Some seek treatment with oestrogen or testosterone, which feminise or masculinise their appearance to line up with their identity. Evidence suggests the treatment can significantly improve mental health, but it can also irreversibly affect fertility, hair growth or the voice.

Olivia Donaghy of Gender Health Australia.

Olivia Donaghy of Gender Health Australia.

A Seahorse Collective spokesperson said that “all DIY HRT experiences in our collective have been positive”, without detailing how many people had taken the treatment. “Especially in comparison to the HRT outcomes through GPs and other doctors’ clinics, which can have a lot of drawbacks, including long waiting lists, transphobic behaviour from doctors, expense, being prescribed very low amounts of hormones for no reason.”

Evidence from long-term studies in gender clinics and meta-analyses of more than 26,000 people suggest trans women receiving hormone replacement therapy in particular have higher rates of stroke, heart attack or blood clots.

On the other hand, not providing gender-affirming hormone therapy also comes with risks. Young trans people have “extremely high rates of depression, self-harm, attempted suicide and suicide”, the Royal Australasian College of Physicians has said. About one in three trans people attempt suicide at least once.

A 2023 systematic review, published in Nature Human Behaviour, found hormone therapy improved quality of life and mental health. In adolescents, providing hormone therapy halved suicidal intentions, a 2020 study found.

In Victoria and NSW, most adults access gender-affirming hormone therapy through their GPs, who either prescribe directly or refer them to gender clinics.

Mental health support is not mandatory but is usually recommended. In people under 18, guidelines recommend a multidisciplinary team assess and care for the child – and the treating team, child and parents must all consent before treatment can begin.

Gender-affirming hormone therapy

People whose gender identity is different to the sex they were assigned at birth often experience intense distress, known as gender dysphoria. This can be alleviated through social, medical, or surgical transition.

Evidence suggests gender-affirming hormone therapy – using oestrogen or testosterone to align physical characteristics with gender identity – significantly improve mental health and wellbeing.

The therapy also comes with risks. It can increase the risk of stroke, heart attack or blood clots. Doctors say the therapy should be performed under medical supervision.

Source: Professor Ada Cheung

DIY HRT has long been a feature of the trans community, which historically struggled to access mainstream healthcare.

Some of those barriers have fallen away in the past decade amid the dramatic increase in the number of GPs able and willing to prescribe gender-affirming hormone therapy, and the establishment of public gender clinics, although Queensland has suspended public hormone therapy for people aged under 18.

“I think the rest of Australia is right to be concerned – if they are doing it there, it could happen here. People are desperate for healthcare. They are not going to not get it,” said Olivia Donaghy, clinical director of private practice Gender Health Australia and the statewide co-ordinator of the Queensland government’s Children’s Gender Service.

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After Queensland announced its ban, the federal government set a review of treatment guidelines for trans young people, which is being led by the National Health and Medical Research Council.

Donaghy was also worried about people buying hormones online.

“If you’re buying it on the internet, you don’t know what’s in the vials and you don’t know the dosage,” she said.

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Trans Action Network spokesperson Amy, who has used DIY HRT and spoke under condition of anonymity, said Queensland’s ban had worried people so much, they were pre-emptively organising DIY supply in case other jurisdictions followed.

“Which is really depressing, but that’s the reality of it,” Amy said.

They said do-it-yourself was becoming more popular as healthcare became more unaffordable.

“I would say probably half, more than half of my friends are using that approach or at least supplementing with that approach,” Amy said.

Waiting lists for Victoria’s free public gender clinics run to two years. A private doctor with a shorter waiting time can cost between $20 and $120 a session, while the hormones are publicly subsidised and cost between $6 and $40 a month.

Cheung, from the Trans Health Research Group, said not all areas had GPs who felt comfortable or confident providing gender-affirming care, particularly in the regions.

“People still encounter quite widespread discrimination, even in healthcare. It’s not perfect. But it’s better than it was, say, five years ago,” she said.

Unlike in the United States, Australia does not offer oestradiol injections, “but many trans people think that it is the best option. So, they often turn to DIY HRT”, Cheung said.

One 2021 study suggested more than one-quarter of trans Australians had experienced healthcare discrimination, which could leave them mistrustful of doctors.

Amy said many of their friends had negative or alarming experiences with doctors when seeking treatment. Amy also initially had safety concerns.

“But if all your friends are using DIY HRT, outside the medical framework, you have proof of concept it is safe and effective. You’re going to trust the testimony of your friends more so than doctors,” they said.

It is unclear how many trans people are turning to DIY hormone replacement therapy.

It is unclear how many trans people are turning to DIY hormone replacement therapy.Credit: Getty Images

Dr Stuart Aitken, a co-founder of Gender Health Australia, has treated multiple patients injured by DIY HRT.

One “had a very large stroke from unmonitored, very high doses of self-administered injectable oestrogen”, he said.

“I have seen cases of tachyphylaxis – where people become desensitised to normal doses of oestrogen and feel dependent on very high doses. I’ve seen people develop thickening of the blood.”

Aitken described the safety profile of DIY as “unclear”. He and other experts were unaware of any published studies on the effectiveness and risks of the practice.

‘We don’t want anyone to be taking a DIY approach.’

Eloise Brook, Australian Professional Association for Trans Health

Dr Vivian Praeger, chair of the Royal Australian College of General Practitioners’ special interest group for transgender and gender-diverse healthcare, disputed claims about access issues via GPs in Victoria.

However, she said many GPs felt concerned about prescribing hormones off-label and a lack of top-level guidelines. “There is a higher medico-legal risk on the prescriber,” she said. “There is a lot of uncertainty among doctors about what is actually the best pathway.”

It is unclear how many trans people are turning to DIY. But there are enough cases that the community and doctors are paying attention.

Transcend, an advocacy group for young trans people, ran a session this week for parents titled Understanding the risks of DIY hormone therapy.

Eloise Brook, chief executive of peak body the Australian Professional Association for Trans Health (AusPATH), said DIY was the only option for trans children who could not access hormone therapy because their families objected, although she did not support the approach.

“We don’t want anyone to be taking a DIY approach. Any kind of medication that is not being properly monitored by a health professional always runs a risk,” Brook said.

AusPATH chief executive Eloise Brook says it’s still common for young trans people to experience discrimination from a GP.

AusPATH chief executive Eloise Brook says it’s still common for young trans people to experience discrimination from a GP.

“It’s indicative, even if somewhere in Victoria – one of the most progressive states – that young people who don’t have support from their families, they have no option. They are deciding they are going to go down their own path. It’s still really common for young people to experience discrimination or a negative reaction from a GP.”

The drugs needed for hormone replacement therapy are readily available online, this masthead has found. One Australian-based website sells various formulations of oestrogen for $US65 to $US90 ($100 to $139) a vial, payable only in cryptocurrency, shipped worldwide with obfuscated labelling.

Several doctors said it was likely cheaper to go through the mainstream pathway because Medicare offers subsidies for the treatment.

Cheung said it was possible some trans people turned to DIY because they struggled to navigate the healthcare system to find the care they needed, rather than it not being available.

Your Community Health has “peer navigation” teams that guide people through the system. Victoria should roll out a similar central system, Cheung said.

A spokesman for the federal Health Department said it “actively monitors for signs of counterfeit and falsified therapeutic goods within Australia. In collaboration with the ABF [Australian Border Force], we work to disrupt the unlawful importation and distribution of illegal products”.

A Victorian government spokesman said it had allocated $2.1 million in the last budget to deliver two extra regional clinics for trans and gender-diverse adults, in Darebin and Ballarat.

“Healthcare and the management of any diagnosed condition should be led by clinicians, which is why the Victorian government has expanded access to multidisciplinary clinical services for trans and gender-diverse individuals,” the spokesperson said.