Self-medicating

What is self-medicating?

“Self-medicating” in the context of gender-affirming healthcare refers to when trans people acquire hormones (like estrogen, testosterone) through informal channels and administer them independently. This is understood to be an approach that more and more trans+ people are using. It is sometimes colloquially referred to as ‘DIY HRT.’

Several studies of transgender and gender-diverse individuals globally have documented reported rates of unprescribed hormone use ranging from 11% in Ontario, Canada, to 31% in London, United Kingdom, to 49.1% in San Francisco, United States, to 78.7% in Rio de Janeiro, Brazil.

A 2014 study found that one in four trans women self-prescribe cross-sex hormones before attending gender clinics, most commonly via the internet, while this practice was rare among trans men.

What does self-medicating involve?

• Obtaining hormones through online pharmacies, friends, or international suppliers
• Using medications intended for other purposes (like birth control pills for estrogen)
• Determining dosages based on online research or community knowledge rather than medical guidance
• Monitoring progress without professional oversight

What are the risks?

• Incorrect dosing leading to ineffective treatment or dangerous hormone levels
• Drug interactions with other medications
• Lack of monitoring for side effects like blood clots, liver issues, or cardiovascular problems
• Using contaminated or counterfeit medications
• Unsafe injection practices
• Missing essential health screenings and preventive care

Ideally, gender-affirming hormone therapy would take place in the context of a professional health setting. However, as noted in multiple studies, many transgender and gender-diverse individuals do not have access to a supportive system. These individuals may seek to access healthcare through friends, peers, and the internet, without consulting a healthcare professional.

Why do people self-medicate?

Long waiting times for gender clinic appointments or hormone prescriptions.

The NHS Constitution says patients have a legal right to start specialist treatment within 18 weeks. But no UK GDC meets this standard; waiting times are measured in years, not weeks, and often exceed five years for a first appointment. There are reports of waiting times exceeding several decades in some cases. See this list of GDC services, wait times, and referral criteria from Trans Actual.

Geographic barriers to accessing knowledgeable healthcare providers. Many rural communities have no local access to trans healthcare support.

Financial constraints. Private healthcare can be financially out of reach for many. Trans people are disproportionately affected by unemployment and homelessness.

Fear of discrimination or judgment from healthcare providers.

Trans Actual reported that Transgender and non-binary people in the UK struggle to access quality healthcare due to widespread discrimination, poorly informed healthcare workers, and scarce transgender-affirming services.

Gatekeeping practices require extensive psychological evaluations before treatment.
People seek self-medication to speed up their transition and avoid pathologising and demeaning services.

Age restrictions that prevent minors from accessing care with family consent.
Access for under-18s for gender affirming healthcare through the NHS in the UK has all but ceased.

Research consistently identifies the need for:

• Better access to knowledgeable, non-stigmatising healthcare providers
• Harm reduction approaches rather than prohibition-focused policies
• Recognition that self-care may be the only option available to many individuals in unsupportive healthcare systems

Participants characterise self-medicating as community-driven, accessible, and empowering.

Online communities

Online communities and information networks can be helpful if you are self-medicating.
We are aware, for example, that several forums on Discord and Reddit offer communities and peer support through information sharing, guidance on dosing, advice on harm reduction practices, and access to resources. However, concerns about medication safety and purity persist.

These self-organised online forums and mutual aid networks allow DIYers (do-it-yourself healthcare practitioners) to construct adaptive health-promoting practices that challenge biomedical conceptualisations of risk.

Navigating NHS pathways while you’re self-medicating

Bridging prescriptions

A bridging prescription is something your GP can provide to help you access hormone therapy while you wait for specialist care at a Gender Dysphoria Clinic (GDC) in the UK.

Bridging prescriptions are intended to bridge the gap between asking for help with your gender identity and being seen by a GDC.

For more information, please refer to our chapter on bridging prescriptions.

Monitoring

When self-medicating, it is important to get regular blood tests to monitor hormone levels and check for other health indicators.

Some clinics in London offer free blood monitoring; the Pocketbook Guide to Bridging Prescriptions shares a list of trans-specific services.

Alternatively, you could request that your GP undertake the blood tests for you; for more information, please refer to our chapter on blood tests.

There are also private providers, such as Anne, that offer a harm reduction service, allowing pay-as-you-go access to blood tests and oversight.