The Trans Community Is The Invisible Face of The Crisis

In a country deeply ravaged by a complex humanitarian emergency, hormones are just a part of the innumerable supplies gone from the health system, and they're essential for those desperate to reach their true self.

Photos: Rayner Peña /El Pitazo, retrieved

Sam Leonidas Marim (43) never felt like a girl. When only a child, he played sports, felt uncomfortable with skirts and couldn’t relate to his mother’s side of the family. Girlhood, in his mind, was a rare imposition, and understanding gender identity beyond his body and the negative stereotypes that pervade in society was a hard feat. 

This society was Caracas in the ’80s, with a landscape of violence, excess and slow decline. Back then, Sam’s favorite person in the world was his grandmother. “The problems started at home when she heard I liked girls. Years later she was diagnosed with dementia, and she started to recognize me as her son. It was a beautiful feeling, like the last present from destiny before she passed.”  

Today, Sam is a male transgender activist dedicated to coaching empoverished youths and exposing the hardships of the transgender community on the radio program TransViviendo. “I feel invisible,” he says. “We have no political representation, no access to medicine, few specialized doctors, no progress regarding our legal status and no public debate about our fundamental rights.” 

Since 2018, finding the medicine for the hormone replacement treatment has become impossible for the trans community, with a 98% shortage of estrogen and testosterone, according to Dr. Luis Madrid, surgeon and psychiatrist specialized in transgender health. Sam hasn’t had any of his required Polysteron and Nebido shots for over a year, even though the testosterone shortage started in 2009. 

“The situation got critical in 2014,” says Dr. Madrid, “but today, finding hormones outside the black market is impossible. It’s easy to get scammed buying medicines through informal methods. I’ve tested bottles with false hormone samples, filled with mineral or palm oil. Getting a shot of untreated mineral oil could result in an abscess, severe cellulite or septicemia.” 

Sam started comfortably feeling like a man as soon as he began the hormone replacement treatment. Currently, he tries to keep his testosterone levels as high as possible using Androgel, a testosterone gel used by bodybuilders and sold at $80 in gyms. It’s an expensive, insufficient option, but safe compared to buying testosterone on the black market. Other transgender men report the use of veterinary hormones, horse testosterone, to push their bodies to their male form. “20 years ago this was a common practice for transgender men who were eager to see quick and radical changes. But today’s tendency comes from desperation. Getting a shot of horse testosterone is incredibly dangerous, as it could result in heart and liver failure, thrombosis and psychotic breakdowns,” explains Dr. Madrid.

Due to unemployment, Sam works sometimes as a taxi driver between Caracas and Guatire. Photo: Rayner Peña, 2017.

Sam came through after a long self-discovery process. Before he started to transition, he married at 23 and got pregnant. “It was a traumatic experience. I never felt like a girl, and I was forced to experience womanhood. After Gaby was born, I couldn’t breastfeed her, due to postpartum depression.” After giving birth, Sam got a divorce and fell in love with a woman. It was his first time experiencing same-gender love, even though it took him a while to realize he wasn’t a gay woman. One day, Sam saw a video of a woman who was transitioning to male and was blown away. He dated an evangelical girl who tried to exorcise his homosexuality away in a ritual called liberation. “The process was tortuous. But I was happy once I made the decision to begin the hormone replacement treatment. I felt free and alive. Now that’s out of my reach.” 

Dr. Madrid says that half of the transgender community is prone to suicide. Globally, this tendency has been reduced to 12%, according to Dr. Madrid, but Venezuela has gone back in time almost 30 years. “An interrupted hormone replacement treatment could easily push someone in a hard situation to end their life,” says Dr. Madrid. Without treatment, Sam’s body started to change back to a female form: his hips widened, his body hair started to disappear and his voice was rapidly feminized. He remembers the first six months without testosterone as the most intense, as he experienced severe depressión, anxiety attacks, abstinence syndrome, and body dysmorphia. “People who interrupt their hormone replacement treatment usually isolate themselves. Their bodies change, so they don’t want to be seen in public. They quit their jobs, stop talking to friends, try to hide themselves and their bodies away. I’ve had patients who have simulated beards with crayons and pencils.” recalls Dr. Madrid.  

The empty shells

Meanwhile, even though the regime has incorporated sexual diversity to its agenda, its role has been limited to making instrumental use of the LGBTQ community. “The government uses the community to assimilate the region’s narrative, but the reality is far from it. There are no public policies, and laws and reforms that can protect the community have been consistently denied. Maduro created a presidential council for sexual diversity, but it’s another empty shell,” said Yendri Velazquez, activist from Caleidoscopio Humano, an LGBTQ collective created in 2018. 

Other required treatments for the trans community are also out of reach. Due to the growth of the unemployment rate, transexual women are more prone to offer sex services to survive. This makes them vulnerable to STDs, especially HIV.  Dr. Madrid recalls at least three of his patients who have told him they ask for food as payment for sex service and four HIV+ trans sex workers who ended up living in the streets, unable to get treatment. In 2018, The Venezuelan Network of Positive People, (RVG+) denounced a 100% shortage of antiretrovirals. Eduardo Franco, revealed that at least five thousand HIV+ people died the first semester of the year. 

The antiretroviral shortage was already included in a 2013 report from the Panamerican Health Organization. A year later, the Pharmaceutical Federation (Fefarven) reported a 60% shortage of medicine and a $2,300 million dollar debt from the government to private laboratories. “Some people believe the trans community is not a priority amidst the humanitarian crisis, because we won’t die without treatment, but the numbers say otherwise. Medicine shortages deeply affects us and could generate circumstances that lead to death,” Sam says, without hiding his disappointment in how minorities are stigmatized and invisibilized amidst the crisis. 

An impossibly dignified life

Medicines shortage aren’t the only health issue affecting the trans community: they also have very little specialized medical disponibility. Last year, a study made by United Doctors of Venezuela claimed that 50% of surgeons and endocrinologists do not agree with hormone replacement treatment and genital adequation interventions. The centers trained with transgender health protocols have shut down, or have been forced to dollarize their services, making it too expensive for 95% of the trans community. 

“The first medical center of transgender medicine was in the Military Hospital Carlos Arvelo, in 2000,” says Dr. Madrid, who has dedicated the last 20 years of his career to improving the health system for the trans community. “Back then, we had solid networks to promote health issues for the trans community. I created with Plafam a program and a protocol of assistance for trans people, based on the WPATH standard of care for the transexual, transgender and gender non-conforming people. Those networks are lost now. Everyone is working separately, and it’s hard to reach out. Transgender people live in a harsh context full of brutality, rejection, and doubt. Many transgender men and women had to leave the country in harsh circumstances because their lives and health were threatened at many levels.”

Sam currently has a fractured relationship with some members of his family. His daughter, Gaby, has shown her full support during the transition. “The pregnancy was hard, but I can’t imagine my life without Gaby. She has taught me a lot about love, patience and understanding.” Photo: Rayner Peña, 2017.

Migration has deeply affected the LGBTQ community as many leaders and human rights activists have been forced to leave their NGOs behind. “Only in 2016, four activists left the country and three of their platforms and organizations died,” says Quiteria Franco, member of Union Afirmativa, an organization born in 2000 that promotes compliance with international human rights standards that protect people from discrimination based on sexual orientation and gender identity. After the 2017 protests, Union Afirmativa was nearly dismantled because its most active members fled in the latest migratory wave. Venezuela Diversa, founded in 2007, was also shut down after getting death threats from religious groups after publishing a report denouncing human trafficking and sexual exploitation of trans women who wanted to migrate. “Venezuela has never had a strong LGBTQ activism, but those who are left work against all odds,” says Tamara Adrian, the first transgender woman of the continent to be elected for parliament as alternate deputy for Voluntad Popular, on 2015. 

Before Chile and Uruguay, Venezuela was the first country in Latin America to recognize the transgender identity, in 1977,  exactly one year before Sam was born. 150 transgender identities were recognized, “but since 1998, not one single trans identity has been changed, as the law stipulates,” says Tamara Adrian. Despite a rocky past, many LGBTQ communities in Latin America now enjoy the right to marry, adopt children, choose their gender identity, be protected by anti-discrimination laws, and experience a broader societal acceptance. “The region has gone forward, but Venezuela has gone backward. The pride parade was taken by chavismo and used for propaganda in 2008. After that, participation fell 50% every year. Then, the parade organizers left the country. There are few people left to take care of the community,” Adrian says. “Trans people in Venezuela live in a revolution that functions as an extreme right dictatorship. We’ve been abandoned by the government, and it’s almost impossible to achieve a dignified life under these circumstances.”