DIY-HRT: Do-It-Yourself Hormone Therapy, Online Community, and Grey-market Drugs

Background: Many transgender people turn to do-it-yourself hormone replacement therapy (DIY-HRT), utilizing online communities for information, support, and sourcing medications. Some transgender people compound their own hormones and distribute them to others in the community. Objective: To explore the motivations, experiences, and practices of transgender individuals engaging in DIY-HRT, and to understand the relationship between professional and DIY hormone therapy. Methods: A qualitative netnographic study was conducted over four years (2020–2024), involving non-participatory observation ("lurking") of online platforms where DIY-HRT communities are active. Primary data were collected from Reddit, with supplementary observations from platforms like TikTok, Tumblr, 4chan, and dedicated forums. Data included posts, comments, shared resources, and user interactions. Additionally, data was supplemented with autoethnographic analysis and chemical analysis of estradiol valerate tablets obtained from a DIY-HRT seller. Results: Reddit emerged as the central hub for DIY-HRT discussions, often referenced by users on other platforms. Transgender individuals cited multiple reasons for engaging in DIY-HRT: barriers to professional care, dissatisfaction with the quality of professional healthcare, and a desire for autonomy over their transition process. Online communities provided support, information on sourcing hormones, dosing advice, and directions for compounding hormones. Despite robust harm reduction practices, concerns about the safety and purity of DIY-obtained medications persisted. Community discussions also highlighted tensions around privacy, safety from harassment, and varying opinions on the ethics of DIY-HRT particularly regarding use by minors. Conclusions: Online communities play a critical role in supporting transgender individuals who resort to DIY-HRT due to systemic barriers to professional care. While these platforms offer valuable resources and foster a sense of community, risks associated with unsupervised hormone use—including inaccurate dosing and potential health complications—remain significant. These findings corroborate existing research showing that these online spaces function as critical lifelines, filling voids left by healthcare systems that are often inaccessible, inadequate, or hostile. The risks associated with self-medication, while real, are weighed against the severe and often life threatening consequences of untreated gender dysphoria. These decisions, contrary to portrayals in mainstream narratives, are marked by careful consideration of the risks and benefits, similar to professionalized medical models and "evidence-based" standards of care. This research seeks to bridge the gap between the lived realities of trans individuals and the perspectives of medical professionals. It advocates for a more nuanced understanding of health-related cultural practices in transgender care settings. Healthcare providers should be aware of the prevalence of DIY-HRT and strive to engage with these communities in a supportive manner to mitigate risks of DIYing and promote the health and well-being of transgender individuals.