People with gender dysphoria who self-prescribe cross-sex hormones: prevalence, sources, and side effects knowledge

J Sex Med. 2014 Dec;11(12):2995-3001. doi: 10.1111/jsm.12691. Epub 2014 Sep 11.


Introduction: There is a scarcity of research into the use of non-physician-sourced cross-sex hormones in the transgender population. However, when medication is not prescribed by health professionals, users' knowledge of such medication may be adversely affected.

Aims: This study aims to define the prevalence of Internet-sourced sex hormone use in a population attending for initial assessment at a gender identity clinic, to compare the prevalence between gender-dysphoric men and women, and to compare knowledge of cross-sex hormone side effects between users who source cross-sex hormones from medical doctors and those who source them elsewhere.

Methods: In the first part of the study, a cross-sectional design is used to measure the overall prevalence of sex hormone use among individuals referred to a gender clinic. The second part is a questionnaire survey aiming at measuring sex hormone knowledge among individuals referred to this clinic.

Main outcome measures: Main outcome measures were (i) categorical data on the prevalence and source of cross-sex hormone use and (ii) knowledge of sex hormone side effects in a population referred to a gender clinic.

Results: Cross-sex hormone use was present in 23% of gender clinic referrals, of whom 70% sourced the hormones via the Internet. Trans men using testosterone had a sex hormone usage prevalence of 6%; one-third of users sourced it from the Internet. Trans women had a sex hormone usage prevalence of 32%; approximately 70% of users sourced hormones from the Internet. Cross-sex hormone users who sourced their hormones from physicians were more aware of side effects than those who used other sources to access hormones.

Conclusion: One in four trans women self-prescribe cross-sex hormones before attending gender clinics, most commonly via the Internet. This practice is currently rare among trans men. Self-prescribing without medical advice leaves individuals without the knowledge required to minimize health risks.

Keywords: Cross-Sex Hormones; Gender Dysphoria; Internet; Prevalence; Transgender; Transsexualism.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cross-Sectional Studies
  • Female
  • Gender Identity
  • Gonadal Steroid Hormones / supply & distribution*
  • Gonadal Steroid Hormones / therapeutic use
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Internet / statistics & numerical data
  • Male
  • Middle Aged
  • Nonprescription Drugs / supply & distribution*
  • Nonprescription Drugs / therapeutic use
  • Self Medication / statistics & numerical data
  • Sex Factors
  • Surveys and Questionnaires
  • Testosterone / supply & distribution
  • Testosterone / therapeutic use
  • Transsexualism / drug therapy*
  • Young Adult


  • Gonadal Steroid Hormones
  • Nonprescription Drugs
  • Testosterone