Index
- Introduction
- Background
information
- Survey
results
- Conclusions
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Appendix
1 — Survey Questions
19 KB
Appendix
2 — Reported purchase price of testosterone
among 70 Australian and New Zealand
consumers.
11 KB
Appendix
3 — Factors affecting decisions about
obtaining testosterone.
15 KB
Appendix
4 — Other comments from
respondents.
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Raw
data table.
Introduction
The "How much do you pay for your
testosterone?" survey invited input from
February 5 to December 31, 2006 from
self-identified female-to-male transsexual men
living in Australia or New Zealand who required
testosterone hormone therapy as medication when
undergoing sex-affirmation treatment to the male
sex.
Background
Information
Testosterone treatment
The single most effective affirmation
treatment for males identified 'female' at birth
is an intramuscular injection of 200-250mL of
testosterone once every 14-21
days1. As a
cumulative drug, testosterone results in male
secondary sexual characteristics which are
irreversible2
within a relatively short period of
time (12 months or less). Over time, physical
masculinisation of the body is indistinguishable
from that of males identified 'male' at birth.
Research indicates the majority of these men
(97%) have increased levels of satisfaction
within
themselves3.
Testosterone Cost in Australia and New
Zealand
This survey investigated the financial cost
of testosterone medication. The price of
testosterone hormone medication is different in
both countries (Australia and New Zealand).
In Australia the cost of testosterone hormone
medication is based on:
- Eligibility for health care concessions
and/or
- The prescription available to the
individual (private or authority)
In New Zealand reduced cost for
pharmaceutical medication is based on:
- The individual's eligibility of health
care concessions and
- Income status.
Australia: Cost of testosterone
Cost of pharmaceutical drugs in Australia is
mediated by a national health care system,
Health Insurance Commission (HIC). The HIC
includes three major national subsidy schemes,
Medicare, the Pharmaceutical Benefits Scheme
(PBS) and the 30% Private Health Insurance
Rebate.
Medicare covers people residing in Australia,
those who are Australian citizens, New Zealand
citizens (on evidence of a NZ passport to the
pharmacist) or holders of permanent visas. The
PBS which is part of the Medicare system,
provides all Medicare-eligible people access to
most prescription medications at a reduced
cost4. The PBS
makes prescribed medication available under a
two-tier co-payment system by the PBS - a
'concessional category' or a 'general
category'.
The concessional-category is available
to individuals who receive "certain pensions,
benefits or cards administered by the
Departments of Family and Children's Services
(FACS) or Veterans' Affairs (DVA), or who meet
certain criteria for being declared to be
disadvantaged"5.
With a concession card, individuals in this
category pay approx.
$4.906 per
item with the Australian Government paying the
balance up to the listed price for the drug.
Those in the general-category pay up to a
maximum of
$30.707 per
item and the Australian Government pays the
balance up to the listed price for the drug.
An additional option available under the PBS
to reduce the cost of testosterone medication is
through the type of prescription available to an
individual. Medical practitioners in Australia
can prescribe the hormone under a 'private
prescription' or under an 'authority
prescription'.
Eligibility for an authority prescription for
testosterone requires the individual to be
registered in the male sex with Medicare and
then practitioners can prescribe under one of
three indications for the drug for the patient
to access subsidised testosterone under the PBS.
Males identified 'female' at birth can correct
their sex designation at Medicare with statutory
declarations from two medical practitioners that
the individual has undergone two irreversible
sex affirmation procedures for at least two
years. The two irreversible procedures are
considered to be surgical procedures (associated
with the sexually differentiated aspects of the
body, ie., chest reconstruction, hysterectomy,
oopherectomy etc) or a surgical procedure and a
minimum two years irreversible testosterone
treatment. The HIC recognises the hazards
associated with female-to-male genital surgeries
and does not insist these males undergo
imitative surgeries such as phalloplasty
or metoidioplasty as a prerequisite to
correcting the sex-designation to
male8. Upon
registration in the male sex in the Medicare
record, males are eligible to receive
testosterone on authority prescription.
The pharmaceutical benefit records the cost
of testosterone for all testosterone products to
be a flat rate of AUD$30.70 on authority
script. The only exception is testosterone
esters (Sustanon100) which merits a costing to
the consumer of up to $23.33. Males who purchase
testosterone under the PBS with a health care
card (linked to some social security
benefits) reduces the price of testosterone
further to a flat rate of $4.90 per
script9.
The PBS lists the cost for testosterone on a
private script from $18.77 to
$194.6610.
New Zealand: Cost of testosterone
Health care in New Zealand is administered by
the Ministry of Health (MOH) as a Government
body which disperses the responsibilities
amongst 21 District Health Boards (DHBs) across
the country. Health services funded by the New
Zealand government provides for free public
hospital services, pharmaceutical subsidies and
support services for people with
disabilities.
Subsidised pharmaceutical medication is
available to all New Zealand residents,
citizens, work permit holders and Australians
resident in New Zealand at a cost of the item or
NZD$15, whichever is the lesser amount.
An additional option is available for people
on low incomes through the use of a community
services card (also known as the Health Card,
Exemption Card or Discount
Card)11.
This card provides eligibility for a further
pharmaceutical subsidy to $3 per item.
Testosterone prescription in New Zealand is
available on authorisation from an
endocrinologist or occasionally by a GP. The
prescription provided by the medical
practitioner is priced at $15 for a three month
supply regardless of dosage or frequency.
Factors not relevant to the New Zealand
respondents include
- sex-designation and
- the geographical place of purchase.
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Survey
Results
Participants
Participants were primarily sourced through
the membership of the FTM Australia network
(Men's Ts Resources in Australia) via the
website and email discussion group of the
network. Information about the survey was placed
on local internet email groups in Australia and
New Zealand.
A total of 220 surveys were posted out to
members with the March 2006 newsletter 'Torque'.
Members were encouraged to ask friends or
personal contacts who fit the participant
profile to participate in the survey.
Eighty-nine self-identified female-to-male
transsexual men taking testosterone as part of
their treatment process responded to the survey.
Eight respondents indicated they were based
outside Australia or New Zealand (USA and Korea)
and these were excluded from this study,
providing a total 81 participants living in
Australia and New Zealand.
The survey was available for completion
online from 5 February 2006 via the internet
service www.surveymonkey.com.
Both the online and hard copy (offline) versions
were identical. The survey closed on 31 December
2006.
Survey design
The survey consisted of 10 questions divided
into four sections:
- collected data on respondent
demographics.
- asked details about testosterone
purchase.
- requested participants to rate the
importance of factors involved in deciding
where to purchased their testosterone.
- offered respondents an opportunity to
make further comments.
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Appendix
1 — Survey Questions
Section 1 - 'About you
as a respondent to this survey'
1. Geographical
Most respondents (87.6%) indicated they were
lived in Australia. The remaining ten (12.4%)
indicated they lived in NZ.
All 81 respondents responded to the statement
"I am in this area of New Zealand or Australia"
by marking the appropriate state, North or South
Island of New Zealand.
Table
1 (popup)
2. Form of purchase
Most respondents (89.9%) indicated they
purchased their medication over-the-counter from
a chemist/pharmacy. Two participants indicated
they purchased from an online chemist/pharmacy
service while the remaining six respondents said
they fluctuated between the two options.
Two respondents skipped this query resulting
in a total of 79 respondents who responded to
the statement "I purchase from..."
Table
2 (popup)
3. Sex-designation at Medicare
Most Australian-based respondents (60%)
reported they were registered in the female sex
with Medicare. The remaining 28 (40%) Australian
respondents indicted they were registered in the
male sex.
All 81 participants responded to the
statement "I am registered with Medicare (at the
present time) as…" by marking either
'female', 'male' or 'not applicable I'm in New
Zealand'. Eleven participants (13.6%) indicated
they were living in New Zealand and this
question was not applicable to them.
Table
3 (popup)
4. Authority-script
The majority of Australian-based respondents
(53 %) reported they did not receive
testosterone on approval on the PBS. The
remaining 32 (47%) Australian respondents
indicted they were prescribed testosterone on
approval prescription as part of the PBS in
Australia.
A total 79 respondents marked either 'yes',
'no' or 'not applicable I'm in New Zealand' in
response to the statement "I receive
testosterone on approval on the Pharmaceutical
Benefits Scheme (PBS) in Australia". Two
respondents skipped this question. Eleven
participants indicated this question was not
applicable because they lived in New
Zealand.
Table
4 (popup)
5. Social security benefit
The majority of Australian-based respondents
(66.6%) reported they did not receive any social
security support (CentreLink). The remaining 23
(33.3%) indicated they were in receipt of a
CentreLink benefit.
A total 79 respondents marked either 'yes',
'no' or 'not applicable I'm in New Zealand' in
response to the statement "I am receipt of a
CentreLink benefit (at the present time)". Two
respondents skipped this question. Ten
participants indicated this question was not
applicable because they lived in New
Zealand.
Table
5 (popup)
Section 2 - 'My
testosterone purchase'
The second section titled 'My testosterone
purchase was divided into three statements with
multiple choice answers relating to the purchase
of testosterone medication.
6. Testosterone Product
In response to the statement "The type of
testosterone I normally buy is…"70 of 81
(86%) participants selected the testosterone
product they use from a list of seven
options:
- Sustanon 100
- Sustanon 250
- Primoteston Depot 250
- Testosterone Pellets (Implants)
- Androderm
- Testogel
- Other
58 of 70 respondents, (83%), reported they
purchased an injectable form of testosterone
('Sustanon 100', 'Sustanon 250' or 'Primoteston
Depot 250'). Seven (10%) indicated they accessed
the pellet (implant) form and four (5.7%) said
they used Testogel.
None reported using the testosterone patch
Androderm. Two indicated they used another
testosterone product,not listed - Andriol -
Testosterone Undecanoate (40mg per capsule).
Table
6 (popup)
7. Price and quantity/dose
Respondents were asked to indicate price paid
for testosterone in Australian dollars and
related quantity/dose (how many
vials/injections/patches)
Only one of seven New Zealand respondents
reported price in AUD. Therefore results are
given in AUD for Australian respondents and in
NZD for New Zealand respondents.
Sixty-three out of 71 Australian respondents
reported they paid AUD$3.20 to AUD$202.00, while
seven out of the eleven New Zealand respondents
reported costs ranging from NZD$2.50 to
NZD$15.00.
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Appendix
2 — Reported purchase price of testosterone
among 70 Australian and New Zealand
consumers.
6. Frequency of testosterone
administration
Seven multiple choice options included:
- One week
- Two weeks
- Three weeks
- "One month
- About six weeks
- About eight months. Other
Seventy of 81 participants (86%) answered
this question. The majority of respondents
(n=27, 38.6%) reported they used their
medication within about six weeks of purchase.
The remaining 43 (61.4%) reported time periods
ranged across the remaining six options. Nine
respondents (12.9%) indicated a range of other
time periods: 12-13 weeks, nine weeks, three
weeks per shot, and 12 weeks. Five New Zealand
respondents reported they used their
testosterone within three months of
purchase.
Table
7 (popup)
Section 3 - 'Please
rate the importance of the following factors in
your decision to obtain your
testosterone'
This part of the survey examined potential
issues influencing participants' purchasing
decisions. Respondents were asked to rate
importance on a four-scale rating from 'Very
Important', 'Important', 'Somewhat Important and
'Not Important' against nine options.
Nine multiple choice answers on purchasing
options were:
- Physical access to the
pharmacy/chemist
- Proximity of the pharmacy/chemist to my
home/work/place of study
- Relationship with the pharmacy/chemist I
purchase from
- The price a specific pharmacy/chemist can
offer me
- Privacy of information with a particular
pharmacy/chemist
- Medical service through a hospital or
research facility
- Chemist/pharmacy services scripts for
other men on testosterone like me
- Chemist/pharmacy can fill my script same
day within the hour
- Location of chemist/pharmacy in area I
pick up other things like groceries.
Sixty-eight of 81 participants answered this
question. 36 of 67 (54%) participants rated
proximity of the pharmacy/chest to my
home/work/place of study as having the greatest
influence on their decisions about obtaining
their medication.('very important'), while 28
(42%) rated access to a medical service through
a hospital or research facility as least
important.
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Appendix
3 — Factors affecting decisions about
obtaining testosterone.
Section 4 - 'What have
we missed?'
A total of 24 comments were made in this
section.
The most common were remarks from Australian
respondents about online pharmacy services while
remarks from New Zealand respondents were about
the New Zealand pharmaceutical health
system.
15 KB
Appendix
4 — Other comments from
respondents.
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Conclusions
The cost of testosterone varied between the
Australia and New Zealand as well as within
Australia. Factors contributing to differences
in price were access to subsidised testosterone
(New Zealand and Australia), a further discount
for health care card holders (New Zealand and
Australia), and access to subsidised
testosterone with authority prescription
(Australia).
Male-registered group
28 Australian respondents reported they were
registered in the male sex at Medicare and this
group were eligible to purchase testosterone on
authority prescription at a reduced price.
However 11 respondents of this 28
'male-registered group' reported they did not
purchase their testosterone on authority
prescription, leaving only 17 'male-registered'
respondents purchasing testosterone at a reduced
price on authority prescription.
The average cost to the 'male-registered'
group accessing testosterone on authority (n=17)
was AUD$14.08 per prescription. Nine of these
respondents stated they also had a health care
card and their average price per prescription
was $7.62.
The average cost to the 'male-registered'
group accessing testosterone without authority
(n=11) was $59.55 per prescription. None of this
group reported lower costs associated with
accessing subsidised testosterone and
eligibility of a health care card.
Female registered group
42 Australian respondents reported they were
registered in the female sex at Medicare) and as
such were ineligible to purchase testosterone on
authority script at a reduced price. However 15
respondents of this 'female-registered group'
reported they still obtained authority
prescription from their GP.
The average cost to the 27 respondents of the
'female-registered' group purchasing
testosterone without authority prescription was
$31.83 per prescription. Eight respondents from
this group of 27 stated they also had a health
card which resulted in a higher average cost of
$33.78.
The average cost to the 'female-registered'
group accessing testosterone with authority
(n=15) was $28.27 per prescription. Respondents
stating they also had a health card (n=4)
reported an average price per prescription of
$4.52.
Table
8 (popup)
Australian respondents without an authority
prescription reported a variation in cost
depending on the testosterone product they
purchased. The pharmaceutical schedule reports
testosterone subcutaneous implant 200 mg as the
most expensive product at AUD$194.66 each and
the intramuscular injection Sustanon100 at
AUD$18.77 as the least expensive. The recently
available intramuscular injection Reandron1000
priced at AUD$146.14, testosterone gel priced at
AUD$93.85 and transdermal patches (both 12.2 mg
and 24.3mg) priced at AUD$94.57 without an
authority prescription.
In comparison, New Zealand respondents were
able to access a flat-rate of NZD$15 per
prescription (or NZD$2.50 concession) regardless
of number of vials, injections or frequency of
dose.
Online purchase prices reported by
respondents did not vary noticeably compared to
over-the-counter purchase prices.
The overall majority of all respondents, 58
of 70 respondents (83%), reported purchasing an
injectable form of testosterone.
Of the 66-68 respondents who rated factors
influencing their decision to purchase their
medication, the proximity of the vendor to the
respondent emerged as the chief influence.
Physical access, privacy of personal information
and price offered was also uppermost in the
decision when deciding where to purchase. Many
respondents preferred a chemist/pharmacy which
could fill their prescription within the hour.
Many respondents did not consider the provision
of service through a medical facility to be
influential on their purchasing choices or
whether there were other men like themselves
accessing the same chemist/pharmacy.
Australian respondents reported purchasing
testosterone on authority prescription with the
added eligibility of a health care card to be
most cost effective.
Likewise, New Zealand respondents reported
purchase of their medication to be most cost
effective with a health benefit card.
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With thanks to Aladdin for editing and
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