Self Medication - Some thoughts...

Understanding Self-Medication of Hormone Therapy Among Transgender People

What Does “Self-Medication” Mean?

Self-medication in this context refers to transgender and gender-diverse people obtaining and using gender-affirming hormones without prescription, medical supervision or oversight by a licensed clinician. This can involve buying hormones online, sharing with others, using medications intended for other purposes, or administering injections without proper clinical guidance.

This phenomenon is often called DIY hormone therapy or DIY HRT (hormone replacement therapy).

How Many Transgender People Self-Medicate Their Hormones?

There’s no single global figure, in part because prevalence varies widely by region, research method, and access to care. But studies and surveys give us broad estimates:

Reported Prevalence Across Settings

• In one survey of transgender adults in the UK, about 25% reported self-medicating with hormones while waiting for NHS gender-identity care. (UK Parliament Committees)

• A study of people referred to a gender clinic found 23% overall had used cross-sex hormones prior to clinic attendance; 32% of transgender women specifically self-prescribed via internet sources. (PubMed)

• Other research and community surveys have reported rates ranging from 11% up to 79% depending on the location and how the data were collected. (Anne Healthcare)

• Some reports suggest variation by gender identity: DIY hormone use is often more common among transgender women than transgender men. (PubMed)

Interpretation: While precise percentages differ across studies, a substantial minority of trans people have self-medicated hormones in places where formal care is slow, inaccessible, or burdensome.

Why Do Transgender People Self-Medicate?

1. Barriers to Accessing Healthcare

One of the main drivers is difficulty accessing medically supervised gender-affirming care. Common barriers include:

• Long waiting times at specialist clinics — sometimes years rather than weeks — especially in public systems like the NHS.

• Limited availability of competent providers, particularly outside big cities.

• Strict gatekeeping models requiring extended psychological assessments before prescribing hormones.

These barriers can make it feel like patients have no timely, supportive option for medically supervised hormones, prompting some to seek alternatives.

2. Cost and Insurance Issues

In many countries, even if care exists, it may be expensive or not covered by insurance. People may self-medicate to avoid high costs or because they lack coverage.

3. Desire for Immediate Gender Affirmation

For many, gender-affirming hormones are deeply tied to relief from gender dysphoria — intense distress related to one’s gender identity. Long delays can significantly impact mental health, pushing individuals toward DIY options.

4. Peer and Community Information

People may share information within communities about how to obtain and use hormones. While well-intentioned, this can spread inaccurate or unsafe guidance if not medically grounded.

What Are the Risks of Self-Medication?

Self-medicating hormone therapy carries a range of health and safety risks, especially when done without medical oversight:

Incorrect Dosing

• Without clinical monitoring, it’s easy to take too much or too little hormone.

• Improper dosages can lead to ineffective treatment or serious side effects.

  Lack of Monitoring

Hormones affect many body systems. Without lab tests and clinical follow-up:

• High blood estrogen can increase risk of blood clots, cardiovascular problems, and liver issues.

• Testosterone misuse can increase hematocrit (blood thickness), affect lipid metabolism, and impact liver function.

• Other drug interactions and undetected side effects may go unnoticed.

  Unsafe Substances or Sources

• Hormones obtained from unregulated online suppliers may be counterfeit, contaminated, or impure.

• Some people use medications not intended for gender-affirming use, e.g., high-dose contraceptives for estrogen, which have their own risks.

  Unsafe Injection Practices

Sharing needles or using non-sterile equipment increases the risk of blood-borne infections like HIV or hepatitis.

Without a healthcare provider, important screenings (e.g., bone health, cardiovascular checks) may be skipped.

How Should Transgender People Ensure Their Safety?

Given the risks, safety should be prioritised even when self-medication occurs. Here are key strategies:

Seek Professional Guidance First

• Whenever possible, connect with a qualified medical provider, endocrinologist or gender-affirming clinic.

• If waiting lists are long, consider asking for a bridging prescription from a primary care doctor while waiting.

• Harm-Reduction Practices

If self-medication feels unavoidable due to urgent distress or lack of options:

• Use trusted sources and verified information rather than unknown online sellers.

• Get regular blood tests to monitor liver function, hormone levels, blood counts, and clotting markers.

• Avoid sharing needles; use sterile equipment and proper injection technique.

• Community and Support

• Engage with supportive, medically informed community groups or clinics offering education on safer practices.

• Ask professionals for help interpreting hormone lab results or adjusting doses if already self-medicating.

• Mental Health Support

• Gender dysphoria, stress related to care access, and the emotional toll of waiting can be heavy. Mental health support can be an important part of safe transition.

• Advocate for Better Healthcare Access

Wider systemic changes—reducing wait times, training more providers, and adopting more inclusive models of care—can reduce the need for risky self-medication.

Conclusion

Self-medication with hormones is a documented reality for many transgender people worldwide, with prevalence estimates varying widely but consistently showing that a significant minority have pursued DIY hormone therapy.

The primary reasons are barriers to accessing care, long waits, cost, and urgent needs for gender affirmation. However, without clinical supervision, this practice carries serious health risks, including incorrect dosing, cardiovascular problems, liver injury, and infections.

For safety, individuals should pursue regulated healthcare when possible, use harm-reduction practices if self-medicating, and work with trusted providers to monitor hormone therapy effectively.

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