NOTE: The intended audience for this weblog post is fellow trans people, if you’re cis you’re welcome to read this but I’m not gonna explain much this time. Also, this whole thing is transfem centric.
I’ve been on DIY HRT for a while meow. After half a decade of existing while on diy hrt, I’ve gotten a lot of reactions to it. I’m pretty tired.
Usually when people comment on my personal medical choices it’s one of these
Sure, there are safety downsides when avoiding medical systems. I don’t have access to blood tests1 and if I did I wouldn’t have the medical degree “required” to interpret the results. But this knee-jerk reaction is very black and white. “Drugs from doctors are safe and drugs not from doctors are dangerous.” For marginalized groups this is often not true. In Denmark the medical institution tasked with trans care are incompetent, dangerously transphobic and unable to keep up with the demand for care. It’s been 10 years since Amnesty’s report about the danish trans care and it’s only marginally better than what the report states. The clinic repeatedly underdoses transfems’ estrogen and doesn’t care when levels they are lower than WPATH guidelines and then dismisses symptoms of low estrogen such as fatigue and brain fog. They have told people that they knowingly don’t follow the “World Professional Association for Transgender Health”’s Standards of Care. They prescribe estradiol patches despite the fact that these regularly go into “restorder” which means they are unavailable in the whole country, for weeks to months. They disregard the fact that estradiol levels fluctuate strongly depending on when you measure blood levels in relation to when you take E. And more. I’m sure they’re doing an equally bad job for transmascs. And trying to get hormones while being nonbinary or having a psychiatric diagnosis is likely to end in a rejection. The psychological harm caused by going through months of evaluation and invasive questioning should not be disregarded.
There are dangers and potential harms in all paths. And you cannot consider the “official” paths to be free of harm.
Do you know what’s in your meds? It’s probably written on them. And most of the drugs you can buy online are from the same factories that make the drugs you can buy in the pharmacy. It says on the packaging what it is, who produced it and so on. I am trusting that the packaging is not fabricated.
Some people don’t even buy it online. If you have trans allies in your life they sometimes have ways to acquire them directly from the official sources. They usually prescribe estradiol for postmenopausal women, so you can just get it from them. Or if you know some doctor who’s an ally they can “procure it.”
A lot of people have taken the medication bought from the same online sellers and experienced the expected feminizing effects with no adverse effects. Some have subsequently gotten blood tests which show the expected elevated estrogen levels and so on.2 While writing this I found out that Trans Harm Reduction exists and has done lab tests on various drugs available through these channels and published the result! All of these things put together can give you a high confidence that the drugs you buy aren’t snakeoil and aren’t poison.
It’s not obvious that all purchases of hrt drugs are illegal. Testosterone is on the danish doping list, which means that importing it or having it is illegal and punishable by fine or up to 2 years in prison. Estradiol is less clear to me, it’s just a prescription drug, it has no special legal classification. I remember hearing that some places in the EU they sold estrogen over-the-counter? But I can’t seem to find a good source on this.3
I don’t have a medical degree. What I do have is the information age, and some lovely trans scientists who have collected and discussed most of the relevant research for transfem hrt. It’s over on transfemscience.org. It’s not the easiest thing to read, but it’s some really valuable information. Doctors are bad at caring for minorities, and therefore it’s especially valuable for minorities to understand what the medical interventions they’re getting are. I’m sorry to the transmascs out there, afaik there is no equivalent to this for transmasc science. If you know of something like this I’d love to hear about it. If you have a biology background or whatever and want to start something like this I’d love to hear about it or maybe help.
It’s important to reiterate that a lot of medical professionals who are tasked with doing trans care do not know what they are doing. As a whole, trans care is under researched, and will likely continue to be for a while.
I’ve had people tell me this in trans support groups (irl) and in trans discord servers. In a lot of social situations people will insinuate that you shouldn’t share information about it. They might even ridicule it as a way of shutting down discussion about diyhrt. Usually discussions about how the trannies are crazy for taking random dangerous drugs are not shut down in the same way. Sharing actual facts and knowledge about this topic has a lot of resistance, but ridicule and shaming less so.
I think it is critical for our fellow trans people that they know of the options available to them and that they know the nuanced truth about diyhrt so they are able to safely make an informed choice about what they want. If I had not known about diyhrt I would have spent a year or more depressed that I wasn’t on hormones. When the medical system repeatedly failed me I had other options that didn’t cost as much as GenderGP4. In order to build more information and improve safety around diyhrt it is vital that we destigmatize it and allow discussion and knowledge sharing.
But none of that actually matters. All of the above are just reasons why diyhrt is a decent idea. But ultimately, I am putting drugs in my body to change my sex characteristics to fit my wishes for my gender presentation. The fact that this is somehow a crime5 is a grave injustice. The fact that it requires your GP, the person doing your intake6, the person doing the ~6 evaluation talks and a gynaecologist to get access to drugs to change your body is absurd. Doubly so when there are places on this earth where you can show up at a clinic and walk out with a prescription the same day. You can just do an informed consent model. It’s cheaper even! You could spend the budget hiring actual endocrinologists instead and it would be safer also! But they don’t. So I will continue to choose bodily autonomy.
dude it’s so bad. children have legal bodily autonomy here at age 15. you are legally allowed to go to your doctor ask for contraceptive pills7, not tell your parents and your doctor cannot legally inform them of what you’re doing. because that’s what bodily autonomy means. it’s your own fucking business and everyone else can sod off
there’s this recording of the danish parliament discussing a bill to ban trans care for children8 where one of the people start talking about the amount of trans kids who were referred to the clinic vs the amount of them who actually got hormones. it was something horrific like less than a percent. i wanna look it up again but it’s so fucked up and i have other things i wanna be able to do today so i can’t let my blood boil too much. i can’t believe we’re not even asking for reparations
I neglected talking about homebrew hrt, which is to say injectable drugs that are manufactured by individuals outside of the pharmaceutical industry. Undoubtedly there are risks in using homebrew hrt not that are not present when using drugs manufactured by the pharma industry. But in Denmark I cannot truly compare homebrew injectables to industry injectables because there is no way to get legally prescribed injections. Which is absurd given how widely used they are in other parts of the world such as the US and Canada. A pattern that you will notice if you look at what care is available globally, is that it is often random and not supported by science. The fact that cyproterone acetate, an effective anti-androgen widely used in Europe, is unavailable in the US is equally absurd.
It is important to remember that these companies do not own any magic sauce that makes their products safe and other people’s products dangerous. The companies are made up of humans all the same and the injectables they sell are oil and hormones. It is therefore possible to improve safety by sharing knowledge and being open about methodologies. One project that is improving the state of things is HRT Cat. I hope to see more mutual-aid projects like this in the coming decade.
Although you can still get blood tests! I would recommend to do it. Some people can convince their GPs to get the relevant blood tests and some people pay (sometimes a lot) to get blood tests privately. In Denmark private trans care is illegal, so I can’t get it here. ↩
This information is not centralized and not easy to find. One of the big problems with diyhrt being on the edges of the law9 is that it makes information about it harder to find. It’s usually not a good idea to say “I am commiting crimes” but not sharing information makes this more dangerous. ↩
According to this source, you can legally import medicine as long as it’s from the EU, legal to sell in the country it’s from, it’s for personal use and not doping/euphoriant. Which to me reads as testosterone basically always being illegal and estradiol sometimes being illegal. I don’t have a good reason to believe it is sold over-the-counter anywhere in the EU, which would be required for it to be legal as far as I can tell. That is if “laegemiddelstyrelsen” are correctly representing the law. There’s definitely more work to be done in the legality area, someone should write about it. ↩
GenderGP is a private British gender clinic that has shorter wait times than the danish system and is less gatekeepy. They have a bunch of their own problems but this post isn’t about them. ↩
Maybe ↩
It is not clear to me what education the people doing the intake or the lengthy psychological evaluation. AFAIK some of the people who have the power to deny you access to hormones are just nurses.10 ↩
Contraceptives and the way they are often prescribed to children who do not understand the effects is a whole can of worms. The goal should be informed consent, and that includes actually informing people. ↩
They “only” proposed banning medical and surgical care for kids. Which leaves “therapy” as the only option. ↩
I don’t know of anyone who’s actually been criminalized for doing diyhrt. Telling the clinics here that you are diy’ing hrt can result in nothing or being expelled from their program. I have heard of a trans guy who got in trouble with the police for importing legal testosterone. I’ve talked to a law student who believed importing drugs was probably illegal, but there’s also good reasons to believe it may not be under most circumstances. It’s complicated and I’m not a lawyer. ↩
Not to hate on nurses. they’re just unqualified to say anything about whether I’m trans or not. ↩