If one is to believe what some transgender women say online, to self-medicate and self-prescribe HRT (hormone replacement therapy) is extremely dangerous and carries a very serious risk of causing death or at least lasting damage to one’s health.

As someone who self-medicated for around the first fifteen months of my transition, I can say that such statements are usually fear-mongering and highly misleading. Self-medicating – i.e. buying estrogen and anti-androgens (testosterone blockers) online or through some other unprescribed channel – carries next to no risk at all IF the person is sensible.

Being sensible is key. If you are not prepared to do the following then it would indeed be very risky to self-medicate:

1. Research as much as you possibly can online about the medication you will be using and become closely familiar with all the details of how it works and what the side effects can be, so that you will always be on guard to notice and deal with any negative side effects that might (but usually will not) arise. “Deal with” in this case means seek professional medical attention promptly.

2. If you smoke and/or have any liver issues and/or have any propensity for blood clots or similar issues, do not self-medicate or at least not without discussing your self-medication intentions thoroughly with your GP. If, due to those or other existing health issues, they urge you not to do it, you should follow their advice.

3. Have regular blood tests to monitor your estradiol (estrogen) and testosterone levels as well as your liver function and ideally other things too such as prolactin levels and SHBG (sex hormone-binding globulin) levels. Ideally have such a test just before starting self-medication and then repeat it one month after beginning. Do it again at the second month and thereafter repeat it every three months if everything is going alright. Here in the UK, many GPs will provide such blood tests for you free of charge, if you go to them and openly and honestly explain what you’re doing and why you need such tests. If for whatever reason you cannot get the blood tests done on the NHS (National Health Service) you ought to do them privately, as otherwise you have no idea what’s really going on in your body.

4. As indicated in the above point, tell your GP that you’re self-medicating and inform them what medications you’re taking and what dosages. Ideally show them the boxes and tablets that you’ve purchased, so that they can confirm that it’s real, genuine, legitimate medication. They will want to refer you (if in the UK) to the Gender Identity Clinic so that you can receive specialist treatment and services and eventually an NHS prescription; unless you have enough money to transition privately (which is very expensive and unaffordable for most people) it would be silly not to agree to the referral. Any GP who has any understanding about transgender issues will not be angry with you but will understand why you’re doing what you’re doing and will be willing to give their consent and approval to your HRT self-medication, even though they know it’s not an ideal scenario. There are good GPs like this in London.

5. Research as much as you can online about dosages for the particular medication you’re buying and make sure you start at a low dose and very slowly and gradually (i.e. over the course of months) work your way up to a higher (but still reasonable) dosage.

6. Research thoroughly about which websites are the best and most reliable sources of genuine HRT medication and search online for other people’s reviews of them before buying.

7. When your purchase arrives, examine it carefully to see if it looks genuine. Take a look online via Google Images at what that particular medication should look like and then compare. Some sellers reduce postage costs by not sending the outer box but it should at least still come with the standard information leaflet and have some official identifying marks. In almost every case it will, seeing as there is no-one out there – as far as I know – who specialises in manufacturing fake counterfeit HRT tablets. 99% of the time you are sure to get the real deal but do check and be attentive just in case. Obviously, if it looks questionable or suspicious in any way, don’t take it.

Following these seven steps, you should be able to self-medicate successfully and without any problems but bear in mind that it should only ever be a preparatory or preliminary step and not a long term thing. Also remember there is more to transitioning than just taking hormones: permanent hair removal is needed plus changing one’s clothes and the way one speaks, moves, and acts, and more besides. It’s a serious, extensive, time consuming process that in almost every case takes years. Do not go into it unless you are absolutely sure about it.

Please note that all of the above applies to transgender women, i.e. male-to-female transsexuals, and should not be taken as applicable to transgender men, i.e. female-to-male. I am a transgender woman and know next to nothing about the female-to-male process other than that self-medicating with testosterone is said to be much more difficult and to carry far greater health risks. From what I understand, it is also illegal to purchase self-prescribed testosterone whereas it is not illegal to purchase estrogen and anti-androgens.

For transgender women, self-medication is not stupid unless YOU are stupid . . . so don’t be!