Amid changes to NHS policy that prevent underage transgender people from medically transitioning, many see self-administering hormones purchased through illegal online pharmacies as the solution. But is it safe or effective?

While the phrase ‘black-market drugs’ conjures images of cocaine or heroin, UK teenagers are hunting a very different – but no less dangerous – type of substance.

What they’re looking for? Hormones, as part of a rising procedure known as “DIY-transitioning” – purchasing illegal prescription hormones online and administering them yourself without the supervision of a clinician.

As the NHS cracks down on access to transgender healthcare – closing the only gender clinic in the UK in 2022, and announcing that the prescription of puberty blockers would be banned for underage transgender people in March of this year – many people in the community feel as though they are running out of options.

Jane Fae, a representative from TransActualUK, suggests that inadequate access to transgender healthcare is the driving force behind DIY-transitioning.

“[Current gender services are] looking at forward waiting lists of 10-12 years. That’s not a gender service, that’s a lottery,” she said.

“The more people cannot access [hormones] through proper means, the more they will go into greyer and greyer markets… if you can’t [access hormones], you won’t go ‘oh damn it, I’m not trans after all’, you’ll go… ‘oh, I can go onto the dark web and buy it’.”

Why DIY-transition?

DIY-transitioning has been around for decades, but as the internet has made illicit substances more accessible than ever, it’s become more popular with an increasingly young audience.

Reddit forums and TikTok accounts have formed communities for young transgender people looking to DIY-transition, providing information about which overseas pharmacies source testosterone and oestrogen, with individuals chiming in with recommended dosage levels.

It’s immediate and unrestricted information concerning accessing Hormone Replacement Therapy (HRT).

While purchasing hormones through black markets is entirely unregulated, it is, most importantly, guaranteed medical intervention.

TransActual UK is one of the largest trans-right advocacy organisations in the country, providing information for the trans community to assist them with transitioning, educating others, and working towards legal protections for the transgender community.

Jane justifies TransActual’s decision to provide information about DIY-transitioning, stating that it’s the only viable option for many transgender people.

“[Both I and TransActual] aren’t going to say, ‘don’t do it’, because we understand the drive of why people do it, and we fear that [the] government doesn’t,” she said.

Is it a solution?

Although for many transgender people DIY-transitioning is the only option, it is far riskier than clinically prescribed HRT. 

HRT conducted under the care of a GP already has its dangers – such as blood clots, stroke and osteoporosis – but regular blood tests are taken to mitigate the risk.

For those DIY-transitioning, there are no blood tests.

Young people often go to Reddit with photos and questions, relying on the advice and knowledge of the older and more experienced trans community to help them.

Buying hormones off the black market is not safer than purchasing any other prescription – there is an increasing concern that these drugs will be laced with an unidentified substance as DIY-ing becomes more popular.

Despite this, many transgender people’s testimonials support DIY-ing their transition; for many, the results are lifesaving.

According to Stonewall, a UK charity that supports the advocacy of the LGBTQIA+ community, approximately 45% of transgender people aged 16-24 have attempted suicide in comparison to only 13% of the cishet population in the same demographic.

Academic Amy Green et al. found in his 2018 study that there was a direct correlation between transgender youth receiving gender-affirming hormone therapy (GAHT) and a decrease in suicidal ideation and depression.

The real problem

According to the Rainbow Map, the UK’s score for the protection and respect of transgender communities has fallen from 79% in 2016 to 51% in 2024.

In recent years, a trend has emerged of the far-right using the transgender community as a scapegoat.

Concerns are growing amongst transgender people that the UK will only further its restrictions of HRT and other transgender healthcare.

“We are subject for study and debate and question, not just people,” Jane said.

“I am constantly worried, frightened, that someone who knows nothing about me is going to, for at least semi-ideological reasons, interrupt the prescription of substances that keep me [alive].”