People with Gender Dysphoria Who Self-Prescribe Cross-Sex Hormones: Prevalence, Sources, and Side Effects Knowledge

Abstract

Introduction There is a scarcity of research into the use of non-physician-sourced cross-sex hormones in the transgender population. However, when medication is not prescribed by health professionals, users' knowledge of such medication may be adversely affected. Aims This study aims to define the prevalence of Internet-sourced sex hormone use in a population attending for initial assessment at a gender identity clinic, to compare the prevalence between gender-dysphoric men and women, and to compare knowledge of cross-sex hormone side effects between users who source cross-sex hormones from medical doctors and those who source them elsewhere. Methods In the first part of the study, a cross-sectional design is used to measure the overall prevalence of sex hormone use among individuals referred to a gender clinic. The second part is a questionnaire survey aiming at measuring sex hormone knowledge among individuals referred to this clinic. Main Outcome Measures Main outcome measures were (i) categorical data on the prevalence and source of cross-sex hormone use and (ii) knowledge of sex hormone side effects in a population referred to a gender clinic. Results Cross-sex hormone use was present in 23% of gender clinic referrals, of whom 70% sourced the hormones via the Internet. Trans men using testosterone had a sex hormone usage prevalence of 6%; one-third of users sourced it from the Internet. Trans women had a sex hormone usage prevalence of 32%; approximately 70% of users sourced hormones from the Internet. Cross-sex hormone users who sourced their hormones from physicians were more aware of side effects than those who used other sources to access hormones. Conclusion One in four trans women self-prescribe cross-sex hormones before attending gender clinics, most commonly via the Internet. This practice is currently rare among trans men. Self-prescribing without medical advice leaves individuals without the knowledge required to minimize health risks.

Sociodemographic Variables, Clinical Features, and the Role of Preassessment Cross-Sex Hormones in Older Trans People

“…It is concerning that 28%of older trans people who presented at the clinical service had obtained hormone treatment via the Internet without medical advice. This is significantly higher than previously reported 17 and it may be a reflection of the significant barriers to treatment for older trans people. Ageism, discrimination in employment, and lack of social and family support plus lack of gender identity clinic services, long waiting lists, and lack of funding 8e10 may why older trans people obtain treatment without medical assistance or support.…”

“…Ageism, discrimination in employment, and lack of social and family support plus lack of gender identity clinic services, long waiting lists, and lack of funding 8e10 may why older trans people obtain treatment without medical assistance or support. 9,17 Moreover, it could be argued that overly prescriptive pathways to access hormone treatment in Standards of Care further increase barriers to treatment.…”

HIV epidemics among transgender populations: the importance of a trans-inclusive response

“…20809 Another important aspect of the Pehchan programme interventions is related to the differentiation of hijra from the transgender communities, both in terms of programmatic focus as well as socio-economic context. While these communities are often assumed to share a common social identity and community practices, the hierarchy within the hijra system works as a potential obstacle to the selfdetermination and autonomy of individuals within the system [49]. Thus, treating them as distinct communities in terms of identity and sexual risks was a central part of the programme.…”

Supporting trans people in clinical practice

“…Knowledge of side-effects was poor and potentially avoidable adverse outcomes were thought to be likely. 15 When patients do access healthcare, fear of denial of care or mistreatment may lead them to avoid disclosure of their gender status. This can lead to inappropriate treatment, with potentially significant implications, eg adverse interactions between HIV medications and hormones.…”

“…However, a thorough assessment is necessary before potentially irreversible treatment begins. 15 Support and sufficient information should be available to patients during transition. 17 Gender affirming surgery (both genital and non-genital) is a medically necessary intervention for many patients with gender dysphoria.…”