Earlier this year, the Center for Safe Internet Pharmacies surveyed 30,000 online drug-sellers, and found that 96 percent existed outside of regulations or licenses typically enforced by the Food and Drug Administration, the National Association of Boards of Pharmacies, and the DEA. “These rogue sites often sell unapproved drugs, drugs that contain the wrong active ingredient, drugs that may contain too much or too little of the active ingredient, or drugs that contain dangerous ingredients,” warns the FDA.
According to Libby Baney, executive director of the Alliance for Safe Online Pharmacies* and a lawyer specializing in the regulation of the healthcare supply chain, patients are rolling the dice when they order prescription medications or controlled substances through most online pharmacies. “One in two of these pharmacies are selling counterfeit medicine,” she says, citing a report by the World Health Organization.
Even if the drugs patients do obtain are legitimate and not counterfeit, many of these pharmacies and manufacturers do not have the same safety standards as the FDA and the U.S. government, she adds, citing India, Russia, and Pakistan as some of the more popular pharmacy locations. (All Day Chemist, an online pharmacy based in India, even has a strict “as-is” policy, meaning they do not claim 100-percent certainty about the products they sell.) Hormones manufactured and distributed from abroad might be contaminated, or kept out of cold storage, which is necessary to keep them from degrading. “Even if you’re lucky enough not to get a counterfeit, you don’t know the quality of the medicine you get,” Baney says.
Simply taking hormones poses health risks, too. Safer, the Boston University professor, notes that estrogen contributes to blood clots and can increase one's chances of stroke or heart disease, as well as put extra strain on the liver. Spironolactone, the most popular testosterone blocker prescribed to transgender women, is a “potassium-sparing diuretic,” meaning a patient with existing kidney problems might have to restrict their dose or not take the drug at all.
The moderators of r/asktransgender, the largest trans-related subreddit, with nearly 25,000 members, have made clear their position against DIY HRT. “I know there are many of us who do not have access to knowledgeable doctors or have unsupportive parents. And there are many of us who have successfully gone down the road of DIY,” a moderator on the forum wrote. “However, please bear in mind that there ARE risks, and you should always try to transition under the support and care of a medical professional.”
While r/asktransgender doesn’t prohibit all talk of DIY hormones, other sites ban users helping each other administer their own HRT. Susan’s Place, one of the largest and oldest transgender forums on the web, explicitly prohibits any discussion of non-prescription hormones and even goes so far as to block discussion about “natural” hormone methods (some transgender women will pursue a diet heavy in phytoestrogens in order to enhance certain feminine characteristics of their body).