Introduction
Waiting lists, living in remote regions, medical gatekeeping, hostile healthcare providers, and costly private healthcare are some of the reasons why trans people may turn to DIYing HRT: hormone replacement therapy without a prescription or away from a medical clinic. Simply put, some trans people experienced systemic barriers and/or want more control over their HRT regimen.
I acknowledge that DIYing HRT has a place in the trans community. Thus, the purpose of this page is to compile a list of resources so that those accessing HRT on their own can do it more safely. It will include information for transfeminine, transmasculine, and non-binary people.
It is pertiment, especially when DIYing HRT, to do your own research. Review the clinical guidelines that are linked in the guidelines page.
Starting DIY
First off, make sure you have done your research and continue to amass resources so that you are doing it as safely as possible. This guide lists many of the best resources for starting DIY HRT.
The Queer Health DIY Roadmap in particular is the most comprehensive and accessible guide that separates it into transfeminine and transmasculine with frequently asked questions and links to source material.
Moreover, the DIY HRT Directory has separate guides for transfems and transmascs.
Other Important Resources
- Trans Harm Reduction
- Queer Health DIY Roadmap - UK based
- Trans Patient Union - Quebec based
- r/TransDIY wiki
- Estradiol Pharmacokinetics Playground
- The DIY HRT Directory
Bloodwork in Canada
Private blood tests are very expensive in Canada. Any type of lab testing (private or public) will require a referral from a doctor.
Generally, doctors will not want to test your levels if you tell them you want it to evaluate self-administered medication. However, coming up with a convincing reason to want a hormonal profile should not be too difficult. Note that some doctors will give you hard time if they feel you are using them for blood work for self-medicating hormones.
Make sure you are aware of the appropriate gender reference ranges so that you can interpret the reports accurately. Labs will send you the results directl if you ask for them.
Private Bloodwork Services
Interpreting Bloodwork Results
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Transfeminine
Review the guidelines listed in the following pages to interpret your results.
- Blood tests (transfem) - DIY HRT Directory
- Transfeminine Science
- Rainbow Health Ontario
Transmasculine
- Rainbow Health Ontario
Risks
This section describes some common variables that those self-medicating HRT should be aware of.
Legality
Transfeminine
Estradiol and antiandrogens are not controlled substances. They are legal to own. However, given that prescription medications are illegal to buy or share with a prescription of license, you may see customs seizure.
Transmasculine
Testosterone and anabolic steroids are often restricted (or outright banned) substances, depending on the jurisdiction. This means that buying and/or selling testosterone can carry a much higher legal risk. Familiarise yourself with the law.
Notes on Anti-Androgens (Blockers)
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Notes on Estradiol
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Notes on Progesterone
Standard clinical guidelines on the use of progesterone is 100mg-200mg daily. Some transfeminine people may independently increase their daily dose by a significant amount. This has significant potential health effects.
There is a mechanism called “backdoor pathway” to DHT (dihydrotestosterone). Basically, the human body has a backdoor mechanism that can convert progestoerone into DHT.
There is some community data (e.g., Dr. Will Powers on r/DrWillPowers) that at normal doses, some transfemmes do actively convert progesterone to DHT at normal doses (100-200mg). When that happens, some doctors will use dutasteride to block that mechanism or stop prog use. Note that DHT has a masculinising effect.
When someone introduces a significant amount of progesterone into their body, your body looks for mechanisms to metabolise the prog because it was just flooded with so much of it. If the body has the enzyme profile that is prone to conversion, then that person would’ve created a huge DHT spike.
If the person’s body sticks to the primary pathways, they will get a sudden rush of allopregnanolone (the byproduct) which results in lethargy, brain fog, mood destabilisation.
For more reading:
- Androgen Backdoor Pathway
- Classic and backdoor pathways of androgen biosynthesis in human sexual development
- Backdoor Pathway of DHT synthesis
Notes on Bloodwork Monitoring
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Notes on Supply Chains
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Notes on Injections
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Notes on Modulators
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Notes on Liver Toxicity
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Notes on Cardiovascular Stress
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Notes on ‘Stall” Panic
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A common trap in DIY transition spaces is that more = faster changes. In many cases, a massive chemical input does not force a faster physical output. Moreover, this has potential to backfire and cause harm.