I had a nice discussion with a lovely woman from Florida who came to my workshop at Southern Comfort two weeks ago. She had been on do it yourself hormones for awhile, stopped taking them and went back on them, but after she heard my comments, she changed her mind and was going to look into getting prescriptions and medical monitoring of her hormones.
I am someone who is not an advocate of doing it yourself, also sometimes known as D-I-Y. But I am also someone who has tried do it yourself, albeit a long time ago and it was only for about 3 or 4 months. I hope that this article will help people to reconsider the D-I-Y route and seek medical supervision.
My personal adventure with D-I-Y does not contain a horror story and I am not going to paint dire pictures of certain doom, illness or death, but there are potentially serious health complication that the D-I-Y person should be aware of and at least take some reasonable steps to minimize the potential for harm that exists with D-I-Y.
I have said before and I will say again, hormones are not playthings. Misuse of hormones can lead to heart, kidney and liver damage. They have the potential to raise blood pressure and cause heart attacks and strokes or fatal embolisms. Some people are not candidates for HRT because of other pre existing serious heart problems.
One of the most serious problems is that the pharmacies that one can obtain these hormones from do not require prescriptions. There is no guarantee that the drug you have purchased was manufactured with adequate standards to insure that the two milligram estradiol tablet actually contains 2 mg of estrogen. It may contain 2.5 mg or it might not even contain 1 full mg if estradiol. You just don't know what you are really getting. When you get a perscription filled, you are buying hormones that have been manufactured under rigorous standards and can feel safe that you are actually getting what you expect to be getting.
Many people who do it themselves ignore the need for regular blood testing every 6 months. This is important for many reasons. One reason is this is how physicians determine that your organs are not being negatively impacted by what you are taking. It confirms that you are getting proper amounts of hormones so that you can get the most benefit from taking them. You just might not be getting the serum levels of hormones up to where they should be in order to be most effective! It allows you to be aware of your cholesterol levels which can affect your heart and arteries and your liver. Adjustments can be made with other drugs, you don't necessarily have to cut back or eliminate HRT with this information if things aren't in balance.
One of the many reasons people don't go to their personal physician is because they continue to experience guilt and shame over experiencing gender dysphoria. That is something that occurs frequently and needs to be addressed, I've been there. I had literally had an old country doctor who was getting near retirement. My own guilt and shame at the time prevented me from going to him and telling him about myself. My solution was to ask my gynecologist to refer me to a female doctor as I'm not keen on having men seeing my body. So now I have a female primary care doctor who I can go to and talk to without feeling ashamed of myself. Whatever you have to do to get rid of the guilt and shame to have a health care provider you trust, please do it. You deserve nothing less than quality health care!
Another thing to consider is that you may be paying way over what you should for those black market hormones. Did you know that a prescription for 90 days of the maximum therapeutic dose of estradiol is $36.00 (U.S.) at Walmart, Kmart, Kroger or Martins for example of stores in my area? That's $12 dollars a month! That's dirt cheap. Most insurance companies' co pays would be higher than that. So isn't it worth dealing with your fears to find a competent practitioner you can trust? Then you know you are getting what you are supposed to be getting. How much is Spironolactone? $18.00 for 90 days at the recommended highest dose. Some of us take progesterone and there is some debate whether it is at all helpful or not in breast development. Generic progesterone is also inexpensive. My gynecologist prefers Prometrium because it is bioidentical to women's natural progesterone. It is expensive though. The maximum dose runs me a bit over $100.00 a month. In 6 more months I'll make a decision whether this is benefitting me or not in terms of breast development. If after 18 months on it and the results aren't that much, I'll likely discontinue it.
"Sherri, you don't get it, do you? I live in BFE (that is a remote place in Egypt). There is no doctor where I live who I can trust to go to or is willing to prescribe HRT. I know this for a fact because I have called around."
Ok fair enough, not all health care professionals are as enlightened as I am or as enlightened as the ones who take care of me. I'll grant you that.
At least, go get your blood work done every six months, Please, please, PLEASE! get your liver and kidney functions tested and cholesterol too, even if you choose not to tell the doctor you are doing it on your own. We have a term for that. It's called HARM REDUCTION.
Speaking of harm reduction, being a member of WPATH, we strongly advocate harm reduction. What does that mean? It means that anyone who comes to see me on DIY hormones goes to the head of the class. I issue a letter of referral and give my patient the names of two, soon to be three doctors in my area who are willing to prescribe HRT for trans people. I give this letter on the second visit. Harm reduction is the overriding principle and it is a principle supported by the WPATH standards of care. I want my patients to be safe!
Please consider these thoughts when you decide whether you decide to go see a doctor or do it yourself. You only get one shot at HRT and it has to be done right so that all we have to endure pays off on our journey to be who we truly are! What good is it, if one ruins her health on the journey?