% Self-medicating with HRT purchased on the Internet

**We are NOT medical doctors. You are responsible for your own health, and we
take ZERO responsibility if you don't do your research properly before
self-medicating. We try to provide accurate information on this page, but
we cannot guarantee it. You should seek proper medical advice. Self-medication
is a last resort (e.g. gatekeeping doctors, or long waiting times to receive
hormones from your doctor).**

If you're a child in the UK, you *should* at least self-medicate on puberty
blockers if possible, ideally full cross-hormones. Ask your parents to take you
to see GenderGP, a private gender clinic, which is listed on our [list of
private trans clinics](private-care.md) - they have been known to provide full
HRT to children in the past. Their waiting times are low (NHS's waiting times
are literally years, and you will go through your natal puberty if you're left
waiting for NHS treatment only).

Otherwise, and especially if you're an adult, we recommend private treatment if
you can afford it, instead of self-medicating. Your waiting times will be
considerably reduced. You should also get yourself immediately on the waiting
list to see someone at a gender clinic, on the NHS, if your country has
publicly funded healthcare. Note that in some states in USA, medicaid covers
trans care; check if it's available for this purpose, to you, in your state, if
you can't get decent health insurance.

Table of contents
=================

-   [New Zealand](#nz)
-   [Portugal](#pt)
-   [United States](#usa)
-   [Suppliers](#suppliers)
-   [Check whether you're intersex](#intersex)
-   [Trans women (MtF)](#women)
-   [Trans men (FtM)](#men)
-   [Non-binary trans](#nonbinary)
-   [External links](#external)

New Zealand, Germany and others {#nz}
-------------------------------

Importing HRT in New Zealand for personal use is restricted. You will be
unable to self-medicate while living in NZ. You \*can\* order HRT, but
you need to prove that you have a prescription for it.

See:
<http://www.customs.govt.nz/features/prohibited/imports/Pages/default.aspx>
(see: Medicines Act 1981). Click on the section that says *Prescription
medicines*.

It might still be possible to self-medicate in New Zealand. **TODO:
research ways of doing this**

Citizens of NZ should campaign for a change in the law, so that
importing HRT without a prescription becomes allowed, and so that GPs
prescribe HRT on an *informed consent* basis, without gatekeeping.

The same is true in Germany and many other countries.

**It might still be possible to import, even with restrictions. Customs
is less efficient, depending on your location, and might not even check
your package. Order smaller quantities e.g. 1.5 month supply, and make
sure to always order the next 1.5 month supply a few weeks before your
current supply will run out. You can ask your supplier to package it as
discretely as possible, and use a generic description on the package
contents when shipping (i.e. not *HRT* or *pharmaceuticals*). QHI is
good at that, but inhouse might be too (make sure they are discrete
about packaging).**

Portugal {#pt}
--------

In Portugal, it is possible to purchase estradiol over the counter at
some pharmacies. Look around. We're not sure exactly what brand or
type, or whether it can be taken sublingually or buccal method, etc, but
this can be a legitimate way to get estradiol without a prescription in
Portugal.

Spironolactone is not available OTC in Portugal. You have to get it
prescribed or buy it on the internet.

NOTE: we looked into this, and most stores in Portugal sell
**ethinylestradiol** which is not bioidentical, and has some very nasty side
effects including heightened risk of DVT. *Avoid ethinylestradiol like the
plague. Make sure that you only buy estradiol valerate or estradiol
hemihydrate*.

United States {#usa}
-------------

In the US, depending on your city/state, you might be able to get HRT
prescribed quickly (within a month) by a doctor, instead of having to
self-medicate. Look for an *informed consent* clinic in your area.

If you can get HRT quickly via informed consent, we recommend doing that
instead of self-medicating. Your insurance will cover any expenses, and
if not, HRT is usually cheap enough without insurance, depending on
income (it's certainly cheaper than self-medicating, in a lot of
cases).

[We have a list of informed consent clinics here](private-care.md) - if
you know of any that are not listed there, let us know!

Suppliers
---------

These companies are overseas (none of them are in the UK), and you can
import HRT into the UK. It's legal to import HRT for your own personal
use. Order no more than a 6 month supply per order. A 3 month supply
would be safer.

**[InhousePharmacy.vu](https://www.inhousepharmacy.vu/default.aspx?):**

InhousePharmacy is well-known and commonly used by trans people when
self-medicating. It has existed for a number of years, and the meds that
they provide are the real thing.

The box that arrives will say "pharmaceuticals" on it. If you need to
receive them secretly, without someone (e.g. parents) knowing, then you
should use a PO box or a friends house, or anywhere where you can
receive them safely.

Recommended pills (trans women):

- Spiractin 100 (spironolactone)
- progynova 2mg (estradiol valerate)
- prometrium 200mg (micronized progesterone)

**[Quality Health Inc](https://www.qhi.co.uk/):**

This supplier ships to Portugal (Inhouse does not, last time we
checked). For other people who can't order from Inhouse, this company
might also be usable.

The box that arrives will be blank, with no information on it from the
outside. This is good if you need to receive it discretely (e.g. at
parents house).

**TODO: add more suppliers**

Check whether you're intersex {#intersex}
------------------------------

**Ignore the doses on this page and do not self-medicate at all, if you
are intersex. You will require special treatment, under close medical
supervision from a doctor.**

This page has information about what intersex means:
<https://nonbinary.miraheze.org/wiki/Intersex>

The endocrine system is the collection of glands that produce hormones
that regulate metabolism, growth and development, tissue function,
sexual function, reproduction, sleep, and mood, among other things.

You can go to an endocrinologist. This is recommended anyway, because an
endo can tell whether HRT is safe for you to take, along with blood
tests. An endocrinologist can check whether you're intersex; this means
having sexual characteristics of both male and female. Being intersex
can have an effect on what type of hormone therapy is suitable for you.
For instance, your doctor might put you on a lower dose of hormones than
if you were not intersex.

In the UK, you can get a referral from a GP. If you're already
receiving treatment from a GIC, they can also refer you to an
endocrinologist.

In the UK, [Dr. Leighton J
Seal](http://gendercare.co.uk/leighton-seal.html) is one of the most
well known endocrinologists specializing in endocrinology for
transgender people, including intersex. However, you might also have
luck with another endo if you don't live near London (where Seal
operates). If you can, we recommend seeing Dr. Seal.

Trans women (MtF) {#women}
-----------------

You should also make sure to book an appointment with an
endocrinologist, if you can (in the UK, you need a GP referral).

**UK residents: you might be able to get help from
[CliniQ](https://cliniq.org.uk/) on things like blood tests and so on,
to make sure that you're safely taking HRT. They can offer advice.
It's a private clinic, but also part of NHS.**

You should also test your blood pressure. If you suffer from low blood
pressure, you should not take spironolactone for instance (use
cyproterone acetate instead, or if you can't get that, take finasteride
and a higher estradiol dose). Similarly, if you have high blood
pressure, you should get that sorted before starting HRT.

You'll see information online about having to lose weight before
starting HRT. It's not actually true. It's good to not be overweight,
but you can still be and start HRT. Just watch for side effects. This is
the same for anyone, regardless of their weight.

Side effects of various medication:

-   [cyproterone acetate](http://www.cancerresearchuk.org/about-cancer/cancers-in-general/treatment/cancer-drugs/cyproterone-acetate)
-   [estradiol valerate/hemihydrate](https://www.drugs.com/estradiol.html)
-   [Spironolactone](https://www.drugs.com/spironolactone.html)
-   [Finasteride](https://www.drugs.com/sfx/finasteride-side-effects.html)

Also look up side effects of micronized progesterone.

Not all of these are serious. Watch out for the serious ones e.g. blood
clots, etc. If you get any of the serious side effects, stop taking HRT
immediately and seek medical help. This paragraph is not meant to scare
you away from taking HRT. You should take it, if you want to. But you
are also taking your own health into your own hands, so you need to be
more aware of risks.

QUIT SMOKING before you start HRT (e-cigarettes / vapour is fine). Smoking
tobacco (or smoking anything, for that matter, including weed) increases
clotting risk, which is even riskier with estradiol.

- [How to quit smoking](smoking.md)

An antiandrogen blocks testosterone. The most popular one is
spironolactone, but cyproterone acetate is also popular in Europe. Both
are toxic long-term and have different side effects. You should research
which one. We recommend using spironolactone, unless you can't use it
for some reason, in which case cyproterone acetate would also work.
***Inhouse and QHI both sell 100mg spironolactone pills and 50mg
cyproterone acetate pills.***

Spironolactine reduces the amount of salt in your body, so you should
take in more salt in your diet while using it. It also increases the
amount of potassium in your body, so you should lower your potassium
consumption in your diet. Some spironolactone pills contain lactose, so
if you are lactose intolerent you might have to take your lactase pills.
We're not sure if the amount is high enough to warrant this.

Cyproterone acetate reduces iron and B12, so you should take supplements
for those while using it. Cypro is an alternative to spiro, which some
doctors in Europe prescribe (in USA, cypro is a controlled substance and
not currently prescribed by doctors). ***Avoid alcohol like the plague,
while taking cypro, because you can get massive hangovers with much
smaller amounts.***

**Only** use bioidentical estradiol. This is either estradiol valerate (progynova 2mg),
or estradiol hemihydrate (estrofem 2mg).

***If you've already had vaginoplasty or orchiectomy (genital surgery),
then you do not need to take spironolactone, cyproterone acetate or
indeed any antiandrogen, because your body no longer produces high
amounts of testosterone (your testicles have been removed, after all).***

***Fun fact: after surgery, some trans women actually have too low
testosterone. Cis women have testosterone, just in small amounts. Some
women have to actually take testosterone (the same kind that trans men
take), but in very very very small doses, to get their testosterone up
to female ranges. [This page documents some symptoms of low testosterone
in women](http://www.everydayhealth.com/low-testosterone/guide/women/)
(applies to cis women and post-surgery trans women). Blood tests will
show whether your levels are too low (most women are between 0.5 to 1.5
nmol/l testosterone levels).***

DHT is what causes hair loss in men, or trans women who waited too long.
Hair loss can be reversed, by taking Finasteride which blocks DHT. You
can get the 5mg finasteride tablets on inhouse or qhi (use a pill cutter
to split them into 2.5mg pills, to be taken every 12 hours). Doctors
usually prescribe between 1-6mg of finasteride. If you already have a
full head of hair without hair loss, then you don't need finasteride.
Finasteride can prevent hair loss, and in some cases can cause lost hair
to grow back.

**NOTE: patches often contain ethinyl estradiol, which is not ideal.
This is not bioidentical to real estradiol, but a synthesized version
that is more potent. The clotting risk is higher with this when taking
orally. It replaces diethylstilbestrol, which is known to be
cancinogenic. We recommend using the *Estradot* brand of patches
(whether 25, 50 or 100mcg variant) because it uses the superior
*estradiol hemihydrate*.**

Most *good* doctors start you off on 100mg spironolactone and 2mg or 4mg
oral estradiol (or 1mg/2mg gels or 50mcg/100mcg patches) daily. Start on
that first (low dose recommended) - take the estradiol *sublingually or
via buccal method*. **If you have trouble with sublingual method, try
the buccal method instead. The buccal mucosa is the inner wall on your
cheeks, between teeth and gums. [Here are some pics on Google image
search](https://www.google.co.uk/search?q=buccal+administration&biw=1280&bih=708&source=lnms&tbm=isch&sa=X&sqi=2&ved=0ahUKEwjF6abeganSAhUMKcAKHaPzDz0Q_AUIBigB)**
You might need a pill cutter, depending on what dose you take and how
you spread it out into the day. Spread your spiro dose into 2 daily
doses (every 12 hours), so for instance with 100mg daily spiro you'd
split it into 50mg every 12 hours. Split the estradiol dose into 2 doses
daily (gels) or 2-3 doses daily (pills, whether oral, sublingual or
buccal). For patches, you don't need to split anything because the
patch stays applied constantly, until you have to put a new one on.

You should use spironolactone and estradiol, usually. If you can't take
spiro (e.g. don't respond well to it, side effects, low blood pressure,
etc) then you could try cypro instead (50mg daily - some trans women go
up to 100 or 150mg). Most doctors would start you off on 50mg if using
cyproterone acetate.

***Take spiro or cypro orally, NOT sublingually or buccal. Only take the
estradiol sublingually (or buccal method)!***

If you can't or don't want to take an antiandrogen (spiro, cypro,
GnRH), you can take estradiol alone, which on its own can block
testosterone, but it means that you have to take it at a higher dose
than usual. Finasteride is a weak antiandrogen.

In our opinion, GnRH antiandrogen injections are the best T blockers. If you
can get this with your doctor, that's great. Otherwise, use spiro or cypro.

Once you get to a decent estradiol/testosterone level in blood tests (T below
1 nmol/l, E 500 pmol/l), you could consider taking micronized progesterone (make
sure it's bioidentical, and doesn't contain ethinylestradiol. some pills do)
at 100mg daily for first 14 days of the month at half your usual estradiol
dose, then stop taking progesterone until the end of the month and take
estradiol at full dose. Repeat this every month. This may increase breast
growth and simulate mental effects of periods that cis women get.

Oral estradiol may raise IGF-1, according to some people we've spoken to,
which could also assist breast growth. Oral estradiol valerate/hemihydrate is
therefore interesting to consider, instead of sublingual.

***Our opinion about patches (estrogen):*** Patches often fall off, and
they can cause skin irritation. They're generally uncomfortable to
wear, and have a lot of reliability issues, especially if your skin
doesn't absorb it well. Some people like it because it guarantees more
stable levels throughout the day, but the problem is that you have to
wear each patch for 3 days, and it can get dirty. Washing is not very
practical with patches, nor is swimming.

***Our opinion gels (estrogen):*** Gels are easier to use than patches,
because it doesn't fall off during the day and it's less intrusive,
but also has the same problem that it doesn't always work with some
people depending on their skin type. You also have to wash your hands
after using it, etc. Gel containers are also large and heavy, so they
are impractical to carry around, and they are not easy to take privately
or discretely.

Whatever daily (24h) dose you take, you should split that into 2 doses
every 12 hours, or 3 doses to be taken every 8 hours. 3 is better, but 2
is more convenient for most people. With sublingual or buccal, the
estrogen wears off quicker so you get more peaks/lows. This is one
reason why oral is better (more even levels throughout the day). If you
can, taking sublingually (or buccal method) every 8 hours is good,
otherwise every 12 is also OK.

Estrogen alone, in high enough doses, can also block testosterone. In
the old days, trans women were given only estrogen, because
antiandrogens didn't exist in most trans healthcare.

2 months after you start HRT, get estradiol and testosterone levels
checked in a new blood test. Female range is about 0.4 to 1.5nmol/l
testosterone, and 400-500 pmol/l estradiol (some trans women go between
500-600). You will start developing breasts and your face will
transform, as will the rest of your body. If your T is too high, \*and\*
your estradiol is too low, try increasing your estradiol dose a bit -
e.g. from 4mg to 6mg, and check levels again in 2 months. Note that the
extra estradiol will also lower T a bit more. If T is still a bit high
on the next blood test, try increasing your spiro dose - e.g. 100mg to
150mg. Then try again. ***If you're taking HRT while getting blood
tests, then before each blood test MAKE SURE that you take your dose 1
hours before, assuming that this is 12 hours after your last dose, so
that you know roughly what your peak levels are.***

We are not responsible for any harm that you may bring upon yourself.
Self-medication is usually safe for most people (and most trans women do
it, or consider it, in their early transition). If you have some
abnormality in your blood results (doctor will tell you) pre-HRT then
get checked up with an endrocrinologist if you can (several private ones
exist, if you can't use NHS) and ask their approval. They are there to
help you. Certain benign brain tumours (prolactinoma) can be susceptible
to estradiol too; blood test results can tell you signs (your prolactin
will be too high, e.g. 3x higher than normal - there are other reasons
that this could occur, not just prolactinoma), and an MRI scan can be
used to detect it. **You can take a *dopamine antagonist* which doctors
will prescribe, to treat the prolactinoma. If it works, your prolactin
levels may drop to normal levels after a month. The antagonists suppress
the prolactinoma, making estradiol safe to take in a lot of cases. Your
doctor will start you off on a very low dose of estradiol while the
antagonists take effect, and then check you later on. If the
prolactinoma is suppressed enough, they'll increase your dose. DO NOT
SELF MEDICATE \*AT ALL\* IF YOU HAVE A PROLACTINOMA. USE AN
ENDOCRINOLOGIST, GET FREQUENT BLOOD TESTS AND ONLY TAKE HRT PRESCRIBED
BY A DOCTOR, UNDER CLOSE MEDICAL SUPERVISION.**

***Self-medication is always risky, but we also understand that
dysphoria is also risky and that delaying HRT can be deadly for some people.
We strongly recommend NOT taking
estrogen orally. Take it sublingually, via buccal method or
transdermally (the blood clotting risk is much less than oral, with less
risk to liver, etc. People with serious heart conditions shouldn't take
estrogen orally either)***

[This website](https://madgenderscience.miraheze.org/wiki/Main_Page)
(not run by Transit) also has some useful information about HRT for
trans women.

**Common/Blood tests:**

Get blood tests before you start HRT! Go to your GP and ask for these
tests:

-   urea and electrolytes
-   bone profile
-   thyroid function
-   C reactive protein
-   ferritin
-   full blood count
-   baseline full blood tests
-   random glucose
-   FSH
-   liver function
-   estradiol
-   testosterone
-   rheumatoid factor
-   SHBG
-   HDL cholesterol
-   TFT1: suspected thyroid disease
-   uric acid
-   lipids
-   LH
-   prolactin
-   cortisol
-   dihydrotestosterone (DHT)

book an appointment with your GP, and ask for the authorisation form,
then find the hospital in your area that holds the blood samples taken,
and go there to get your blood taken. It\'ll be on the list of blood
clinics that your GP will probably give you. Go there, and then they\'ll
send the results to your GP usually a week later, and you can go to
collect them. If your GP refuses to authorise a blood test, try another
GP. Some GPs are assholes.

Every 3 months afterwards, get these tested:

-   liver function
-   testosterone
-   estradiol
-   potassium (if taking spironolactone)
-   B12 (if taking cyproterone acetate)
-   Iron (if taking cyproterone acetate)

If you're taking progesterone, then also get progesterone tested, during
your 14 day cycle. Your level should be no more than 40nmol/l

Trans men (FtM) {#men}
---------------

Trans men take testosterone (steroids). This is a controlled substance
in the UK, and not legal to purchase without a prescription, unlike
male-to-female HRT. You can still get it though, just not in inhouse or
qhi. \*hint hint\*

TODO: put dosages on this section, as a general guide.

[This website](https://madgenderscience.miraheze.org/wiki/Main_Page)
(not run by Transit) has some information about HRT for trans men.

Non-binary {#nonbinary}
----------

This page has info:
<https://madgenderscience.miraheze.org/wiki/Non-binary_hormone_therapy_guide>
- We don't have much info about it on Transit. We do not run the
madgenderscience wiki.

It's difficult to recommend anything to non-binary people, because they
are not binary. There is a lot more variation in non-binary people, and
a lot of cross over between trans men/women.

Assigned male at birth: whatever dose you take, HRT (if you want HRT)
will still cause breasts to develop. If you're dysphoric about breasts
(you might not know you are until you start) or you start being so, stop
all HRT immediately. We've had experiences before with people who
thought they were trans women, but then decided that they were
non-binary, because although they wanted feminization, breast growth
increased their dysphoria, so they had to stop taking HRT. Feminization
without breasts is possible, if you later get top surgery (breast
removal) after a few years on HRT when breast growth has settled. You
can wear a binder. On the other hand, some non-binary people like having
breasts.

Assigned female at birth: taking testosterone will masculinize you also.
If you want to masculinize a bit (low dose testosterone), but don't
want hair growth, you might be out of luck, so you'd have to later get
laser hair removal. If you want an androgynous voice, and testosterone
masculinizes your voice too much, note that you can still use the same
kind of voice training that trans women use, to get back to a voice that
you're more comfortable with. Taking testosterone means that your voice
will deepen over time, but this can be overcome.

Intersex: TODO, write about intersex people. (this has nothing to do
with non-binary identity necessarily, but intersex people need different
HRT treatment, if they take HRT).

Some non-binary assigned male at birth take spironolactone without
estrogen, or with low estrogen dose (e.g. 0.5mg) because they want to
not have too much of either hormone. or they take full HRT but there are
certain things they don't want; e.g. they don't want hair removal
(hormones will not reduce facial hair, but will reduce body hair a bit),
etc. If they're assigned female at birth, they might just just an
antiestrogen (e.g. tamoxifem).

These are just some notes with a few bits of advice. We don't assume
how a person is, and we recognize that non-binary people have more
variation between them than binary people. You will just have to make
your own mind up. Transition is more difficult for non-binary people
than for binary people.

External links
--------------

<https://madgenderscience.miraheze.org/wiki/Main_Page> also has
information about self-medication.

