersex, not gay.
Four years ago, Gift says, he went to a private hospital to have his hormone levels checked. Before that, he had been to a public hospital, which didn’t have the equipment to carry out the procedure. He paid 800 Zambian kwacha ($67) for the test. Weeks later, doctors asked him to go through more tests. They kept rescheduling those appointments without explanation, he says, even though he had already paid close to 5,000 kwacha ($420) for them.
Gift turned to a friend in South Africa for help.
“When I traveled to South Africa in 2017 for work, I took the opportunity to buy the testosterone,” he says. He used his friend’s prescription to buy the drugs from a pharmacy there.
Without a doctor to determine his dosage, Gift is at risk of serious health complications, including liver damage and blood clotting. Taking hormones unprescribed could also lead to abnormal growth of certain body parts and cause aggressive behavior, says Dr. Chishimba Lumbwe, an endocrinologist.
But after months of researching hormone therapy on the internet, Gift says he’s convinced he’s nailed down the right dosage.
So is Amon, a transgender man who has been injecting himself with testosterone for the past six months. Amon says he was never willing to go the hospital for hormone therapy, because of the stigma that comes with being transgender.
There are no laws that provide protection for transgender people who face discrimination.
“We have means of obtaining prescriptions without going to the hospital. We pay some people to give us the prescriptions for the drugs,” he says.
The people selling testosterone to Amon use fake prescriptions to get it at pharmacies, he says.
In Zambia, the most common types of testosterone drugs are injected, Lumbwe says. Sharing them with friends is never a good idea, says Mwansa Chanda of Trans Bantu Zambia, a local organization that defends the rights of intersex and transgender people.
“Self-medication is dangerous, because the users risk infecting themselves with HIV,” she says.
While Chanda’s organization advises its members to stay away from unprescribed hormones, Lumbwe says health professionals across the country need to step up their efforts to provide more support to intersex people.
He blames a lack of trained endocrinologists for the long medical tests and procedures that intersex people have to go through.
“For a very long time, I was the only endocrinologist in the country, until recently, so we need a lot of these doctors, because they are usually overwhelmed,” he says.
Prudence Phiri, GPJ, translated some interviews from Nyanja.