Real solutions for self-medication: Expanding access to transition care via family physicians and informed consent protocols

If you’ve perused the British press lately, you’ve probably noticed that mixed in with the daily barrage of cookie-cutter anti-trans opinion pieces was this alarming headline: “Cowboy chemists are selling ‘DIY trans’ pills to teenagers as more and more are ‘risking their lives’ by taking black market drugs”. This subsequently led to the closure of the online pharmacy QHI. The issue of self-medication via online pharmacies by trans people, particularly trans youth, is not new: the Independent published a similar investigation in 2016, and I’ve received plenty of outraged tweets from transphobes who were unhappy with my own post collecting studies of generic medications that have been used as a substitute for puberty blockers in clinical practice.

I trust that these people recognize and value the importance of access to safe and competent gender-affirming care – and so do I. No one should be placed in a situation where this is their only means of obtaining timely transition treatment. Fortunately, if you’re worried about trans people and youth self-medicating unsafely, there are already many known ways to reduce the prevalence of this phenomenon. It’s simple: just meet the needs that aren’t being met for them.

Receiving prescriptions and appropriate blood work and monitoring for HRT does not require seeing a specialist. Family doctors and general practitioners are capable of caring for trans patients in need of HRT within the WPATH Standards of Care and other protocols such as the Endocrine Society clinical guidelines. Due to the length of their wait list for transgender care, Canada’s Centre for Addiction and Mental Health has encouraged family doctors to evaluate trans patients and prescribe HRT as appropriate. This has been a well-known issue in England for years, where trans patients can face wait times of up to two and a half years for an appointment at an NHS provider. Numerous organizations of family physicians are now working to make the availability of trans-affirming care such as HRT a routine part of primary care.

Clinicians can also expedite trans people’s access to medications by adopting an informed consent model. This protocol differs from the traditional pathway of requiring trans patients to obtain a diagnosis and letter of referral from a mental health professional before seeing an HRT prescriber, a step which can sometimes cause delays in treatment of weeks, months, or years. Instead, providers can drop this requirement and prescribe HRT on an informed consent basis, ensuring that a patient clearly understands the effects of this treatment and allowing them the autonomy to make this choice for themselves. This simple step removes yet another barrier to trans people’s safe access to HRT with appropriate medical oversight.

Finally, trans youth are especially in need of understanding from their parents or guardians of why affirming treatment, including treatment with puberty blockers or cross-sex hormones, is so important. Because minors require permission from their parents or guardians to begin treatment, parental disapproval of their gender identity can obstruct their access to care. While they may be forced to wait, their bodies are not waiting: they’re continuing to experience the permanent changes of the wrong puberty every day. For gender-dysphoric adolescents, treatment with puberty blockers can lead to long-term improvements in overall health, mental well-being, and quality of life. Concerted public education campaigns should work to inform parents and guardians about these facts. Trans youth don’t have the choice to stop having gender dysphoria, and they deserve to have their parents working with them, not against them, in effectively addressing this.

Self-medication among trans people is not a phenomenon that can be regarded in a vacuum: it emerges as a result of numerous systemic factors that can cut us off from timely care through appropriate channels. By taking steps to change the factors that have given rise to this, trans people’s providers and families can work to help ensure that we don’t have to go it alone. 

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About Zinnia Jones

My work focuses on insights to be found across transgender sociology, public health, psychiatry, history of medicine, cognitive science, the social processes of science, transgender feminism, and human rights, taking an analytic approach that intersects these many perspectives and is guided by the lived experiences of transgender people. I live in Orlando with my family, and work mainly in technical writing.
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