Shipping HRT medication from the USA to Kaohsiung. advice? (transgender healthcare)

Life LGBTQ+ Forum
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OK, so I have a very important question for all of you.

I have visited three different major hospitals here in Kaohsiung City, and emailed scores of others across the island.

Not a singular one can get estradiol valerate in liquid injection form. They can get two other meds I take (spironolactone, progesterone) but not a third (melatonin liquid, for sleep – apparently it’s some sort of controlled substance here, and I didn’t realise this until Amazon repeatedly refused to ship it to me here.) And the big one: liquid estradiol. They just don’t believe it exists anywhere. It’s like the chupacabra of Taiwan, apparently: people have heard of it in hushed tones, but no-one has survived to actually pinpoint its present whereabouts.

In any case I’ve just been awarded an ARC this past month and I won’t be eligible for an NHI card until December 1st, so national healthcare is out as an option, I’m afraid.

So, being the undeterred, typical Taurus that I am, I’ve naturally resolved to have the US Veterans Administration (my stateside healthcare provider) ship it to my ex in Washington State, which they’ve very politely agreed to do, and she’s gonna box it up and ship it to me here in Kaohsiung. Rube Goldberg problems, meet Rube Goldberg freakin’ solutions.

My question is this: what kind of silly games do I need to play here to make sure this gets through the thousand-layer procedure that is Taiwan customs? Is it enough to tell the truth about what’s in the box (a 90-day supply of 16g and 23g injection needles and syringes for injection, liquid estrogen, pharmaceuticals of various kinds, a printed copy of my prescriptions for all of the above)? Or do I need to have my ex-wife play cute little games and to declare that the box is a gift-package filled with Wonkabars, cashew butter, puppy cuddles, and the laughter of lost children?

I only want to have to do this 2-3x a year max, and although I am grateful that my ex is thoughtful and kind enough to do this thing for me, I don’t want the task to be any more onerous than it has to be, you know? So I want it done in a way that ensures that the package has the best possible chance to sail through customs not the third, nor the second, but THE FIRST time around.

I’ve gamed out all the chess ahead of time: my EZWay is linked to my Gold Card, has the correct +886 phone number, the correct email address, yada yada.

Does anyone have any advice for me? Because I’m not going back to oral estrogen. That would be a step backward for my medical care, and I’m absolutely not doing it.

I’ve been here for three weeks now. I love it here. I will do what I need to do to integrate: I am studying Chinese for around three hours a day, and picking trash up off the ground where I walk. I smile at my neighbours; I say things like “please” and “thank you.” But going back to a less satisfactory means of banishing dysphoria from my life as comprehensively as possible? Yeah, that’s not going to happen on my watch, and that’s where things get personal for me.

Thanks in advance.

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This is the most official advice I can find:

https://www.fda.gov.tw/ENG/siteListContent.aspx?sid=10369&id=28123

A couple of others (one may be out of date)
https://etaipei.customs.gov.tw/singlehtml/1366?cntId=cus12_86112_1366

https://www.roc-taiwan.org/us_en/post/102.html

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Needles and syringes are easy to get at the pharmacy.

Have you asked pharmacies directly to see if they can order the estrodiol?

As far as I am aware, shipping is not legal. USPS will not accept it and most courier will also not accept it. DHL for example will open it up and see what’s inside. The only way to get around it is if you’re a business account like mine that automated the declaration online. I won’t get into other ways as it’s against forum rule.

I think you have two real options here if you want to continue HRT.

Annual visits to the US if it’s enough to bring a years worth to Taiwan.

Or switch to oral estrogen.

Biden admin has also made telemedicine more complicated after Trump relaxed the rules. So there’s a lot of complications right now with medications in the US.

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I have asked the pharmacies this directly, sitting in person at the pharmacy depts at multiple major hospitals. No Can Do.

I have to continue HRT. I will be on these meds for life. without them my bones become brittle; without them I could die.

annual visits to the USA

the more I think about this option the more it upsets me. who’s paying for all that airfare? and why, exactly, you know? particularly when there isn’t a single reason that can be marshalled as to why I can’t have a prescription medication that has been prescribed to me by a competent authority in the USA, and which isn’t even a controlled substance. feel me here?

oral estrogen is associated with higher risks of deep-vein thrombosis. again, why would I go back to that, when my physician stateside has seen fit to put me on something much less likely to get me a bloodclot in my leg?

I am going to try and go the official route I think by filling out this form:
https://www.roc-taiwan.org/uploads/sites/28/2015/08/5851012571.pdf

because the more I ponder this the more upsetting it all is. I’m going to spend thousands of dollars, why, for no reason? put myself at higher risk of blood clots, of getting hatecrimed in the USA, even for limited periods of time, why? there is no reason; my medical care doesn’t hurt anyone and I’m having a hard time understanding why I can’t just ship things here accompanied by a doctor’s prescription and all paperwork in order, particularly when they’re not controlled substances.

sorry if this comes off as arch – it’s not at you – but you’re helping me refine my feelings about how wrong that all seems. why should I be the one assuming all the expense and risk, when there isn’t a single reason I shouldn’t be able to import something I need for my continued health? I could quote WPATH’s standards of care here as if it were the book of Deuteronomy, but I won’t trouble you further.

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Since you have a Gold Card ARC: If you are either employed, an employer, or self-employed, there seems to be no need to wait 6 months to join the NHI:

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I’m not too sure about this. The supposed rule change came into effect too late to make a difference to me so I haven’t followed it closely, but I seem to remember it being a bit of a damp squib with some people complaining here about it not making much of a difference to how quickly gold card holders can get NHI.

The problematic part seems to be this (from your link):

foreign special professionals and foreign senior professionals who meet the criteria for being insured as employers or self-employed business owners may apply for NHI immediately upon receipt of their Resident Certificates

IIRC, this has been interpreted as “people working for or owning Taiwanese companies”, and gold card holders working for Taiwanese companies were always eligible for NHI from the start of their employment, as with any other ARC holder.

It doesn’t seem to make a difference to the main category of gold card holders who couldn’t get NHI before (i.e., people working as freelancers, contractors, or otherwise remotely for non-Taiwanese companies). They couldn’t get NHI immediately before and they still can’t get it immediately now, AFAIK. Maybe @fifieldt knows more, but that’s how I’ve understood it.

Maybe it made a difference for dependents or something, not sure.

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I understand your frustration. I personally do travel to get my medication and do telemedicine.

I think people often shit on the US for the cost of healthcare and Americans are often unappreciative of how liberal it is to get access to all sorts of medical care and medications in the US. All the new stuff gets to the US first as well and overall it’s very easy for drug companies to sell and market their drugs for Americans to get access to.

US was on the forefront of telemedicine for example when Trump relaxed the rules. One of the things he did very right. This allows people better access to medical care, especially if you’re in an area where you might not be able to see a specialist for something like HRT easily.

Unfortunately the Biden admin is botching it and tightening rules and confusing doctors and patients.

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It sounds like you can do that, the process described at Application of the regulation - Drug Application for Personal Use - Registration - Drugs - Food and Drug Administration, Department of Health seems straightforward enough. One of those links above says it should only take a few days for approval. Hopefully there won’t be any hiccups. Maybe you can get a local friend to help you fill out the “application form”.

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@hopie will however need to see if any couriers will do this for her if she declares it as medication. USPS for example does not allow shipments of medication unless by doctors, hospitals, or pharmacies for example when I checked.

So definitely look into rules couriers have set on this issue as well @hopie. You may need to get your prescriber to send it to you.

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Yeah. The confusion comes between the original intention and what eventually got passed by the legislature. The official line is:

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Getting a bit off-topic here, but:

Previously, those moving onto a gold card from a visa-exempt entry had difficulty. They needed to apply for a separate residence visa between having their visa-exempt entry and their gold card. That’s no longer the case. You can now move directly from visa-exempt entry to a gold card.

I actually did that in January-March 2020 before the amendment came into effect. Entered on an exemption, got a gold card, picked it up in Taipei. Are you saying that shouldn’t have been possible under the rules at that time?

I remember it cost a bit more to do it this way, which it occurred to me might have been to pay for the separate visitor visa (as with switching from a visa-exempt entry to a regular work-based ARC), but if that happened it happened behind the scenes, I didn’t have to do anything additional myself, no new visa appeared in my passport, and there wasn’t really any difficulty.

That said, the first time I left and re-entered Taiwan with the gold card after COVID in December 2022, I got pulled over by immigration and had to wait in the side room for 20 minutes or so while they figured something out (they didn’t give much of an explanation, but indicated there was an issue with something being wrong on their system records). I also remember getting a funny look and a couple of questions from the IO when I was leaving Taiwan in October 2022.

I wonder now if that might have been caused by me switching from an exemption to a gold card. :man_shrugging:

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I’m going to try this “Drug Application for Personal Use” route everyone – I’ll keep you posted as to how it goes, so as to benefit future people dealing with such issues who chance upon this thread :slight_smile: I’ll let you know if I am able to have it shipped over directly or if my ex is able to ship it to me with official prescription documents printed out and appended, again, so as to benefit future readers.

appreciate everyone’s empathy and help. ~~~Hope

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Weird things happened during Covid (and also that ‘early’ in the program, so could’ve been that. But yeah, if there was an extra fee it could have been for an intermediary visa.

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@anon9757851

Thank you for posting this! I’m very interested in moving to Taiwan but this is my #1 biggest concern. I’ll be keeping an eye on this to hear how things go for you. Good luck!

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Hi! Thanks for your comment. So, I have managed to make an appointment with a transgender care team who boast over 30 years of experience with GRS and GAHT. I have my first appointment with them in early August. Feel free to message me here once you arrive! I’m very happy to be of assistance in all the ways. Cheers! ~~~Hope

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Congrats! That’s great news! Glad you’re able to access what you need. :grin: