Know the basics about hormone replacement therapy but feel like there’s still more to learn? Previously, I wrote about the basics of HRT – the process of taking prescribed synthetic testosterone or estrogen to align one’s physical body and sex characteristics with their gender identity. Despite the GOP’s war on transgender people, HRT has been firmly backed by medical science for nearly a century as the best treatment to prescribe. No amount of conversion therapy or repression is as effective nor humane as accessible trans-affirming care – and ‘trans regret‘ and ‘social contagion‘ theories have been repeatedly debunked by scientific research.
DISCLAIMER: This post is for informational purposes only and does not provide professional advice. Always seek the advice of a qualified healthcare provider with questions regarding medical conditions or treatments.
What’s the difference between HRT 1.0 and HRT 2.0?
My previous post explained the basics of hormone replacement therapy, puberty blockers, common myths, and recommended routes to accessing legal HRT via informed consent and written letters.
In today’s political climate, it may not be possible to access HRT through traditional legal routes. In contrast to my previous post, HRT 2.0 provides an overview of alternative routes – but remember the above disclaimer and be mindful of the legal risks involved. When possible, always get HRT prescribed through traditional legal routes. Don’t take risks when they aren’t necessary. For American adults, we are currently still at a point where it is feasible – and safer – to obtain HRT through mainstream doctors. Even when there are no local doctors physically available, telehealth now offers transgender folks the ability to get legal prescriptions online.
“DIY HRT” is the practice of obtaining and administering hormone replacement therapy without a licensed medical provider or prescription. Today, it’s fairly rare within the United States as long as individuals have physical and financial access to a provider, but it was the most common method for transgender folks decades ago when most healthcare professionals were unwilling to prescribe HRT. Beyond the US, DIY is still a common practice in countries where transgender identity is strictly regulated or criminalized.
By nature, DIY HRT communities are difficult to find on the mainstream internet, but they aren’t impossible to find. In addition to the medical disclaimer, DIY HRT communities are not open to minors. You might be able to find basic information, but these communities are already on high alert due to their potentially illegal nature and therefore generally unwilling to have open discussions with individuals under the age of 18. DIY HRT and its legality vary drastically by country – even within the United States, synthetic estrogen and testosterone have different laws applied to them. Throughout most of the world, possession of HRT isn’t a criminal offense, unlike the trade of unprescribed medication. To circumvent this, this article uses the same logic as most DIY communities on the clear web – this article is for purely informational purposes, and I do not endorse DIY HRT. As mentioned above, I actually advise getting your hormones from a licensed provider when possible.
Is DIY HRT Dangerous?
Anecdotally, it’s generally safe. All medicines and procedures carry some inherent risk, and hormone replacement therapy is no different. Traditional HRT carries no substantial medical risk compared to cisgender people, although there are (often discredited) doctors who will attribute unrelated issues to being on HRT.
DIY HRT isn’t much different as long as you know the potential risks and benefits of basic hormone therapy. The largest health risks associated with DIY are reduced by monitoring and appropriately adjusting your hormone levels through regular blood work – a process you’d normally do with a licensed provider, too. Blood tests are not negotiable; most external signs cannot feasibly identify whether you’re on a safe or unsafe dose. Monitoring your levels protects your long-term health.
Where do I learn more about DIY HRT?
For clear web users, there are two sources: r/TransDIY and The DIY HRT Directory. The Directory provides details on medication levels, distributors, and blood work, whereas r/TransDIY offers an open forum for discussions and questions in addition to general guides. The Directory currently does not offer any contact feature, so you should visit r/TransDIY for support.
Transmasculine DIY
For basic information about testosterone-related HRT and effects, read HRT 1.0 or check out these sources from Planned Parenthood, University of California San Francisco, Rainbow Health Ontario, Trans Hub, them, Healthline, GenderGP, and FOLX.
The most common form of synthetic testosterone is injection-based, usually as testosterone propionate, testosterone cypionate, or testosterone enanthate. Both cypionate and enanthate have long half-lives (which determines the length of time the testosterone will last in your body). Gels are rare, but occasionally possible to find – although it is difficult to source the amount of gel needed for appropriate hormone levels.
For all forms of HRT, you begin on a much lower dose initially and progress to a stable regular dosage based on your blood work. Most medical providers mimic the natural hormone cycle of cisgender men, putting individuals on a low dose before increasing over the first few years, and then slightly lowering to a long-term level.
DOSAGE
| Low Dose | Initial Dose | Typical Maximum | |
| Testosterone Cypionate | 20 mg per week IM/SQ | 50 mg per week IM/SQ | 100 mg per week IM/SQ |
| Testosterone Enanthate | 20 mg per week IM/SQ | 50 mg per week IM/SQ | 100 mg per week IM/SQ |
For more info on dosages, mainstream providers have guides available online for informed consent purposes.
Do NOT try to achieve a higher dose than what is needed. In addition to long-term health risks, high hormone doses are subject to the possible ‘spillover effect’ (clinically known as aromatization), where excess HRT will convert to your naturally produced sex hormone (aka estrogen).
Vials of injectable testosterone are often compounded as 200 mg/mL, 250 mg/mL, or 300 mg/mL. In common language, in a 200 mg/mL vial, there is 200 mg of testosterone in each milliliter. If the vial contains 10 milliliters of liquid testosterone, there are 2,000 milligrams of total testosterone in that vial.
Due to this, you will have to do math to calculate exactly how much liquid to inject to achieve your target dosage. Medical providers would calculate this for you, but you’ll have to do so when calculating for DIY. The formula used is: (amount you want to inject) ÷ (concentration of the vial) = amount to inject per dose in mL.
EXAMPLE:
John has acquired a 200 mg/mL vial of testosterone and wants to have a 50 mg per week dose.
(50) ÷ (200) = 0.25
Based on the above formula, John should inject 0.25 mL per injection.
Since injectable testosterone is fairly thick, it requires a thicker needle for proper injection. For intramuscular injections, it is recommended to use needles between 1″ to 1.5″ in length and 23-25g gauge (needle thickness). Subcutaneous injections should use needles between 1/2″ to 5/8″ in length and 25-30g gauge.
Transfeminine DIY
For basic information about estrogen-related HRT and effects, read HRT 1.0 or check out these sources from Trans Hub, Healthline, FOLX, Rainbow Health Ontario, Mayo Clinic, UVA Health, and University of California San Francisco.
Compared to transmasculine DIY, which usually only requires injecting and monitoring testosterone levels, effective transfeminine HRT requires both synthetic estrogen and testosterone blockers.
Additionally, estrogen can be ‘homebrewed’ rather than purchased through a pharmaceutical company unlike testosterone (which cannot be produced at home). Within the DIY community, estrogen is commonly ‘homebrewed.’ Homebrewed estrogen is produced by individuals through raw estradiol ester/bicalutamide/etc powder. Pharmaceutical-grade estrogen is produced by legitimate pharmaceutical companies – these forms of estrogen are widely considered safer, but they are more expensive than homebrewed sources.
The most common form of estrogen is pill-based – they’re the most prescribed by licensed doctors and also the easiest to DIY. Synthetic estrogen does not harm the body the same way testosterone does in pill form, which is why transmasculine folks opt for injection routes. Always use bioidentical estrogens such as estradiol hemihydrate or estradiol valerate. Never use non-bioidentical estrogens for HRT. Estrogen can also be taken as a gel, patch, or injection – pills are cheapest per month, while injections are cheaper annually or long-term.
The most common testosterone blockers (antiandrogens) are pills that must be swallowed, which include spironolactone, cyproterone acetate, and bicalutamide. Spiro is the most famous, but is considered a weak (but much safer) antiandrogen. Cypro and bica are considered strongly effective but must be used with caution due to harsher health risks.
DOSAGE
The following guidance is considered a higher-than-average regimen than what most individuals may use. Adjust accordingly based on blood testing.
| REGIME 1 | Cyproterone acetate | 6.25-12.5 mg per day | Estradiol | 3 mg twice per day |
| REGIME 2 | Bicalutamide | 50 mg per day | Estradiol | 3 mg twice per day |
For DIY cypro, you will need a pill cutter to create the above dosage. If your testosterone levels are not adequately suppressed, increase your estrogen dosage.
Bica may cause blood testosterone levels to INCREASE slightly, so make sure your T is adequately blocked. 50mg is advised as generally adequate for testosterone suppression when combined with estradiol.
For more info on dosages, mainstream providers have guides available online for informed consent purposes.
Do NOT try to achieve a higher dose than what is needed. In addition to long-term health risks, high hormone doses are subject to the possible ‘spillover effect’ (clinically known as aromatization), where excess HRT will convert to your naturally produced sex hormone (aka testosterone).
Sourcing & Supplies
How do you find DIY HRT? Considering its legal status, it can be difficult to find – the following information and links are from major sources like r/TransDIY and the Directory. The Directory has not been updated in a few years, but r/TransDIY continues to be moderated – check its information for the most current verified distributors.
Injection Supplies
It’s fairly easy to get syringes and injection equipment – you don’t need a prescription to access them. Most countries allow you to purchase needles from any pharmacy, although you may need to speak directly with a pharmacist. Online, Amazon is the most popular source for American DIY users.
Amazon states needles are ‘not suitable’ for human use – but this is untrue and put to skirt around American Amazon regulations that prohibit the sale of medical supplies.
Medications
Listed below are the most common and reputable pharmaceutical distributors for DIY HRT. Use extreme caution if using a source that is not listed below or on either r/TransDIY or the Directory. Most in the DIY community purchase legitimate pharmaceutical-grade medication from foreign companies that permit the sale of these drugs internationally. To use these companies, you will have to learn how to buy cryptocurrency like Bitcoin or utilize an international system like Zelle or MoneyGram.
When purchasing HRT internationally, it is best practice to buy small amounts in case it is confiscated by customs. Individuals are rarely prosecuted or arrested for attempting to order international HRT, but your shipment can be seized. By ordering in small amounts, you reduce the amount lost when seized. Domestic purchases are not screened like international shipments, so there is little to no risk of losing your order.
Another route for DIY-ish HRT is stockpiling, which works well alongside informed consent and other methods of obtaining legal HRT. Since hormones are prescribed at an exact dose by providers, there are two ways to stockpile HRT from stockpile-adverse providers (although there is a growing number of providers that understand the volatile political climate transgender Americans are facing and why folks want to stockpile). Both methods described below are slow processes – you’re not going to be able to stockpile overnight through your provider.
- By purposely taking less than your prescription in the days leading up to blood testing by your provider, your hormone levels will show up as low. In response, most providers will prescribe an increased dose to stabilize your levels. Once prescribed, individuals return to their former dosage regime and save the excess for future use.
- Some individuals purposely take a lower dose regularly than their prescription to save the excess for stockpiling. This method is used when an increased prescription cannot be received but will result in slower transition, similar to the effects of low-dose HRT.
If possible, do not travel with DIY HRT – especially testosterone. Testosterone is strictly regulated compared to estrogen, and unprescribed medication can be charged as possession of a controlled substance if found by airport security. If you MUST travel, clearly label your testosterone in a large clear Ziploc bag and throw in over-the-counter medication like aspirin and allergy meds alongside in the bag. Airport security will be less likely to hound you for a prescription. If you are arrested, do not say anything to the police and contact a lawyer as soon as the opportunity is presented.
Blood Testing
Especially when beginning HRT, blood testing is recommended every three months – although every six months becomes more common later on. For DIY, you should get a blood test after one month on HRT and then every three months. It is advised to find a healthcare facility local to your location for blood testing, although you may have to ask to manually see your results. For accurate results and monitoring purposes, ALWAYS get your estradiol (E2) and total testosterone (T) tested every time. Additional information from blood tests are useful for monitoring potential side effects of HRT, but not as mandatory.
Transfeminine
Testosterone levels should range at 50 ng/dL or lower and estradiol should range at 100 pg/mL or above.
Transmasculine
Testosterone levels should range between 300-1,000 ng/dL and estradiol should range between 10-50 pg/mL. Unlike transfeminine HRT, testosterone hormone therapy naturally lowers naturally produced estrogen more easily.