Barriers to transgender health care lead some to embrace a do-it-yourself approach

More transgender people may choose a DIY approach to gender-transition care due to the political environment and transgender health ban.

Max Adomat considers themself fortunate. Adomat, 26, who is nonbinary and uses they/them pronouns, has been on a steady regimen of feminizing hormones for the last six years. They also began their gender transition in New Jersey, a progressive state where clinics offering transition-related medical care are commonplace, and name changes are confidential, they said.

But Adomat still found themself obtaining and self-administering gender-affirming hormones from unregulated, and oftentimes illegal, overseas online pharmacies instead of licensed medical offices. The reason, Adomat said, was a lack of both health insurance and money: When they began transitioning, their low-paying job in the food service industry did not provide insurance, and they were unable to afford the steep cost of transition-related care — including hormone therapy and routine doctors appointments — without it. 

Though they knew the risks — which, without supervised care, can include higher chances of blood clots, heart attacks and some cancers — Adomat felt their window for a successful transition was closing, they said.

“I just sort of decided, ‘I’m going to do it, and if and when I can see a doctor somewhere down the road, sure, but I would rather do it now and face those consequences,’” they recalled, adding that their alternative at the time was to continue to “live miserably.”

Max Adomat, 26, has been on a steady regimen of feminizing hormones for the last six years.Max AdomatThere are approximately 1.6 million transgender teens and adults living in the United States, according to a report published last year by UCLA’s Williams Institute. While not all trans people opt for hormone therapy, a 2020 study published in the Annals of Family Medicine estimated that 9% of those who did had obtained hormones from unlicensed sources, including friends and unregulated online pharmacies.