DIY hormones aren’t dangerous, the dismissal of trans knowledge is
Gender-affirming care is life-saving, but formal access to it is limited for many
When I was 18, I told my mother that I wanted to start masculinizing HRT as part of my transition.
I thought that she would be supportive. After all, it had been three years since I first came out as non-binary. I had already socially transitioned, legally changed my name and had the backing of my therapist. My medical records even stated that I was a verified real transsexual. I had fulfilled all the requirements typically expected of transgender people before we pursued hormones and surgeries. Plus, my mother had more or less gotten over her initial ignorant response to my transness.
To my surprise, her response was fearful. “Testosterone can cause so many health problems,” she said.
Other members of her local support group for cis parents of trans children had warned her about the supposed dangers of DIY HRT. The idea that I might want to follow in the footsteps of the most historically marginalized and revolutionary members of my community must have frightened her middle-class sensibilities, reflecting an attitude towards DIY that dates back to its initial prominence in the 1970s.
I quickly reassured her that I wasn’t going to do DIY, and would instead go to an informed consent clinic where a cis doctor would tell me all the risks and benefits—things my trans siblings have known for decades.
Despite its long, autonomous history and repeatedly shown efficacy, self-administered or do-it-yourself (DIY) gender-affirming care in the form of hormone replacement therapy (HRT) is heavily stigmatized.
The opposition to DIY isn’t just coming from overtly transphobic bigots who want to stop people from transitioning altogether. Many trans people and allies also view it as a risk that isn’t worth taking, even if it means enduring long wait lists and heavy medical scrutiny through invasive procedures and questioning. However, even going through the tedious formal channels does not guarantee access. Not meeting the specific criteria for a diagnosis of gender dysphoria, not having insurance, or not having access to a trans-friendly doctor are all major obstacles. DIY may seem sketchy, but for many, being denied the gender-affirming care they need is not available is a much more pressing danger.
In reality, self-administered HRT is only viewed as an excessive danger because it draws upon medical knowledge about types of treatment and dosage and that trans people have uncovered for themselves—knowledge that is dismissed in mainstream medical and social spaces. DIY is not nearly as dangerous as it seems, and any risks associated with it can be alleviated by simply making legal hormones more widely available.
More and more trans people have been opting for DIY as anti-trans moral panic sweeps through North America, limiting access to gender-affirming care in some U.S. states and Canadian provinces. According to historian Jules Gill-Peterson, this is nothing new. Trans people have been self-administering hormones and other gender-affirming medical services for decades, forming networks to provide effective treatment for our communities.
Patients seeking HRT through formal avenues were—and in some places continue to be—denied care for failing to adhere to strict norms of what a “real transsexual” should look like. Trans women of colour and sex workers have historically been (and continue to be) particularly vulnerable to discrimination, which made them take matters into their own hands. Instead of facing dehumanization from bigoted doctors, trans people gathered the medical knowledge required to administer HRT by themselves.
As with any medication, it’s true that HRT is not without risks. In extreme cases, estrogen can increase the risk of blood clots, and excess testosterone can cause heart attacks. These risks are not exclusive to trans people; they also affect cis people who use HRT or have a naturally occurring hormonal imbalance.
Luckily, the more serious risks are easily avoidable with proper dosage and diligent blood testing. Plenty of everyday over-the-counter medications are dangerous if used incorrectly, but are perfectly safe most of the time. Hormones are no different.
Thanks to the internet, it's easier than ever for trans people to share our knowledge with each other. We are perfectly capable of educating ourselves about the potential risks of HRT outside of a formal medical environment. The widely shared resources for DIY HRT place heavy emphasis on safety, including detailed instructions on proper dosage, avoiding contamination, side effects and how to perform blood tests. In my experience, these guides provide more transparency and in-depth information about each available option than either one of the informed consent clinics I utilized. Informed consent and DIY are functionally providing the same service; DIY is simply dismissed for its independence from cis society.
The solution is not to restrict HRT even further. Gender-affirming hormones are widely understood to be life-saving. Cis doctors even agree with us on this, if a trans person saying so wasn’t enough. The informed consent model is certainly a step in the right direction, but clinics are not widespread enough worldwide to be effective, and they continue to force trans people in need of care to jump through unnecessary hoops.
The only solution is to make safe hormones and blood testing available to all without a prescription. Restrictions might force DIY users to hide information from their doctors if they end up needing formal medical care, creating situations that are legitimately dangerous.
It’s time to stop ignoring the decades of medical knowledge about hormones and about our own bodies that have been built by trans people. I’ve already undergone unwanted irreversible changes from the estrogen my body produces by itself—I don’t need a doctor to tell me that changes from HRT may be permanent.