Within trans communities, self-management of transition related healthcare is often referred to as ‘do-it-yourself’, typically denoted as DIY. This names the various ways in which people transition outside of, or without the support of, institutional medicine and state sanction. This part of the PharmaSMaSH project focuses on one of the most prominent examples of a trans DIY practice, often described as DIY HRT; the use of hormones to transition without obtaining a legal prescription for these through healthcare services, and/or using them with little to no medical supervision.

For transmasculine people this usually means the use of testosterone while for transfeminine people it involves estrogen, sometimes alongside antiandrogens. Both testosterone and estrogen can come in a variety of forms from transdermal gels to injections, as well as oral pills in the case of estrogen and antiandrogens. These types of medications are the focus, and we want to understand how these are sold through online pharmacies (often operating in legal grey areas) and move transnationally to the purchaser. Some trans people also engage in ‘home-brewing’ of hormones for personal use, and in some instances to sell to other trans people; we want to better understand homebrewing including where the active pharmaceutical ingredients (APIs) for these are produced and purchased, and how homebrewed medications are made and used.

We take a harm reductionist approach; as a significant body of research and many major medical organisations have attested, access to gender affirming healthcare is of fundamental importance to the wellbeing of trans people. In the absence of such healthcare, many people choose to take their health into their own hands. This project aims to produce knowledge that contributes to safer use of DIY HRT for people who rely on it, as well as knowledge that can inform and improve gender affirming healthcare.