I've found self medicating to be an empowering alternative to the NGS and private trans healthcare providers

I came out as trans around 5 years ago, at which point I felt very isolated and uncertain about medical options for transitioning. I was aware of the situation with the NGS including endless wait times and the horrifying stories of interrogation by hostile psychiatrists. I wanted absolutely nothing to do with that system because I didn’t think my mental health would withstand it. I also wasn’t in a position to pay for private treatment because I was unemployed and the fees for Gender GP or one of the other private healthcare providers were out of my reach.  
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Fortunately, I managed to get in touch with other trans people who were able to provide support and get me started with self-medicating, which I’ve been happily doing ever since. As a result, I’m not suffering in silence for years on the NGS wait list or putting myself under financial strain to pay for basic medical care from a private, for-profit enterprise. People call it self-medicating, or DIY HRT, which both suggest that it’s something you do on your own, totally in isolation, but that hasn’t been my experience at all. In reality, I have received a huge amount of support and advice from peers and friends who were in the same position, and together we have accumulated a massive volume of experience and knowledge. There is also an immense wealth of knowledge available on the internet that has been put together by dedicated members of our community in places like transfemscience.org or r/transdiy. In almost all cases now when I have to interact with medical professionals I’m aware that I have vastly more knowledge than they do and I also don’t have to rely on them for my healthcare, which is a fundamentally empowering experience.

That’s not to say that I don’t have any worries because there are real risks associated with self-medicating. It’s just that there are, in my opinion, much greater risks associated with any of the alternatives, including going for years without access to HRT on the NGS wait list, the psychological trauma of undergoing interrogation by a hostile psychiatrist or the financial insecurity and stress associated with paying for private healthcare. 

In terms of the risks of self-medicating, there’s an enormous amount that even standard GPs could do to reduce these including doing blood tests to give an indication if my dosage is correct or to flag any other health issues. The first GP I went to and talked to about my situation refused to do blood tests to test my hormone levels, despite the fact that this would be a standard check they would do for any cis person who asked for it. She told me that doing blood tests would encourage me to continue with a practice they saw as risky and undesirable. ​

The ridiculousness of this situation is obvious if you compare it to drug or alcohol use or any other activity that involves risks to one’s health. If I had an addiction issue and went to the doctor because I was concerned about my health, basically everyone would acknowledge it would be totally irresponsible and unethical of them to say they wouldn’t treat me because it would enable or encourage me to keep drinking or taking drugs. Likewise, if I played a sport they thought was risky and injured myself, it would again be obviously ridiculous for them to say they wouldn’t treat me because it would allow me to continue. There’s clearly a double standard here where my GP treated me differently because I was trans and, even worse, because I was taking control of my own body and healthcare. Fortunately, I was able to find another GP who was totally fine with doing blood tests, rightly regarding it as his basic responsibility as a medical professional. This has been great for me but shows a bizarre level of variability in how trans patients are treated in the general medical system.  

For anyone else who wants to get blood tests, Trans Harm Reduction (transharmreduction.org), a grassroots community group based in Ireland and Scotland that supports people who are self-medicating, keeps a list of GPs that should provide blood tests for people who are self-medicating, and you can email them to ask if they’re aware of any good GPs in your area.  

There are other important risks that I’m worried about including the quality of hormones that I’m using, because these are non-prescription and sourced online. Fortunately there are again community resources available for understanding the quality of hormones available online. Trans Harm Reduction have a hormone testing programme for assessing the quality of sources of HRT that are popular amongst people who are self-medicating. So far this has shown some variability in the concentration of estrogen medications, which means it’s important for me to get regular blood tests and monitor my hormone levels, but more importantly, there has been no evidence of dangerous contamination, which is a huge relief. It would be great if better funded organisations could take up this idea and do more comprehensive testing.

I’m also concerned about losing access to HRT due to unforeseen circumstances, so I’ve since gotten a referral for the NGS. My plan is that if, one day in the distant future, I get to see a psychiatrist there, I’ll be in a position to refuse to cooperate with their questioning and general model of care if I decide to do so, because I’ll be aware I’m not totally dependent on them for my healthcare.  

I’ve found that people in general tend to emphasise the risks of self-medicating, without actually wanting to take any practical steps to reduce them or focusing as much on the very significant risks of any of the alternatives. As a recent article in GCN put it, trans people who are self-medicating are used as a ‘cautionary tale to underline the failures of the current system’ but our actual needs and voices are not listened to (https://gcn.ie/trans-healthcare-ireland-change/). I’ve had hostile reactions including from other trans people when I’ve told them about my situation, or in other cases they treat me as a victim who needs to be advised on a better or more responsible course of action. Fundamentally I understand my own situation the best and I’m in the best position to make decisions about my life and my body. Nobody should be trying to tell me otherwise. It’s a small step from advising someone not to self-medicate because it’s dangerous to telling someone they shouldn’t medically transition because they might regret it.
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Related to this, many of the mainstream trans and LGBT+ NGOs in Ireland shamefully do not offer any form of support for people who are self-medicating because they are terrified of being associated with them and potentially losing their funding. This is despite the fact that research from the UK shows that up to 25% of trans people are accessing HRT through self-medicating. The figures from elsewhere in the world are even higher, especially for trans women, and there’s no reason to think Ireland is any different. If mainstream NGOs can’t offer support for a very significant vulnerable section of our community and instead only provide for those who are being ‘responsible’ and ‘respectable’ in how they access healthcare, what are they good for?  

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