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+---
+title: How to buy hormones on the Internet, and self-medicate
+x-toc-enable: true
+...
+
+Introduction
+------------
+
+It is possible to buy HRT online. Often called self-medding,
+self-prescription, self-prescribing, self-medication or self-medicating or
+*DIY HRT*,
+it is fully legal in most countries. This page attempts to provide safe
+instructions, for purchasing and administering HRT without a prescription.
+This includes information on blood tests, and endocrinology. Doctors often
+refer to this as *self-prescribed hormones*.
+
+When a transgender or trans person wishes to begin taking hormones, they may
+run into some problems (gatekeeping doctors, long waiting times, and so on).
+This can cause some distress, for some people. If you are one of them, then
+DIY HRT can be a good alternative.
+
+**We are NOT medical doctors. You are responsible for your own health, and we
+take ZERO responsibility if you don't do your research properly before
+self-medicating. We try to provide accurate information on this page, but
+we cannot guarantee it. You should seek proper medical advice. Self-medication
+is a last resort (e.g. gatekeeping doctors, or long waiting times to receive
+hormones from your doctor).**
+
+If you're a child in the UK, you *should* at least self-medicate on puberty
+blockers if possible, ideally full cross-hormones. Ask your parents to take you
+to see GenderGP, a private gender clinic, which is listed on our [list of
+private trans clinics](private-care.md) - they have been known to provide full
+HRT to children in the past. Their waiting times are low (NHS's waiting times
+are literally years, and you will go through your natal puberty if you're left
+waiting for NHS treatment only).
+
+Otherwise, and especially if you're an adult, we recommend private treatment if
+you can afford it, instead of self-medicating. Your waiting times will be
+considerably reduced. You should also get yourself immediately on the waiting
+list to see someone at a gender clinic, on the NHS, if your country has
+publicly funded healthcare. Note that in some states in USA, medicaid covers
+trans care; check if it's available for this purpose, to you, in your state, if
+you can't get decent health insurance.
+
+NOTE: this page only contains information about estradiol-based HRT. We
+currently lack information for trans men and non-binary people, and we would appreciate
+help adding this information to the page.
+
+If you have such information to provide us, then could you get in touch with us?
+Our contact details (IRC chatrooms) are mentioned on the homepage.
+
+Mexico {#mx}
+------
+HRT is over the counter in Mexico. Inexpensive options include for pills
+Mileva-35 (same composition as Diane-35), Diane-35 and for injections
+Patector.
+
+New Zealand, Germany and others {#nz}
+-------------------------------
+
+Importing HRT in New Zealand for personal use is restricted. You will be
+unable to self-medicate while living in NZ. You \*can\* order HRT, but
+you need to prove that you have a prescription for it.
+
+See:
+<http://www.customs.govt.nz/features/prohibited/imports/Pages/default.aspx>
+(see: Medicines Act 1981). Click on the section that says *Prescription
+medicines*.
+
+It might still be possible to self-medicate in New Zealand. **TODO:
+research ways of doing this**
+
+Citizens of NZ should campaign for a change in the law, so that
+importing HRT without a prescription becomes allowed, and so that GPs
+prescribe HRT on an *informed consent* basis, without gatekeeping.
+
+The same is true in Germany and many other countries.
+
+**It might still be possible to import, even with restrictions. Customs
+is less efficient, depending on your location, and might not even check
+your package. Order smaller quantities e.g. 1.5 month supply, and make
+sure to always order the next 1.5 month supply a few weeks before your
+current supply will run out. You can ask your supplier to package it as
+discretely as possible, and use a generic description on the package
+contents when shipping (i.e. not *HRT* or *pharmaceuticals*). QHI is
+good at that, but inhouse might be too (make sure they are discrete
+about packaging).**
+
+Poland {#pl}
+------
+
+Unauthorised sale of medicines on the territory of Poland is illegal
+(art. 124 of September 6th, 2001 pharmaceutical law act). It doesn't
+mean, however, that importing medication from abroad for personal use
+can lead to legal consequences (we're not 100% sure about this information, though).
+
+If you decide to self-medicate in Poland, you can run into some other problems, however.
+Most doctors (especially ones associated with the public healthcare system) react
+reluctantly or even aggressively to patients who self-medicate. You can expect
+to be asked to stop your therapy for the duration of the "diagnostic" (gatekeeping)
+process, before you get your HRT medication prescribed.
+
+A solution to this problem may be to take some medicines which do not have a significant
+impact on blood test results (e.g. bicalutamide or flutamide as a testosterone blocker).
+
+Portugal {#pt}
+--------
+
+In Portugal, it is possible to purchase estradiol over the counter at
+some pharmacies. Look around. We're not sure exactly what brand or
+type, but
+this can be a legitimate way to get estradiol without a prescription in
+Portugal.
+
+Spironolactone is not available OTC in Portugal. You have to get it
+prescribed or buy it on the internet.
+
+NOTE: we looked into this, and most stores in Portugal sell
+**ethinylestradiol** which is not bioidentical, and has some very nasty side
+effects including heightened risk of DVT. *Avoid ethinylestradiol like the
+plague. Make sure that you only buy estradiol valerate or estradiol
+hemihydrate*.
+
+Russia
+------
+
+According to some people who we've spoken to, estradiol and spironolactone
+over the counter in Russia. Blood tests might be possible too.
+
+We're not yet sure about prescribed HRT in Russia. It might be necessary to
+use DIY.
+
+Testosterone is (we think) a controlled substance in Russia, so DIY on T might
+be a bit difficult. Not impossible, just difficult.
+
+United States {#usa}
+-------------
+
+In the US, depending on your city/state, you might be able to get HRT
+prescribed quickly (within a month) by a doctor, instead of having to
+self-medicate. Look for an *informed consent* clinic in your area.
+
+If you can get HRT quickly via informed consent, we recommend doing that
+instead of self-medicating. Your insurance will cover any expenses, and
+if not, HRT is usually cheap enough without insurance, depending on
+income (it's certainly cheaper than self-medicating, in a lot of
+cases).
+
+[We have a list of informed consent clinics here](private-care.md) - if
+you know of any that are not listed there, let us know!
+
+Suppliers
+---------
+
+These companies are overseas (none of them are in the UK), and you can
+import HRT into the UK. It's legal to import HRT for your own personal
+use. Order no more than a 6 month supply per order. A 3 month supply
+would be safer.
+
+**[InhousePharmacy.vu](https://www.inhousepharmacy.vu/default.aspx?):**
+
+InhousePharmacy is well-known and commonly used by trans people when
+self-medicating. It has existed for a number of years, and the meds that
+they provide are the real thing.
+
+The box that arrives will say "pharmaceuticals" on it. If you need to
+receive them secretly, without someone (e.g. parents) knowing, then you
+should use a PO box or a friends house, or anywhere where you can
+receive them safely.
+
+Recommended pills (trans women):
+
+- Spiractin 100 (spironolactone)
+- progynova 2mg (estradiol valerate)
+
+NOTE: GnRH antiandrogens (e.g. decapeptyl) are vastly superior to anything
+else as anti-androgen, in that they fully suppress testosterone. However, we
+do not recommend using this on DIY; get it from your doctor (it has to be
+injected every so often. Do *not* self-inject unless you know what you're
+doing)
+
+NOTE: spironolactone is a weak antiandrogen, and causes increased pottasium
+build-up in the body. We do not recommend taking spironolactone, unless you
+can't get another antiandrogen that is better.
+
+Spironolactone doesn't suppress T, but blocks some of its effects, so T may
+seem high on blood tests. Spironolactone also affects estradiol readings on
+blood tests (they'll be higher than they actually are on the test).
+
+NOTE: progesterone is not proven to increase feminization, and can lead to
+further negative side effects. We do not recommend taking progesterone.
+
+**[Quality Health Inc](https://www.qhi.co.uk/):**
+
+This supplier ships to Portugal (Inhouse does not, last time we
+checked). For other people who can't order from Inhouse, this company
+might also be usable.
+
+The box that arrives will be blank, with no information on it from the
+outside. This is good if you need to receive it discretely (e.g. at
+parents house).
+
+**TODO: add more suppliers**
+
+Check whether you're intersex {#intersex}
+------------------------------
+
+**Ignore the doses on this page and do not self-medicate at all, if you
+are intersex. You will require special treatment, under close medical
+supervision from a doctor.**
+
+This page has information about what intersex means:
+<https://nonbinary.miraheze.org/wiki/Intersex>
+
+The endocrine system is the collection of glands that produce hormones
+that regulate metabolism, growth and development, tissue function,
+sexual function, reproduction, sleep, and mood, among other things.
+
+You can go to an endocrinologist. This is recommended anyway, because an
+endo can tell whether HRT is safe for you to take, along with blood
+tests. An endocrinologist can check whether you're intersex; this means
+having sexual characteristics of both male and female. Being intersex
+can have an effect on what type of hormone therapy is suitable for you.
+For instance, your doctor might put you on a lower dose of hormones than
+if you were not intersex.
+
+In the UK, you can get a referral from a GP. If you're already
+receiving treatment from a GIC, they can also refer you to an
+endocrinologist.
+
+In the UK, [Dr. Leighton J
+Seal](http://gendercare.co.uk/leighton-seal.html) is one of the most
+well known endocrinologists specializing in endocrinology for
+transgender people, including intersex. However, you might also have
+luck with another endo if you don't live near London (where Seal
+operates). If you can, we recommend seeing Dr. Seal.
+
+Trans women (MtF) {#women}
+-----------------
+
+You should also make sure to book an appointment with an
+endocrinologist, if you can (in the UK, you need a GP referral).
+
+**UK residents: you might be able to get help from
+[CliniQ](https://cliniq.org.uk/) on things like blood tests and so on,
+to make sure that you're safely taking HRT. They can offer advice.
+It's a private clinic, but also part of NHS.**
+
+You should also test your blood pressure. If you suffer from low blood
+pressure, you should not take spironolactone for instance (use
+cyproterone acetate instead, or if you can't get that, take finasteride
+and a higher estradiol dose). Similarly, if you have high blood
+pressure, you should get that sorted before starting HRT.
+
+**WARNING: cypro causes depression symptoms. Use with care.**
+
+You'll see information online about having to lose weight before
+starting HRT. It's not actually true. It's good to not be overweight,
+but you can still be and start HRT. Just watch for side effects. This is
+the same for anyone, regardless of their weight.
+
+Side effects of various medication:
+
+-   [cyproterone acetate](http://www.cancerresearchuk.org/about-cancer/cancers-in-general/treatment/cancer-drugs/cyproterone-acetate)
+-   [estradiol valerate/hemihydrate](https://www.drugs.com/estradiol.html)
+-   [Spironolactone](https://www.drugs.com/spironolactone.html)
+-   [Finasteride](https://www.drugs.com/sfx/finasteride-side-effects.html)
+
+**WARNING: cypro causes depression symptoms. Use with care.**
+
+Not all of these are serious. Watch out for the serious ones e.g. blood
+clots, etc. If you get any of the serious side effects, stop taking HRT
+immediately and seek medical help. This paragraph is not meant to scare
+you away from taking HRT. You should take it, if you want to. But you
+are also taking your own health into your own hands, so you need to be
+more aware of risks.
+
+QUIT SMOKING before you start HRT (e-cigarettes / vapour is fine). Smoking
+tobacco (or smoking anything, for that matter, including weed) increases
+clotting risk, which is even riskier with estradiol.
+
+- [How to quit smoking](smoking.md)
+
+An antiandrogen blocks testosterone. The most popular one is
+spironolactone, but cyproterone acetate is also popular in Europe. Both
+are toxic long-term and have different side effects. You should research
+which one. We recommend using spironolactone, unless you can't use it
+for some reason, in which case cyproterone acetate would also work.
+***Inhouse and QHI both sell 100mg spironolactone pills and 50mg
+cyproterone acetate pills.***
+
+**WARNING: cypro causes depression symptoms. Use with care.**
+
+Another alternative to spiro/cypro is flutamide or bicalutamide.
+bicalutamide is usually taken at 50mg daily, though we're not sure about
+flutamide. NOTE: the pills are plastic and harder to cut/split.
+Both affect certain liver enzymes which could be a problem; in extreme cases,
+jaundice and liver failure. They don't suppress testosterone, but they block
+its effects, so free flowing testosterone in your body will not actually work.
+You should be careful when taking this, and get constant blood tests to check
+for this.
+
+Spironolactine reduces the amount of salt in your body, so you should
+take in more salt in your diet while using it. It also increases the
+amount of potassium in your body, so you should lower your potassium
+consumption in your diet. Some spironolactone pills contain lactose, so
+if you are lactose intolerent you might have to take your lactase pills.
+We're not sure if the amount is high enough to warrant this.
+
+Cyproterone acetate reduces iron and B12, so you should take supplements
+for those while using it. Cypro is an alternative to spiro, which some
+doctors in Europe prescribe (in USA, cypro is a controlled substance and
+not currently prescribed by doctors). ***Avoid alcohol like the plague,
+while taking cypro, because you can get massive hangovers with much
+smaller amounts.***
+
+**WARNING: cypro causes depression symptoms. Use with care.**
+
+NOTE: cyproterone acetate on long term usage, depending on dosage, has been
+known to cause some depression symptoms.
+
+**Only** use bioidentical estradiol. This is either estradiol valerate (progynova 2mg),
+or estradiol hemihydrate (estrofem 2mg).
+
+***If you've already had vaginoplasty or orchiectomy (genital surgery),
+then you do not need to take spironolactone, cyproterone acetate or
+indeed any antiandrogen, because your body no longer produces high
+amounts of testosterone (your testicles have been removed, after all).***
+
+***Fun fact: after surgery, some trans women actually have too low
+testosterone. Cis women have testosterone, just in small amounts. Some
+women have to actually take testosterone (the same kind that trans men
+take), but in very very very small doses, to get their testosterone up
+to female ranges. [This page documents some symptoms of low testosterone
+in women](http://www.everydayhealth.com/low-testosterone/guide/women/)
+(applies to cis women and post-surgery trans women). Blood tests will
+show whether your levels are too low (most women are between 0.5 to 1.5
+nmol/l testosterone levels).***
+
+DHT is what causes hair loss in men, or trans women who waited too long.
+Hair loss can be reversed, by taking Finasteride which blocks DHT. You
+can get the 5mg finasteride tablets on inhouse or qhi (use a pill cutter
+to split them into 2.5mg pills, to be taken every 12 hours). Doctors
+usually prescribe between 1-6mg of finasteride. If you already have a
+full head of hair without hair loss, then you don't need finasteride.
+Finasteride can prevent hair loss, and in some cases can cause lost hair
+to grow back.
+
+**NOTE: patches often contain ethinyl estradiol, which is not ideal.
+This is not bioidentical to real estradiol, but a synthesized version
+that is more potent. The clotting risk is higher with this when taking
+orally. It replaces diethylstilbestrol, which is known to be
+cancinogenic. We recommend using the *Estradot* brand of patches
+(whether 25, 50 or 100mcg variant) because it uses the superior
+*estradiol hemihydrate*.**
+
+Most *good* doctors start you off on 100mg spironolactone and 2mg or 4mg
+oral estradiol (or 1mg/2mg gels or 50mcg/100mcg patches) daily. Start on
+that first (low dose is recommended, when you first start HRT).
+
+You might need a pill cutter, depending on what dose you take and how
+you spread it out into the day. Spread your spiro dose into 2 daily
+doses (every 12 hours), so for instance with 100mg daily spiro you'd
+split it into 50mg every 12 hours. Split the estradiol dose into 2 doses
+daily (gels) or 2-3 doses daily.
+
+For patches, you don't need to split anything because the
+patch stays applied constantly, until you have to put a new one on.
+
+You should use spironolactone and estradiol, usually. If you can't take
+spiro (e.g. don't respond well to it, side effects, low blood pressure,
+etc) then you could try cypro instead (50mg daily - some trans women go
+up to 100 or 150mg). Most doctors would start you off on 50mg if using
+cyproterone acetate.
+
+**WARNING: cypro causes depression symptoms. Use with care.**
+
+If you can't or don't want to take an antiandrogen (spiro, cypro,
+GnRH), you can take estradiol alone, which on its own can block
+testosterone, but it means that you have to take it at a higher dose
+than usual. Finasteride is a weak antiandrogen.
+
+In our opinion, GnRH antiandrogen injections are the best T blockers. If you
+can get this with your doctor, that's great. Otherwise, use spiro or cypro.
+
+Oral estradiol may raise IGF-1, according to some people we've spoken to,
+which could also assist breast growth. Oral estradiol valerate/hemihydrate is
+therefore interesting to consider, instead of sublingual. NOTE: there is not a
+lot of research on the effectiveness of sublingual administration, and not all
+pills are suitable to be taken this way. We recommend oral method, and if not,
+use patch or gel. We recommend against use of sublingual method for taking
+pills. Most doctors do not prescribe sublingual estradiol either.
+
+Patches: if you don't want to take oral estradial, then you can take patches.
+We recommend Estradot 100. This is 100mcg of estradiol hemihydrate, equivalent
+to about 2.5mg oral estradiol daily. You wear the patch for 3 days (you can
+still shower, swim, etc) and replace it after 3 days, wearing each patch for
+3 days.
+You might get marks around the patch, on your skin, but this is just residue
+from the adhesive. You can remove it.
+Wear it on your lower abdomen, around your hips on either side, left or right.
+
+Gels: we do not currently have information about estradiol applied via gels.
+We recommend oral or patch method.
+
+Whatever daily (24h) dose you take, you should split that into 2 doses
+every 12 hours, or 3 doses to be taken every 8 hours. 3 is better, but 2
+is more convenient for most people.
+
+Estrogen alone, in high enough doses, can also block testosterone. In
+the old days, trans women were given only estrogen, because
+antiandrogens didn't exist in most trans healthcare.
+
+2 months after you start HRT, get estradiol and testosterone levels
+checked in a new blood test. Female range is about 0.4 to 1.5nmol/l
+testosterone, and 400-500 pmol/l estradiol (some trans women go between
+500-600). You will start developing breasts and your face will
+transform, as will the rest of your body. If your T is too high, \*and\*
+your estradiol is too low, try increasing your estradiol dose a bit -
+e.g. from 4mg to 6mg, and check levels again in 2 months. Note that the
+extra estradiol will also lower T a bit more. If T is still a bit high
+on the next blood test, try increasing your spiro dose - e.g. 100mg to
+150mg. Then try again. ***If you're taking HRT while getting blood
+tests, then before each blood test MAKE SURE that you take your dose 1
+hours before, assuming that this is 12 hours after your last dose, so
+that you know roughly what your peak levels are.***
+
+We are not responsible for any harm that you may bring upon yourself.
+Self-medication is usually safe for most people (and most trans women do
+it, or consider it, in their early transition). If you have some
+abnormality in your blood results (doctor will tell you) pre-HRT then
+get checked up with an endrocrinologist if you can (several private ones
+exist, if you can't use NHS) and ask their approval. They are there to
+help you. Certain benign brain tumours (prolactinoma) can be susceptible
+to estradiol too; blood test results can tell you signs (your prolactin
+will be too high, e.g. 3x higher than normal - there are other reasons
+that this could occur, not just prolactinoma), and an MRI scan can be
+used to detect it. **You can take a *dopamine antagonist* which doctors
+will prescribe, to treat the prolactinoma. If it works, your prolactin
+levels may drop to normal levels after a month. The antagonists suppress
+the prolactinoma, making estradiol safe to take in a lot of cases. Your
+doctor will start you off on a very low dose of estradiol while the
+antagonists take effect, and then check you later on. If the
+prolactinoma is suppressed enough, they'll increase your dose. DO NOT
+SELF MEDICATE \*AT ALL\* IF YOU HAVE A PROLACTINOMA. USE AN
+ENDOCRINOLOGIST, GET FREQUENT BLOOD TESTS AND ONLY TAKE HRT PRESCRIBED
+BY A DOCTOR, UNDER CLOSE MEDICAL SUPERVISION.**
+
+***Self-medication is always risky, but we also understand that
+dysphoria is also risky and that delaying HRT can be deadly for some people.***
+
+[This website](https://madgenderscience.miraheze.org/wiki/Main_Page)
+(not run by TransChat) also has some useful information about HRT for
+trans women. NOTE: some of the information there is highly experimental.
+
+Blood tests
+------------------
+
+Get blood tests before you start HRT! Go to your GP and ask for these
+tests:
+
+-   urea and electrolytes
+-   bone profile
+-   thyroid function
+-   C reactive protein
+-   ferritin
+-   full blood count
+-   baseline full blood tests
+-   random glucose
+-   FSH
+-   liver function
+-   estradiol
+-   testosterone
+-   rheumatoid factor
+-   SHBG
+-   HDL cholesterol
+-   TFT1: suspected thyroid disease
+-   uric acid
+-   lipids
+-   LH
+-   prolactin
+-   cortisol
+-   dihydrotestosterone (DHT)
+
+book an appointment with your GP, and ask for the authorisation form,
+then find the hospital in your area that holds the blood samples taken,
+and go there to get your blood taken. It\'ll be on the list of blood
+clinics that your GP will probably give you. Go there, and then they\'ll
+send the results to your GP usually a week later, and you can go to
+collect them. If your GP refuses to authorise a blood test, try another
+GP. Some GPs are assholes.
+
+Every 3 months afterwards, get these tested:
+
+-   liver function
+-   testosterone
+-   estradiol
+-   potassium (if taking spironolactone)
+-   B12 (if taking cyproterone acetate)
+-   Iron (if taking cyproterone acetate)
+
+Trans men (FtM) {#men}
+---------------
+
+
+Trans men take testosterone (steroids). This is a controlled substance
+in the UK, and not legal to purchase without a prescription, unlike
+male-to-female HRT. You can still get it though, just not in inhouse or
+qhi. \*hint hint\*
+
+TODO: put dosages on this section, as a general guide.
+
+Info about HRT for men, with dosages
+http://www.ftmguide.org/ttypes.html
+
+[This website](https://madgenderscience.miraheze.org/wiki/Main_Page)
+(not run by TransChat) has some information about HRT for trans men.
+
+TODO: integrate that info into transchat
+
+Non-binary {#nonbinary}
+----------
+
+This page has info:
+<https://madgenderscience.miraheze.org/wiki/Non-binary_hormone_therapy_guide>
+- We don't have much info about it on TransChat. We do not run the
+madgenderscience wiki.
+
+It's difficult to recommend anything to non-binary people, because they
+are not binary. There is a lot more variation in non-binary people, and
+a lot of cross over between trans men/women.
+
+If you want feminizaton, whatever dose you take, HRT (if you want HRT)
+will still cause breasts to develop. If you're dysphoric about breasts
+(you might not know you are until you start) or you start being so, stop
+all HRT immediately. We've had experiences before with people who
+thought they were trans women, but then decided that they were
+non-binary, because although they wanted feminization, breast growth
+increased their dysphoria, so they had to stop taking HRT. Feminization
+without breasts is possible, if you later get top surgery (breast
+removal) after a few years on HRT when breast growth has settled. You
+can wear a binder. It may also be possible to take a partial
+estrogen blocker (SERM) (e.g. Raloxifene) along with HRT, to suppress breast
+growth. On the other hand, some non-binary people like having
+breasts.
+
+TODO: Research more about SERMs, their proper dosing and effects they cause.
+
+If you want masculinization, taking testosterone will masculinize you also.
+If you want to masculinize a bit (low dose testosterone), but don't
+want hair growth, you might be out of luck, so you'd have to later get
+laser hair removal. If you want an androgynous voice, and testosterone
+masculinizes your voice too much, note that you can still use the same
+kind of voice training that trans women use, to get back to a voice that
+you're more comfortable with. Taking testosterone means that your voice
+will deepen over time, but this can be overcome.
+
+Intersex: TODO, write about intersex people. (this has nothing to do
+with non-binary identity necessarily, but intersex people need different
+HRT treatment, if they take HRT).
+
+Some non-binary people take spironolactone without
+estrogen, or with low estrogen dose (e.g. 0.5mg) because they want to
+not have too much of either hormone. or they take full HRT but there are
+certain things they don't want; e.g. they don't want hair removal
+(hormones will not reduce facial hair, but will reduce body hair a bit),
+etc. If they want to get rid of the effects of feminization, they might just use an
+antiestrogen (e.g. tamoxifen).
+
+These are just some notes with a few bits of advice. We don't assume
+how a person is, and we recognize that non-binary people have more
+variation between them than binary people. You will just have to make
+your own mind up. TransChation is more difficult for non-binary people
+than for binary people.
+
+External links
+--------------
+
+* [Pharmacology of transsexualism in
+  17beta](https://n2t.net/ark:/21206/10003). A compendium of relevant
+  references to the literature about hormones used in male to female
+  transition.
+* <https://madgenderscience.miraheze.org/wiki/Main_Page> also has
+  information about self-medication.