Online forums and blogs devoted to DIY HRT—do-it-yourself hormone replacement therapy—help transgender people access drugs that are typically meant to be guarded by a doctor’s prescription and certified pharmacies. The websites’ members recommend online pharmacies of dubious legality and help each other navigate shipping and possessing such drugs. They monitor their own blood results and manage each other’s side-effects—all without the oversight of a doctor. (Because of the legal questions around these practices, we agreed not to identify the full names of some individuals we spoke to for this story.)

For Andrea, the do-it-yourself method was only a stepping-stone towards a doctor-managed approach. But she may return to DIY to retain the independence and control it gave her, she says. “It's not fun to depend on having sympathetic doctors around (or money) every two months to refill prescriptions.”

* * *

“My initial goal was to try a few weeks’ supply and see how it felt from there,” says Adam, a member of r/TransDIY, a discussion page—or subreddit—on the website Reddit. Without insurance coverage to affordably (and legally) pursue a transition, however, Adam ended up ordering hormones for a number of months, and monitored the results through close observation of lab results and online research into the side effects of the different hormones. r/TransDIY links users to pharmacies, labs, and the clinical guidelines of the Endocrine Society. Numerous posts detail “Amy’s Quick-And-Dirty Guide To DIY” and “Ellie’s Awesome DIY Guide,” offering advice on medications and proper dosages. “I am not a doctor, and this is not medical advice,” clarifies one tutorial. “This is all stuff I've pieced together from a combination of personal experience, reading other people's posts, and discovering medical literature.”

Estradiol and Spironolactone are the most popular drugs for transgender women to increase estrogen and decrease testosterone, respectively, which help develop softer skin, feminine fat distribution in the face and body, and breasts. Transgender men are typically prescribed Depo-Testosterone, regular consumption of which helps them develop muscle, body hair, and a deeper voice. While Estradiol and Spironolactone can be acquired at numerous online pharmacies, most forms of testosterone are regulated as a steroid by both the Controlled Substances Act and the Anabolic Steroid Control Act of 1990—meaning most DIYers are transgender women.

Katherine Sterling, a woman who sought hormones online, describes how it’s “incredibly hard” to access them through traditional channels. After obtaining insurance that would cover HRT, she “kept getting the same kinds of issues,” she wrote to me in an email. “Either they wouldn't work with my insurance (and hence declined to have me as a patient), didn't know enough about transgender HRT to even consider me, kept bouncing me around to different clinics, or just told me to see a therapist or anything else—because they didn't know what I needed.” Months after pursuing HRT through doctors, Katherine says she found herself stuck with off-prescription medications she obtained online because it was her only option. “At times I would literally be brought to tears over being rejected so much.”