This is an update to two previous posts on the current intramuscular (IM) testosterone shortage:
- Canada’s Testosterone Shortages – Jan 15, 2012
- Testosterone Shortage Update: Sandoz Suspending Production – Feb 20, 2012
ETAs for Testosterone Brands in Canada
1. Pfizer Depo-Testosterone (t. cypionate)
On Feb 22, CanadaPharma.org listed Feb 29, 2012* as the availability date for Pfizer’s Depo-Testosterone. However, by Friday the notice had been removed from the website (along with a notice about Sandoz Testosterone.) I contacted them to find out what this meant but received no response.
On Feb 23, the Saskatchewan Drug Information Services (SDIS) posted an availability date for Pfizer Depo-T of Feb 29, 2012*.
With two reports citing this ETA date there’s good reason to believe that Depo-T will be available shortly.
*UPDATE, 03/01/12: These ETAs were provided by Pfizer and as such don’t necessarily reflect the date that your pharmacy will have Depo-T in stock. Before it gets to you, it has to go from Pfizer to the distributors, then on to pharmacies. This may explain the March 7th ETA date that’s being relayed by some pharmacists.
2. Valeant Delatestryl (t. enanthate)
I’ve heard several people say that their pharmacists told them that Valeant Delatestryl will be back in March or April. I’ve also heard that Delatestryl is expected to be out indefinitely. (It’s possible this is being confused with Sandoz, see below.) I have not located a bulletin with a return to market date for Delatestryl, and there are no updates available on the Theramed or Valeant websites. (Valeant doesn’t list Delatestryl as one of their products, but Theramed still does.)
3. Sandoz Testosterone (t. cypionate)
FridayPM.ca lists an availability date of Dec 30, 2012 for Sandoz Testosterone, however SDIS reports that “all Sandoz injectable products are now on allocation until further notice.”
No bulletins have been posted by Health Canada on the shortages of any of the three brands of injectable testosterone marketed in Canada. I requested that they post an advisory and have received no response.
Testosterone Shortages in the United States
As of Feb 9, 2012, a few of brands of IM testosterone remain off the market in the U.S.:
- Paddock has testosterone cypionate 200 mg/mL 1 mL and 10 mL vials are on intermittent back order due to raw material shortage, and the company is allocating product to wholesalers as supplies are released.
- Teva has temporarily discontinued their testosterone cypionate injection presentations.
- Sandoz discontinued testosterone cypionate 200 mg/mL 1 mL and 10 mL vials in September, 2011.
Available products in the U.S.:
Watson had been unavailable for several months and did not provide a reason for their shortage, but is reportedly now back.
- Testosterone Cypionate intramuscular injection, Watson
200 mg/mL, 10 mL multidose vial (NDC 00591-3223-79)
Though they remain unavailable in Canada, both Pfizer and Sandoz have IM testosterone on the market south of the border:
- Depo-testosterone intramuscular injection, Pfizer
100 mg/mL, 10 mL vial (NDC 00009-0347-02)
200 mg/mL, 1 mL vial (NDC 00009-0417-01)
200 mg/mL, 10 mL vial (NDC 00009-0417-02)
- NEW – Testosterone Cypionate intramuscular injection, Sandoz
100 mg/mL, 10 mL multidose vial (NDC 00781-3073-70)
The FDA has no advisories posted for injectable testosterone brands in their list of Current Drug Shortages.
Need Your Prescription Filled? Alternative Sources of Testosterone
“The bottom line for patients is to expect more shortages.” — Dr. Jacalyn Duffin, The Globe and Mail
It looks like we’re at the tail end of this shortage, but with shortages becoming more common the following information may be helpful the next time this happens and you’re caught short:
1. Find a pharmacy that still has T in stock. You’ll need to crack the phone book and call around. You may even have to look outside the area where you live, I did. If you find a source, you’ll have to ask your doctor to call in a new prescription because they can’t be moved pharmacy-to-pharmacy for controlled substances.
If you live on Vancouver Island, Central Drugs in Nanaimo currently has lots of Depo-T in stock. The pharmacist there anticipated the shortage and stocked up. (Thanks for this information, Timmy!)
2. Get injectable testosterone compounded. If you can’t locate a pharmacy with T in stock or wait for Depo-T to return to the shelves, or if you’re allergic to the cottonseed oil in Depo-T, consider getting an injectable testosterone compounded for you. Compounding pharmacies are not uncommon, but those that can make injectable drugs are. Here are a few Canadian compounding pharmacies that can make injectable T:
- Marks Pharmacy, Vancouver, BC 100mg/ml 10ml vial – $70-80 (Doesn’t have materials in stock but believes they can be acquired shortly.)
- People’s Pharmacy, White Rock, BC – 100mg/ml 10ml vial – $90
- Pace Pharmacy, Toronto, ON – T. cypionate, 100mg/ml, 10ml vial – $100
- York Downs Pharmacy, Toronto, ON – 100mg/ml 10ml vial – $46 (Why so much cheaper here?)
(Thanks to K for doing this sleuthing!)
In the U.S., compounded injectable testosterone seems more common. Many American guys I know get their T from Strohecker’s or ApotheCure (who can make your testosterone up with sesame or olive oil instead highly GMO’d cottonseed oil.) Note the price at Strohecker’s too: $52.95 (+ S/H) for 200mg/ml T. cypionate in sesame oil, 10 ml vial.
Why is compounded IM testosterone so much pricier in Canada?
Possible Causes of the Testosterone Shortage
“The causes [of drug shortages] are unknown to most people – patients, pharmacists, and physicians – who are dealing with this problem. Those who do know the causes are reluctant to publicize them.” — canadadrugshortage.com
A “raw materials supply” has been cited as the reason for the testosterone shortage, but there are some holes in this claim.
First, what’s in an injectable testosterone preparation?
- Theramed Delatestryl: Testosterone enanthate, sesame oil, chlorobutanol
- Pfizer Depo-Testosterone and Sandoz Testosterone: Testosterone cypionate, benzyl alcohol, benzyl benzoate, cottonseed oil
Delatestryl went off-market around the time that Theramed sold production rights to Valeant. A raw materials supply issue emerged right at the same time as this change of hands? It’s possible, but how inconvenient for Valeant! It doesn’t sound like they did their due diligence. (I also heard that there were production “hiccups” in moving the manufacturing duties to Valeant but I can’t confirm this.)
Sandoz became unavailable in the U.S. immediately following the FDA crack down in the summer. While there are Novaris/Sandoz plants in the U.S., it’s the Canadian plant that made the U.S. supply of Sandoz T. It didn’t go off-market because of a raw materials supply issue; it looks like it disappeared because of the FDA blocking import of Sandoz T from Canada. (Notice above that a different concentration of Sandoz testosterone is available in the U.S. It’s unclear if this is older stock or if it’s being manufactured by another Novaris/Sandoz plant.)
Here in Canada, Sandoz T was sold until it went out of stock. Because of the FDA warnings heeded earlier this month, all Sandoz injectable products are now on allocation until further notice.
The Pfizer advisory from SDIS states that the reason for their shortage is increased demand because Delatestryl has been unavailable.
So, it’s possible that Delatestryl became unavailable due to a lack of t. enanthate or medical grade sesame oil, but there’s no clear evidence to support this. (Strohecker’s has lots of sesame oil…) Sandoz and Pfizer definitely didn’t go out of stock because of raw material supply issues. They were 1) shut down and 2) caught unprepared.
“Lots of different causes have been mooted. I think somebody knows the answer and is not telling us,” said Dr. Jacalyn Duffin, a hematologist and medical historian at Queen’s University in Kingston, Canada.
But she noted that many of the “missing” drugs are inexpensive generics, and there is widespread speculation that pharmaceutical manufacturers may be choosing to reduce or even discontinue production of less profitable generics in order to boost sales of newer, more expensive brand-name drugs.
“I think there’s more money to be made by selling expensive drugs, so what you want to do is try to kill the cheap ones, your competitors,” she suggested. — metronews.ca
Having read these comments, now consider this: One of the brands of injectable testosterone that has been “temporarily discontinued” in the U.S. is marketed by Teva Pharmaceutical Industries Ltd., an Israeli firm that happens to be the world’s biggest manufacturer of generic drugs. A Teva spokesperson said 2011 was a challenging year but predicted that earnings and sales would rise in 2012, aided by the introduction of new generic drugs that could help its U.S. business recover.
Teva was in the news just last week as shares in BioSante rose dramatically when the FDA approved their new Bio-T-Gel topical T product, which will be marketed by… Teva. The FDA approval was somewhat surprising as there are already five other practically identical testosterone gels on the market in the U.S. (“Realistically, Bio-T-Gel doesn’t stand a chance.”):
- Abbott is the testosterone gel market leader. Worldwide sales of Androgel totaled $875 million in 2011, and the company enjoys a 74% U.S. market share.
- Auxillium Pharmaceuticals (AUXL) has reported $150 million in sales of Testim through the first nine months of 2011, making it the second-largest testosterone replacement gel in the U.S.
- Watson Pharmaceuticals (WPI), Eli Lilly (LLY) and Endo Pharmaceuticals (ENDP), crack $100 million in testosterone gel sales.
The current U.S. market for male testosterone products is estimated at over $1.6 billion, where hypogonadism affects as many as 5 million men.
Now consider Teva’s potential profits on sales of gel compared to injectable testosterone (assuming Bio-T-Gel is priced competitively):
|Brand / Preparation||Amount||Approx. Supply||Cost (USD)|
|Testosterone Cypionate||100 mg/ml 10ml vial||2.5 months||$57.99|
|AndroGel||30 x 25 mg/2.5 gm packets||1 month||$270.61|
(Pricing from DrugBank.ca. I’ve seen U.S. AndroGel pricing as high as $360/month.)
Here in Canada, we have two testosterone gels on the market: AndroGel by Abbott and Testim by Auxilium. However, I noticed that a patent related to topical T recently expired in Canada (see patent info and DrugBank link above.) So will we see a new, expensive brand of T gel hit the Canadian market soon… to replace one of the less profitable injectable preparations? We shall see.
Have a tip to share? If you have a reference for Delatestryl’s return to market date, know of pharmacies with injectable testosterone in stock or that can make injectable T, or have related thoughts about these testosterone shortages, please leave your comments below.
- Canadian Generic Pharmaceutical Association – Drug Shortage Advocacy
- Canadian Drug Shortage – A website for information about drug shortages in Canada.
UPDATE 2, 03/01/12: Added Pace Pharmacy in Toronto to the list of compounding pharmacies in Canada that can make IM testosterone preparations.
Hey, thanks for keeping on top of this.
I’m not changing my gender. 🙂 But I have been using Delatestryl for a number of years to boost my low testosterone levels. Of course, I have been affected by the present shortage; when Delatestryl became unavailable, I was able to find some Depo-Testosterone, but the testosterone content was lower and would require two injections instead of one each time. I communicated with Valeant a few weeks ago and they told me that production of Delatestryl had started in December and they expected the product to be available at the end of February. Checking to see if there was any news in this regard, I was today surprised and delighted to find all of this freshly updated material on the subject right here.
The work you have done is much appreciated by me and, I am sure, by many others.
A big THANK YOU!
That is the most direct information on a Delatestryl ETA that I’ve heard yet, so thank YOU!
I’m happy to know this information is proving helpful to non-trans men as well. I’ve been slightly annoyed that the few media outlets that have reported on this have framed it as a “trans issue” when it’s really a larger scope men’s health issue.
I’ve seen two reports today about two pharmacies that successfully ordered Pfizer Depo-T yesterday, so it seems that Feb 29 ETA was correct.
Sandoz has just shut down production completely at its Boucherville, Quebec facility because of the clean-up required after a fire. They said production will resume partially during the week of March 12th.
I couldn’t find an English source, but here is the article from Le Droit reprinted in La Presse today:
It’s gone from bad to worse for Sandoz! I noticed this story yesterday: Sandoz drug shortage prompts Ottawa fast-track efforts – Opposition grills government over hospitals cancelling some elective surgeries.
Any more word on the depo (phizer) shortage? I went to Shoppers DM yesterday and they said their warehouse still has no date for resupply 😦
I know of two pharmacies that successfully ordered Pfizer Depo-T on March 1, both in Toronto, so I’m surprised to hear this. Pace Pharmacy in Toronto got 10 vials in stock on March 2. Call them: 416-515-PACE.
In Montreal, my pharmacy (Jean Coutu) is back in stock (plenty of it, it seems) of Pfizer Depo-T.
Thanks for the info guys 😀 Time to make some calls!
Depo is back, I put the order in yesterday but the pharmacist I dealt with two weeks ago didn’t confirm with my doctor, so I won’t be able to pick it up until today or tomorrow most likely.
Meanwhile, Delatestryl has disappeared from the listing again with no new ETA.
I have to wonder what they are actually doing there. If they started up production back in December you’d figure by now at least some supply should be available again, yet, nada.
And an update to the update.
I just got a call from the pharmacy who was just informed by their distributor that they are out of stock (already) again and have no date on when they will receive another shipment. At least the pharmacist kept BOTH prescriptions now on file but it’ll be weeks if not months apparently.
So, if anybody knows of a pharmacy in Vancouver that has Depo, please let me know. I am seriously starting to consider to looking at Gel or patches.
First, thank you for the information and keeping us up to date!
An update from British Columbia: Phoned my pharmacy on March 6, they confirmed that Depo-Testosterone would be available March 7 so I faxed in my prescription. Called March 7, they said that Depo-Testosterone was already back-order with no date provided for availability. Delatestryl still has no date listed.
Called another pharmacy, both on backorder but they had a March 29 date of availability for *both*. First date for Delatestryl I’ve heard in a long time.
Called one more pharmacy, by sheer luck they had a vial of Sandoz available so I grabbed it but all 3 on backorder with no date at this pharmacy.
Not sure what I’m gonna do if all brands of Test are still on backorder after next month. Last week I called pharmacies within a 200 km radius… even some next door in Alberta, everyone was cleaned out of Delatestryl. ARGH!
My pharmacy in Richmond BC received some depo-t on March 6, but it was sold out when I got there. No ETA on more.
Today I got a call from my Wal-Mart pharmacy (one of the pharmacies I called on March 7 and was told all testosterone was on backorder) and was told that a vial of Delatestryl had shipped! They saved it for me and I picked it up tonight. Supposedly they have ordered more for other customers. Might have just been a fluke! The box indicates it was manufactured by Theramed.
Damn. you got me there for a moment. guess there was some old stock left
I hope that end of the month is really a solid date. It “annoys’ me a bit that the sudden failure of Sandoz seems to have gotten the media interested but they still seem to be only concerned about hospitals… Idiotic.
As I mentioned, my pharmacy had plenty of Depo-T stock as of last week, but I’m not taking any chances from now on. I picked up 2 more vials to get me through the next 4 months, and I will continue to buy a few vials every couple of months as a safeguard. I would advise everyone to do the same if their pharmacy allows it. Mine was quite concerned about the shortages and renewed my script with no problem.
Delatestryl is now available, just got a vial ordered in from Marks Pharmacy on Oak street
I picked up two vials of Delatestryl (finally), will try and order the rest of my prescription later this week just in case.
Interestingly enough, the claim still is that it’s made by Theramed, which is…. curious.
Wow, I didn’t realise this was so widespread! Here in the UK we’re also having shortages, and have been for nearly a year. My normal prescription is for Sustanon 250, though I’ve only managed to get hold of one vial of that in the last 5 months. The alternative here is Testosterone Enantate, which is also now having supply issues. I’m not sure now what else we can get here, but it sounds like the next alternative is Testogel..
Thanks for your comments, Morgan! Has anyone given you any explanations for the shortages? I imagine you’d get a similar story to the one that we were getting through that last shortage: problems with raw materials supply. Here in Canada, testosterone enanthate comes under the brand name Delatestryl; it was unavailable for about 6 months earlier this year. Can you get any preparation of testosterone cypionate? It’s basically the same as enanthate. (See testosterone cypionate vs enanthate.) Pfizer is the brand we get here.
So glad you wrote this up! Some people online are whipping up some total bull crap about how “transtrenders” (read: not exactly in line with the medical diagnosis of transsexuality) are causing the T shortages and prompting people to bully others on the internet and it makes me SO MAD and I’m glad I have this link to throw at them.
Now that’s laughable! The ratio of cis gender men to trans men on testosterone is very heavily weighted to cis men. There’s zero chance that testosterone shortages are caused by trans men filling their prescriptions. Please do throw this link (and anything else handy) at folks making this ludicrous claim.