DIY HRT Guide and Resources
Justine White
If you can’t access the healthcare you need and you’re ready to take your medical transition into your own hands with DIY HRT, you’re in the right place.
Although I initially started taking estradiol under the supervision of a doctor, I started my DIY HRT journey when I moved to Germany and discovered that they didn’t offer injectable estrogen at all. Rather than switch back to pills or patches, I figured out my own solution.
Disclaimer: I am not a doctor, and I can’t offer you medical advice. All I can do is share my experience, along with the resources I have collected. Do your own research, recognize that there are risks, and protect yourself as much as possible.
In this article, I’ll list out everything you need to know to start DIY transfeminine HRT and give you the resources to take the next steps yourself.
What is Feminizing HRT?
Hormone Replacement Therapy (HRT) shifts the levels of hormones in your body so that your experience more closely matches your gender.
For trans women and transfeminine enbies, this means blocking the natural production of testosterone and introducing estrogen.
This normally requires an anti-androgen (to block testosterone) and a form of estrogen, typically estrogen that is bioidentical to the natural estrogen your body produces.
What does DIY HRT Do to the Body?
The purpose of hormone replacement therapy is to feminize the body and brain.
Many different changes happen, physically and mentally, that help to align you with your gender identity. Some of these changes are noticeable quickly, while others can take several years to develop fully.
Your skin softens and produces less oil. It also thins, which can make you feel colder.
Muscle mass decreases overall, especially in the arms. You might find it more difficult to lift things, or move furniture.
Body hair thins and grows more slowly. Male pattern baldness can stop, or reverse itself somewhat.
All of these changes are temporary and reversible if you stop taking HRT.
The irreversible changes are sterility and breast growth.
When you start taking HRT, your testicles shrink and you produce little or no semen. The decrease in testosterone causes you to stop having spontaneous erections, and will likely decrease your sex drive significantly. In the long term, you will no longer produce viable sperm and will become infertile.
If having biological children is important to you, it’s a good idea to look into preserving your sperm in a sperm bank before starting HRT.
Another irreversible change is breast growth. This can start as early as 1-3 months into HRT, but growth will not finish until after 2 or more years.
There are so many other effects that it would be impossible to cover them all. There are psychological and emotional changes that can even include changes to your sexual orientation. Some women find that estrogen helps them overcome anxiety or depression that had been crippling before, while others start breaking down into tears more and getting in touch with their emotions more after starting HRT.
However, the greatest effect is the reduction of gender-related dysphoria.
For more information about the short and long-term effects of HRT, check out these resources:
The Mayo Clinic: Feminizing Hormone Therapy
The Cleveland Clinic: Feminizing Hormone Therapy
Is DIY HRT Illegal?
The rules around controlled substances will vary depending on the country you live in, but for most of the world estrogen and anti-androgens are not controlled substances that are illegal to possess, and people who order them online are unlikely to face consequences.
Although your country might prefer that you get a prescription and go through the medical system, unless you are trying to purchase a drug that is controlled, you aren’t doing anything illegal.
You won’t go to jail for ordering your HRT online, but you’re not exactly protected, either. Customs can seize your order and destroy it, and this does happen occasionally. However, very few packages are searched, and if you are ordering domestically rather than internationally this is reduced to zero.
TL;DR, don’t worry about legal consequences for ordering transfeminine HRT. The worst that can happen is that you’ll lose your money.
What are the Risks and Side Effects?
Whenever we talk about the “risks” and “side effects” of HRT, it is important to separate legitimate medical concerns from transphobia.
For example, is infertility, breast growth, and reduced sex drive a “risk” or a “negative side effect” when that is exactly what many trans women are hoping for?
Trans women on HRT experience an increased risk of blood clots. However, their risk is nearly identical to that of cis women (higher than AMAB people). Is this increased a negative side effect of HRT or a perfectly understandable side effect of being a woman?
HRT is very safe and effective overall, but any medication has potential side effects and we all take minor risks every day.
Oral estradiol has the potential to damage the liver, as does bicalutamide. There are concerns about blood clots with transdermal estradiol patches, especially. You should look at each medication individually to assess your risk, and the more you know about your body and your medical history, the better you can assess that risk.
If you are doing DIY HRT you probably don’t have a doctor on standby, but if you can order blood tests at your local hospital or online, these can provide early warnings about liver problems and other side effect issues, as well as help you keep your hormone levels within the acceptable range.
Do I Need Blood Tests?
If a doctor was supervising your HRT, they would perform a blood test at least every 3 months to check your hormone levels and make any necessary adjustments. This is doubly true if you are taking a medication like bicalutamide that has some risk to the liver (however small, 1/4000 people experience liver toxicity when taking bicalutamide).
Since you don’t have a doctor supervising you, the next best thing is to supervise yourself by ordering the blood test yourself and reviewing the data. There are some communities online like r/transDIY that might be able to help you with your results.
You might be able to get a blood test locally by contacting your local clinic or getting a doctor to help you get a requisition form.
If you don’t have a local connection for a blood test, there are services online offering them at affordable rates. All you need to do is draw the blood yourself and send it through the mail.
If you can’t access blood tests in person or online, that doesn’t mean your DIY HRT regiment is unsafe, or that you are taking a huge risk. There are other ways to monitor your hormone levels, including tracking spontaneous arousals and semen production.
However, it is a good idea to get the blood tests if you are using bicalutamide as an anti-androgen, if only because there is a 1/4000 chance that you could develop a serious liver problem, and you want to know about that as early as possible.
What Methods of DIY Estrogen HRT are there?
There are multiple ways you can take estrogen, and although the feminizing effects are the same, maintaining the correct levels over time to get the best results can be a tricky process and is highly impacted by how you take it.
Estrogen Pills
Estrogen Pills are one of the most common ways to take Estrogen. They are typically ingested orally twice a day, 12 hours apart. The dose is typically 2-6 mg. Estrogen pills are easy to find online and one of the easiest ways to do HRT. All you need to do is take your pills on time.
You want to buy pills that are “bioidentical estrogen” - in other words, estrogen molecules that are exactly the same as the ones that your body naturally produces.
The most common pill forms of estrogen are estradiol hemihydrate (Estrofem, Estrace), although you can also find estradiol valerate in pill form.
Estradiol pills cost approximately $20 - $40 a month.
You can take the pills orally every 12 hours, sublingually (letting it dissolve under the tongue), or buccally (letting it dissolve between the cheek and gums). Sublingual/buccal methods lead to better absorption, but the effects drop off more quickly. If you take pills sublingually or buccally, you’ll need to take a dose 3 times a day, or every 8 hours.
Transdermal Estrogen
An estrogen patch is designed to release a certain amount of estrogen every day, which makes it a convenient method for those who forget their pills and are afraid of shots.
There are also gels available that can be rubbed onto your skin. In a pump system, the amount of gel is controlled and measured, but unfortunately, many gels come in tubes that are difficult to dose.
Estrogen creams aren’t really recommended for transfeminine people. They work for older women who are replacing their natural estrogen but aren’t strong enough for trans people.
Transdermal patches typically cost between $30 and $45.
Estrogen Injections
Injecting estrogen can make some people feel squeamish, but injections are the best method for keeping your hormone levels constant over time and avoiding the spikes and valleys associated with short-term estrogen delivery methods.
Estrogen can be injected subcutaneously or intramuscularly. You can decide which is most comfortable for you. It doesn’t have a meaningful effect on hormone levels.
There are 3 varieties of estrogen that are typically sold for injection and are worth considering.
Estradiol Valerate has the shortest half-life, meaning it is the quickest to be metabolized by your body. That means you’ll have to inject more often - every 3-5 days. It is also the variety most prescribed by doctors.
Estradiol cypionate has a half-life of 6.7 days, so it takes longer for hormone levels to rise and then drop off as they are metabolized.
Estradiol enanthate has a half-life of 4.6 days, but the peak levels of estradiol enanthate come later than with cypionate. In practice you can consider these two equal, needing to be injected every 5-7 days.
Injections are arguably the cheapest method of DIY HRT, costing between $8 and $20 a month.
What Testosterone-Blocker Should I Use?
First of all, you might not need a testosterone blocker.
High levels of estrogen naturally suppress testosterone. It’s hard to get levels this high with pills or patches, but with injections, some women can achieve the results they want without an anti-androgen.
If you are not using injections, or you want to follow the conservative route and make sure testosterone is not screwing up your transition, it makes sense to use a testosterone blocker.
Spironolactone
The most commonly prescribed anti-androgen is Spironolactone, a potassium-excluding diuretic that binds to testosterone receptors.
The popularity of spironolactone is mostly among doctors who prescribe it along with estradiol - not because it is the best medication.
There are two problems with spironolactone.
The first is that it’s not that effective as an anti-androgen and sometimes doesn’t reduce testosterone enough. Other drugs do a better job, and this is basically all it does.
The second problem is that there are a lot of side effects, some of which we don’t understand very well. Everyone knows that spironolactone makes you crave salty foods and need to pee, but not many are aware that it can raise your stress levels, or cause poor breast development.
For more information, check out The Case Against Spironolactone.
I don’t want to be hyperbolic - plenty of happy trans women use spironolactone. If you want to go the conventional route you can buy it online for $10 - $20 a month.
Bicalutamide
This is an interesting choice because it achieves the same result differently. Instead of stopping your body from producing testosterone, Bicalutamide prevents your body from uptaking it and using it.
This means that technically your testosterone blood levels will rise on bicalutamide because your body thinks that it is low on testosterone. However, none of this testosterone will have any effect on your body.
Bicalutamide is better than some other hormone blockers are preserving penile function and semen production, which might be a good thing for some trans women and a bad thing for others.
There is also a slight risk to Bicalutamide users, which affects the liver in about 1 in 4000 users. If you are using bicalutamide, it’s a good idea to get regular blood tests.
Cyproterone acetate
Cyproterone acetate is an effective testosterone blocker, and it is affordable at $5 - $20 a month.
However, it is often sold in pills that are 4-8 times the dose that trans women need, so you might also need to buy a pill cutter to get the right dose.
Can I Get An HRT Doctor Online?
If your local doctor is not an option, you might still be able to have a medically supervised transition through telemedicine.
Some doctors are now able to prescribe medications and administer blood tests over the internet. Trans people benefit from these services becoming available.
Here are some telehealth services where you can speak to a doctor about HRT, and order medications to your home. These services may be more expensive than DIY, and may not be accessible in your country or state.
GenderGP (the UK and International)
Can I Trust HRT Medications I Buy Online?
Online pharmacies are always a risk, but with lots of reviews out there it is possible to be safer, if not completely safe.
If an online pharmacy has a good reputation and has been working for other people, it is pretty unlikely to scam you - even though there are no guarantees.
To stay safe online, choose an online pharmacy from HRT.cafe
These listings are reliable and are regularly used by trans people. Things can always change, but if there are major problems with an online pharmacy it will be removed from HRT.cafe.
There are so many choices here that I don’t recommend looking elsewhere. The risk is too great, and there are many well-vetted choices on HRT.cafe.
How Do I Pay for HRT Online?
It’s quite safe for you to buy HRT from an online pharmacy, but the pharmacy itself is probably at some legal risk for selling it to you.
There is a lot of security around payments, and paying for your HRT. It might not be as easy as typing in your credit card.
Some online pharmacies take wire transfers or money orders, and some may even take payment processors like PayPal.
However, for security reasons, some online pharmacies will only take cryptocurrencies like BitCoin or Ethereum, which are untraceable.
This can seem a little bit overwhelming, but anyone can do it. Investopedia has a great guide on paying with cryptocurrency online.
Can I Travel with DIY HRT Medications?
Yes, you can pack and travel with your DIY HRT.
The best advice is not to hide it. Keep it in the original bottle, well labeled, along with any other medications you are bringing with you.
You can check online to see if hormones are a controlled substance in the country you are visiting, but estrogen is not in the vast majority of countries. You are almost definitely fine.
DIY HRT Resources
Here is a list of the resources included in this article, as well as some that were not mentioned.
The Mayo Clinic: Feminizing Hormone Therapy
The Cleveland Clinic: Feminizing Hormone Therapy
Erin’s Informed Consent Map for HRT clinics in the US
https://www.reddit.com/r/TransDIY/
Injection of Hormones for MTF Transsexuals [sic]
What’s Wrong with Spironolactone
I was able to take control of my transition with DIY HRT, and I hope it works out as well for you as it has for me. Be safe, be careful, and go for it!
If you want to connect with other trans people about DIY HRT and other topics like this, join my discord community where we have these types of conversations and share our experiences. You should also sign up to my email list so you get new content from me, subscribe to my YouTube channel, and hit the bell so that you’ll be notified every time I release a new video.