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Self-medication is the private purchase – often on the black or grey market – of what are believed to be prescription drugs for self-administration at home. The most common medications sought are those that are routinely in high demand but are difficult to access, including medicines for mental health, reproductive health and contraception, and, of course, transgender healthcare.
When access to safe healthcare for trans people is threatened – as we saw with the Dec 2020 Bell v Tavistock ruling in the UK, or the subsequent withdrawal of gender-affirming care by the Karolinska Institute in Sweden – it is often accompanied by a rise in online queries about self-medication.
It’s easy to understand why, for some, the notion of self-medicating might be appealing. In the UK, for instance, waiting times for access to gender-affirming hormones can run into years. If you or your child or a loved one are suffering with gender dysphoria, facing a seemingly endless wait and you know you can access information on what and how to administer your own care, it could be a tempting option. So why shouldn’t you just take matters into your own hands?
Accessing prescription medication
Medications like puberty blockers and gender-affirming hormones require a prescription because they need to be administered and monitored safely, by a doctor. Medical transition isn’t just about getting as much or as little oestrogen or testosterone as possible; a careful and gradual balance needs to be maintained and the process needs to be monitored. A trained prescriber will be able to prescribe medication tailored to each patient’s needs and ensure that they are able to transition successfully and remain in a good state of health.
Some medications also carry risks in the administration itself. For instance, a common preparation of testosterone comes in injectable format, as do many GnRH analogues (puberty blockers). Administering these injections requires training, which is why it is usually only ever done by a trained medical professional. It is possible to injure yourself or your child with untrained at-home injections, and improperly disposing of sharps (like needles) and medical waste can be dangerous to your household and to the general public. If you are administering untrained injections to a child it could lead to a safeguarding issue, and social services may get involved.
There is also no guarantee that the medication you are purchasing is genuine. While licensed prescribers obtain their medications from regulated sources, online retailers may not be so scrupulous about the source of their products. There is no guarantee that their medications are in-date, packaged correctly, or in the right dosage or preparation – indeed there is nothing at all to say that what you are purchasing is even medication.
For these reasons GenderGP strongly discourages people from self-medicating. However, we do also understand that due to the desperation many trans people so often feel and the negative experiences they may have had in trying to access medication legitimately, they may believe it to be their only option.
If you are self-medicating there are a number of ways to stay safe.
Access your care through a legitimate service, like GenderGP.
We provide prescription services and monitoring to help you transition safely. We won’t make you ‘start over’, if you’ve been self-medicating with hormones and your blood tests look good, we’ll happily continue at the same dosage. We’ll never punish anyone for self-medication or try to push them down to a lower dose for the sake of it. The only thing that matters is that we can safely prescribe the medication that is right for you. Our team can teach transmasculine people to safely self-inject as well as providing access to sharps disposal services so that you can safely administer injections at home. Alternatively, we can provide you with a treatment summary that you can take to your doctor to arrange for your injection to be administered by a professional.
Talk to your GP about obtaining a bridging prescription.
The GMC (General Medical Council) provides guidance on this subject in its guidelines for transgender healthcare: ‘If your patient is self-medicating, consider issuing a bridging prescription as part of a harm reduction approach.’ A bridging prescription is a prescription offered by your GP to cover the time until you can be seen by a specialist service like a GIC (Gender Identity Clinic). The GMC advice means that if you explain to your GP that you are self-medicating and you want to transfer to a safer option, they should consider making this prescription available to you. They may want to talk to a gender specialist, and if this is the case you could refer them to GenderGP. There are lots of resources in our Medical Hub to support healthcare providers in treating their trans patients.
Use a regulated pharmacy
Make sure the pharmacy through which you are accessing your medication carries the MHRA logos and appropriate regulatory stamp of approval. Without this assurance you cannot be sure that the medication you are accessing is safe.
We understand that transition can be costly, and that some people turn to self-medication because they believe it offers a cheaper alternative to private services. However, it is important to note that accessing genuine prescription medicine is often cheaper than people realise. Talk to a member of our team to see if we can help and what costs might be involved.
We will always try to do everything we can to ensure our patients can transition safely, and we’ll always discuss financial support options rather than turn away someone in need.
The GenderGP Fund has been set up to help those under the age of 16 who might not ordinarily be able to access private healthcare. You can find instructions on how to apply for access to the Fund – or how to donate – on our website.
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