Nonprescribed hormone use and self-performed surgeries: "do-it-yourself" transitions in transgender communities in Ontario, Canada

Am J Public Health. 2013 Oct;103(10):1830-6. doi: 10.2105/AJPH.2013.301348. Epub 2013 Aug 15.


Objectives: We examined the extent of nonprescribed hormone use and self-performed surgeries among transgender or transsexual (trans) people in Ontario, Canada.

Methods: We present original survey research from the Trans PULSE Project. A total of 433 participants were recruited from 2009 to 2010 through respondent-driven sampling. We used a case series design to characterize those currently taking nonprescribed hormones and participants who had ever self-performed sex-reassignment surgeries.

Results: An estimated 43.0% (95% confidence interval = 34.9, 51.5) of trans Ontarians were currently using hormones; of these, a quarter had ever obtained hormones from nonmedical sources (e.g., friend or relative, street or strangers, Internet pharmacy, herbals or supplements). Fourteen participants (6.4%; 95% confidence interval = 0.8, 9.0) reported currently taking nonprescribed hormones. Five indicated having performed or attempted surgical procedures on themselves (orchiectomy or mastectomy).

Conclusions: Past negative experiences with providers, along with limited financial resources and a lack of access to transition-related services, may contribute to nonprescribed hormone use and self-performed surgeries. Promoting training initiatives for health care providers and jurisdictional support for more accessible services may help to address trans people's specific needs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Androgen Antagonists / administration & dosage*
  • Confidence Intervals
  • Estradiol / administration & dosage
  • Female
  • Gonadal Steroid Hormones / administration & dosage
  • Humans
  • Male
  • Mastectomy
  • Middle Aged
  • Ontario / epidemiology
  • Orchiectomy
  • Prescription Drug Misuse*
  • Self Mutilation / epidemiology*
  • Self Mutilation / psychology
  • Sex Reassignment Surgery*
  • Social Identification*
  • Transgender Persons / psychology*
  • Young Adult


  • Androgen Antagonists
  • Gonadal Steroid Hormones
  • Estradiol