Spain hit by shortage of estradiol spray Lenzetto, pushing demand onto gels and patches

Pharmacies across Spain have run out of Lenzetto, an estradiol spray used in menopause hormone therapy and by many trans and intersex patients, and the shortage is now spreading to the alternatives prescribers turn to first, according to Cadena SER.

Alex Candela, a 30-year-old trans woman who has used the medicine for five years, said she contacted 86 pharmacies in a single morning without finding it. “At first I wasn't alarmed, because it is fairly normal every so often, but when I had already been through 86 pharmacies, I started to get alarmed, because both for trans women and for women in premenopause it is a treatment we need,” she told Cadena SER. Aria, 27, has been without the product for months; after her pharmacy said it had no stock and no restocking forecast, she went a month without hormone therapy.

The substitution chain is tightening

Lenzetto is an estradiol-based medicine used mainly to relieve menopause symptoms. Since its launch in 2017 it has become widely used, helped by its application as a spray on the skin, and it has turned into a key option for many trans and intersex people because of its effectiveness in delivering estrogen.

“Lenzetto is not there and we have to move to other formats, to an estradiol gel. What happens now? That pharmacies are already having supply problems with this gel. From there we can move to a patch. Well, some of the patches are now entering verified shortage status with the Spanish Medicines Agency. This is a domino,” said Yolanda Galiana, a pharmacist specialising in hormonal health and menopause. The pieces are falling one by one, she added, and there are almost no medicines left to cover the whole of demand.

Switching formats is not clinically neutral. Galiana said the gel is absorbed more slowly and some patients report a weaker effect, while patches cause skin irritation or allergic reactions in some users, on top of the discomfort of wearing a patch through the summer. Aria, who moved to patches, described psychological changes, tiredness, fatigue, loss of muscle mass and skin reactions.

Price gap drives cross-border purchases

Cost is the second consequence of the switch. Candela said the Lenzetto hormones cost 30 cents, while the cream she was given instead comes in a tube priced at a little over 20 euros. Many women who contacted her, she said, cannot afford hormone treatment at 20 euros every three weeks.

Supply gaps are also moving patients across borders. Galiana said women in Galicia are crossing into Portugal to buy the product at twice the Spanish price, and noted that European parallel trade is legal as long as the medicine does not leave the source country in shortage. She added that she has received messages about the same problem from Australia, the United States and Colombia.

Manufacturer cites capacity, experts point to price

The laboratory that manufactures the medicine attributes the situation to demand that exceeds its production capacity, according to Cadena SER. Some experts consider it paradoxical that other markets with higher prices are not seeing shortages, and speculate that profitability in Spain, shaped by the price negotiated with the Ministry of Health, may be another factor.

Demand has risen on two fronts: trans patients and menopausal women, who in recent years have had access to more information and no longer accept menopause as a process to be endured without treatment. Professionals interviewed by Cadena SER say the pharmaceutical industry has not matched that growth. Access is further constrained by waiting lists, since only an endocrinologist can prescribe the alternatives and patients say the wait can run to about three months, which makes rapid substitution difficult when a product disappears overnight. For trans women who have had gender reassignment surgery the dependence on hormone therapy is permanent, because the body no longer produces the hormones itself.