The Troubled History of DIY Trans Healthcare |
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The Troubled History of DIY Trans Healthcare
Trans people have been going underground to access care for generations. But that doesn’t mean DIY networks are a large-scale strategic answer to transphobia.
A trans woman prepares a hormone shot obtained on the black market, in New York City on December 1, 1999.
Donald Trump’s return to the White House in 2025 made many trans Americans worry about whether their access to healthcare would be taken from them. Nearly 18 months later, as Trump continues to dismantle rights for minorities of all kinds and for trans people in particular, that fear is worse than ever.
The Trump administration has already moved to ban trans care for minors nationwide—a position backed in principle by the Supreme Court—and has attempted to remove trans care from federal health plans. Furthermore, 11 states have passed laws banning Medicaid from covering trans-related care for adults as well as children—a serious attack on a group of people who are disproportionately likely to live in poverty. Many people suspect that it’s only a matter of time before the federal government tries to outlaw hormone replacement therapy altogether. A few experts are even worried America is in the early stages of an attempt “to destroy a gender group.”
Against this backdrop, some trans people have been forced to find hormones outside official channels, turning to online forums for help securing estrogen or testosterone. Recent reports detail trans people ordering drugs from countries like Taiwan and China.
Hormones, for what it’s worth, are relatively easy to produce. They’re readily available across the medical market. Most people who take estrogen or testosterone are not trans, and such hormones are not inherently dangerous. The onslaught of anti-trans legislation is designed to demonize the small fraction of people who do medically transition.
It’s not the first time trans people have been forced to seek healthcare underground, smuggling hormones across state lines or locating sympathetic doctors in the face of a repressive government. In fact, the history of do-it-yourself hormone replacement therapy stretches back decades. That history can be traced through zines, documentaries, and contemporary interviews with trans women. Legendary trans activist Miss Major once said she bought estrogen from a fortune-teller in Chicago, who furtively handed over pills from behind her crystal ball.
In the mid-20th century, many poor trans people shared material resources, including hormones, with one another on the streets, while more upwardly mobile white trans people dismissed DIY hormones as unnecessarily dangerous in newsletters like Tranvestia and Moonshadow. But only a select few were able to transition through mainstream healthcare institutions. Doctors often set draconian standards for those they were willing to treat—often only helping wealthy white trans people who professed heterosexual inclinations.
That didn’t stop people from wanting to transition—and, after World War II veteran Christine Jorgensen rose to fame in 1952 as an early transgender celebrity, the demand for surgery continued to increase. In 1966, John Hopkins Hospital opened a gender clinic, one of the first of its kind, but it only treated 24 candidates out of nearly 2,000 applicants during its first few years.
Faced with such stingy proscribers, many trans people circumvented bureaucracy through dubious sources. In the 1960s, trans starlet Candy Darling bought her estrogen from a less-than-reputable doctor, something many believe contributed to her early demise. Around the same era, Agnes, the subject of Dr. Harold Garfinkel’s foundational sociological text, Studies in Ethnomethodology, convinced her physician that she was intersex and talked him into giving her a vaginoplasty. (Some doctors like John “Butcher” Brown preyed upon trans women as an easy mark, performing “crude” and harmful operations; Brown even killed a patient in 1998.)
In the 1970s, the controversial entrepreneur Geraldine Elizabeth Carmichael tricked a veterinarian into prescribing her estrogen for a pet that she then used herself. Others went to Tijuana to buy estrogen off the shelves, returning to the United States with suitcases full of hormones to distribute. Venus Xtravaganza, a ballroom ingénue and the breakout star of the 1990........