Transgender people who engage in hormonal therapy lie in the strange nexus of being “here (and) queer”, the idea that we are inherent, normal and okay, but also requiring medical approval (and in some cases court approval) for a range of medicinal and surgical paths that in many cases are necessary and life-saving.

Research into transgender lives and bodies is both predominantly conducted by cisgender scientists (often who publish incorrect and harmful ideas), and rare, leading to a lack of widely available knowledge in areas from statistical data to practical solutions and studies.

This becomes especially harmful when we consider that any General Practitioner (or similar medical professional) can prescribe courses of hormones and infer contraindications based on what may be outdated research, if they are willing to help transgender patients in the first place.

I myself, a transgender woman who has been on hormones for close to a decade, have only in the past year or two felt comfortable to do my own research, ask questions, and make changes to my hormonal regimen to better fit how I want to exist, fearing that this precociousness would earn me a tacit red mark in a system where gatekeeping can make the difference between gaining and losing access to hormones, surgeries and support.

In light of trying to find more information out about the way that transgender people are prescribed and take hormones, on February 28th 2017 I posted a callout to Twitter, asking a group of trans people to self-report their current hormonal landscape. This callout was meant to pose as a first probe into the international state of hormonal affairs, which would then allow the construction of a more rigorous international survey with time.

In this article I will discuss the limitations of the method and data, describe the process, engage in a discussion of the results, and conclude with what the next steps may be.

Language Note: In this article I will be using the term ‘treatment’ in relation to hormonal medication, despite the various connotations of the word. I will also be using the term ‘surgery’ to refer to the range of procedures that have an outcome of removal of the testes, among other end goals, as this has a direct correlation to the hormonal medication being taken.

Collecting the Data & Limitations

In my original tweet (pictured below), I asked DMAB/CAMAB* (Designated Male At Birth/Coercively Assigned Male At Birth) transgender individuals on hormones to DM me a summary of their current hormonal medication and country of residence. Some people additionally responded with their hormonal history and/or their surgical status.

*DMAB/CAMAB is used only at this point in the article to state exactly who I am talking about: transgender people whose bodies currently (or at one point) naturally produce/d a high level of androgens, and for the purposes of this call out, which they have medical interest in arresting.

I don’t consider birth designation to be a particularly useful tool for categorisation, and it is often hijacked to express harmful notions about transgender people by non-transgender people. Additionally, I don’t consider hormones (or dysphoria, for that matter) to be essential or integral parts of the transgender experience, but due to the nature of this article, am only referring to transgender folk who do engage in hormonal treatment.

98 people responded, whose DMs I deleted after collecting the de-identified data in a spreadsheet.

Part way through this process I asked my friend Alex Topfer, who has a background in collection and analysis of medical data, to help with looking at and configuring the data. She also has experience researching hormonal medications from when she was self medicating early in transition.

It’s worth noting that there are a range of limitations of this collection method, but that this was meant to be a wider look at international hormone use, and not a rigorous dataset for study.

Limitations included, but are not limited to:

- The sample consists of people who follow me, or follow people who retweeted my original post, which limits respondents to people on Twitter who are willing to trust me with their medical information.

- By asking participants to describe their medications in their own words, some responses are more precise than others, which limits analysis (this mostly affects the oestrogen data, as it’s far more complex in regards to specificity of drugs, doses and administration methods). Confusion between units was a frequent issue, as was a lack of detail on form of oestrogen taken.

- Additionally, by asking participants to describe their medications, there may be cases of misreporting, which could account for outliers in the data.

- There were more participants on anti-androgens than we would expect, based on comparing our results to the published 2015 Trans survey data. This is potentially due to a Twitter audience skewing younger and/or of lower socioeconomic status, which may affect access to or interest in surgery by a significant margin.

- Specific drug access is highly dependant on national availability and approach.

In summary, as expected the sample is not representative of populations either national or global, but we cannot quantify exactly how. However, the data provided is still interesting and useful for shaping future projects.

Some Initial Graphs

The 98 respondents come from 8 specified countries, with 5 participants not specifying a country of residence.

As an initial overview, of these 98 respondents, the following medications are being taken:

These medications include:

- estrogens (estradiol, estradiol valerate, and ethinylestradiol)

- anti-androgens (spironolactone, bicalutamide, cyproterone, finastride, duasteride and lupron)

- progesterones (progesterone, MPA, and Levonorgestrel)

- and others (decapeptyl)

This is not an exhaustive list of medications used as hormonal medication by trans people, but a reflection of the callout participants. For more details about many of these drugs, Transhealth.ucsf.edu is a comprehensive resource.

All 98 participants reported that they were taking estrogens, of the following kinds:

and in a range of methods including oral tablets, sublingual tablets, injections, dermal patches, and implants, though half of the respondents left the method unspecified.

Doses of both the oral estradiol and oral estradiol valerate were in the following ranges:

However, the ranges of patches and injections respectively, were: