Faced with delays to accessing gender-affirming care, some trans people are being forced to self-medicate using hormones bought online
For 16 years, Alejandra Muñoz has been navigating trans healthcare in both her home country of Spain and the UK, where she moved at 18 to study fashion at university. At 12 years old, she first went to an “adolescent and child” gender clinic unit in Spain; after four years of psychiatrist appointments, she was prescribed feminising hormones. Moving to the UK took her back to square one, and it was only after going through a few different GPs that she managed to get a hormone prescription.
Muñoz also started seeing private healthcare professionals in Spain, and in her mid-twenties, she was told by a private endocrinologist that the testosterone blockers she had been taking for years came with long-term side effects – such as increased risk of depression – which she had never been told about. “I just felt failed by the system,” Muñoz tells Dazed. So, like countless trans people, she resorted to taking matters into her own hands.
Muñoz has been self-medicating with injectable oestrogen for the last four years. “There are incredible forums online, full of super knowledgeable trans women. Some are even doctors,” she says. “Now, I’m literally my own endocrinologist. It’s sad, but it’s true. I pay for private blood tests, I check them myself, I upload my results to these groups where people give me advice on my results.”
Similarly, Jack Parker sought private treatment through Gendercare, a network of UK specialists who offer private gender therapy, after realising the length of the gender clinic waitlist (and his GP misgendered him in the referral letter). But even Gendercare came with a nine-month waitlist for a hormone assessment. Frustrated and disillusioned, Parker “became suicidal” one night.
In a bid to help Parker, one of his friends, who had personal experience with self-medication, reached out to help with resources, information and risk mitigation advice. That same night, Parker managed to order testosterone online. He self-medicated until the nine-month wait at Gendercare was over, and then managed to get a prescription. But even after he secured a prescription, he had to self-medicate once again a few months ago due to a testosterone shortage.
Muñoz and Parker aren’t naïve – they know the risks of self-medicating. “If you import liquid oestrogen, you don’t have much information on where it’s coming from,” Muñoz says. But faced with a years-long wait, she saw no other option.
Max* moderates a harm reduction forum like the one Muñoz uses, which gets “hourly” posts from trans people looking to self-medicate. “Globally, I would say most trans people go down the DIY route,” he tells Dazed. In many parts of the world, he says, both oestrogen and testosterone are relatively easy to buy over-the-counter. But this isn’t the case in the UK or the US. Mary Burke, lead clinician and specialist nurse at the GHC (Gender Hormone Clinic), says “approximately five to ten per cent of our patients self-medicate prior to accessing care,” and she’s not surprised. Currently, hormone prescription requires a ‘gender dysphoria’ diagnosis, which means waiting years for a gender clinic appointment. Even with a diagnosis, Burke says it can take a further six to eight months to get a hormone prescription, and even then, there’s no guarantee that you’ll get one.
‘[Not being able to access hormones] can cause massive distress. They’re faced with a decision: wait out the agony of not being treated, or do it yourself. We would never endorse it, but we understand it’ – jane fae
Unfortunately, these are only obstacles for trans people. Hormone therapy is often mistaken as a uniquely trans treatment, but it isn’t: last year, a national HRT shortage sparked widespread upset among menopausal cis women. Max recalls a BBC article from the time which sympathised with women sharing their prescriptions with each other online – “but they [were] buying it from the same sources as trans women,” he says. There’s a difference in framing: when cis women can’t get hormones, it’s terrible, tragic and horrible (all of which is true). “But when trans people self-medicate, [the press says] ‘scary transgenders are poisoning themselves with unknown substances from the dark web’.”
Through her work at TransActual, which consults with media, legal and medical bodies, activist jane fae has talked to plenty of trans people who self-medicate. “People are desperate,” she tells Dazed. “Some self-harm as a result. [Not being able to access hormones] can cause massive distress. They’re faced with a decision: wait out the agony of not being treated, or do it yourself. We would never endorse it, but we understand it.”
Muñoz says there’s a misconception that self-medication is idealised or glamourised within the trans community. “People think we say, ‘oh, just take it, you’ll be fine!’”. But in reality, Muñoz says the women she’s talked to “never run with crazy facts,” and they “break down the pros, cons and what could go wrong. They’re very careful and specific.”
Many trans people have also been forced to self-educate due to substandard GP care. Max gives the example of a friend, who “has been transitioning for around 30 years now.” After ten years of being told her blood tests looked fine, she realised her GP “hadn‘t been testing for testosterone or oestrogen levels”. Tracking levels is crucial to dosing hormones, but Max hears of trans-masculine people whose testosterone has been “dosed inappropriately”. Long-term, this can increase the risk of health conditions like polycythaemia – a high concentration of red blood cells in your blood – and patient case studies are showing that lack of proper medical oversight can lead to trans-masculine people developing the condition as a result.
Alex has also been self-medicating with testosterone since July 2021, after attending a self-med workshop. “I used resources from other trans people to help me figure out the appropriate dosage, and to understand the half-lives of the different testosterone esters.” Because Alex was well-informed, he knew to ask his GP for a bridging prescription. According to Burke, this is “generally a low-dose prescription, which is given to patients to tide them over until they are seen at a gender identity clinic.”
Although GPs are advised to issue them as a harm reduction measure, some don’t. TransActual has resources for people who are denied these prescriptions; fae says this denial is sometimes for no good reason. Max has heard similar claims. “Any GP who is telling you they can’t prescribe hormone therapy is telling you they’re incompetent,” he says. The GMC states that it “wouldn’t be against their guidance [to issue a bridging prescription],” and while fae says that some GPs likely refuse out of fear, “sometimes, it’s simply transphobia.”
The issues are simple: GPs aren’t trans healthcare experts, and the gender clinicians they’re advised to defer to are overwhelmed with demand. “It’s all about education,” says Burke. “I believe that nurses in general practice can monitor patients on gender-affirming hormone therapy, just as they monitor diabetic patients, asthmatic patients, or patients with hypertension and heart disease.”
Gender dysphoria diagnosis is also an obstacle. As Max says, there are valid reasons to not want the diagnosis. “You might not want to put yourself through the humiliation of it, because it is humiliating,” he explains. “It’s draining, and if you go private, as many people are forced to do, it’s expensive.” Burke also stresses that “gender dysphoria is not a mental health diagnosis,” and Alex concurs, saying hormones “could be provided by any GP without degrading psychiatric assessments, which aren’t evidence-based, to check we’re ‘trans enough.’”
The system shows no signs of changing, so trans people will likely continue to self-medicate. “If doctors aren’t going to provide a safe way to access hormones, people are going to do it in less safe ways,” concludes Max. Self-medication is potentially risky and dangerous, and nobody I speak to endorses it. Medical transphobia is dangerous too, though, and substandard care is a reality faced by many. “Trans people just feel lost and confused within the system,” concludes Muñoz. “Sisters are doing it for ourselves, and I’d say we’re doing pretty damn well.”
*Name has been changed
For trans people in need of healthcare guidance, there are trans-led resources like TransActual, the Trans Safety Network and the Gender Construction Kit, as well as institutional guidelines through the General Medical Council and WPATH.
Join Dazed Club and be part of our world! You get exclusive access to events, parties, festivals and our editors, as well as a free subscription to Dazed for a year. Join for £5/month today.