Radical Creation V. Government Legislation
HRT and you—past and present, found or created
Quinn McClurg
(Preface: Though I’ve been planning this article for two weeks, news of Sam Nordquist broke during my writing. As a trans journalist, I’ve done the same research countless times: At least 30 trans people are reported killed every year, around 70% of them being BIPOC; our unemployment rate is more than three times the national average, and rates of unhoused trans people have increased 217% since 2015. Seemingly, most media only mentions us when we are murdered, as if there are no other relevant means of living than succumbing to the hands of sensational hatred.
I dedicate this article to those who are no longer with us, and to those who suffer discrimination daily for their sacred self-creation. And I dedicate this article to those who live their radical, alternative futures in spite of everything—futures of love and health, futures of healing and possibility.)
“All of us have had to take ourselves apart to figure out who we really are… It’s one of the most beautiful things I’ve ever seen”
– Lilith Cooks
At the time of writing, it’s been slightly under a month since President Donald Trump has taken office, though he’s still flooding the zone with executive orders. As you may know, these orders include:
The general DEI purge and the transgender military ban
Banning LGBTQ+ content in schools
Erasing mentions of trans folks on every federal website* and grant application
Restrictions on federal gender markers (using only sex assigned at birth)
Prohibiting trans girls' participation in (cis) women's sports teams
Putting transgender women in men's prisons*
Making gender affirming care inaccessible to people under the age of 19*
Though the last two listed have received temporary restraining orders (by Federal Judges Lamberth and Hurson / King respectively), things are… still not looking great. Long story short, at least 15,000 government employees will be out of a job (this number is mostly from trans people in the military, not considering countless trans people who have been forced out from other government departments). This is a loss of “billions of dollars of investment” with expertise that may take “more than a decade to replace,” according to Geirid Morgan, a trans woman, lieutenant commander, and research physiologist interviewed by Slate.
And with a lacks of employment comes a lacks of income and health insurance—those two being the deciding factors in accessing gender affirming care. Obviously, these insecurities and barriers are major problems for the other 1-million-plus transgender people in America, especially since a large chunk of that population depends on federal, state, or city-specific insurance—insurance that can be cut off by one executive order due to depending on federal funding.
So, when the barriers to gender affirmation are growing higher, what can we do? First, we must look to the past. Enter, well… I can’t say his name, primarily due to his concerns that identification may damage his very visible, professional career. Instead, I’ll identify him as the “Radical Activist” (RA), my oldest trans elder. In 2007, RA started hormone replacement therapy (HRT) at the age of 21.
“Hormones were kind of a holy grail,” RA said during our interview. “They were relatively hard to get, both because of a shortage of doctors and because you had a lot of requirements of normalcy. I got my first vial from a doctor after giving her a lecture on heteronormativity and how the pathologization of trans people was oppression… The doctor [later] backed out.”
With his doctor refusing him, RA had no one to teach him how to safely inject his testosterone, so he learned from online bodybuilding forums. This type of discrimination wasn’t new to RA—18 years later, RA says he is still read as a woman everywhere he goes.
“[Testosterone] doesn’t help me pass or afford me other societal privileges… It makes me more of a target if anything,” RA said. “But it’s what I need to do to feel like myself.”
Regardless, after no longer being able to rely on surplus hormones from a friend whose doctor “was clueless about dosage,” RA had to travel to Chicago—over four hours away—to get his own prescription at a sliding-scale clinic. Here, RA needed to lie about his chronic health problems and medical refusals to receive care.
“I also lied… so I could get more T than I needed in case something went wrong, or someone else needed a shot,” RA said. “By that point I had another friend on T, and it was normal for us to run out, not get a package on time, or run out of needles, so we lent each other doses until we were squared up [on] our own.
“I could make a vial last about 6 months. I knew that, by then, the T was long since expired, but there were also different medical policies then,” RA said. “I could barely afford it, so even if I didn’t choose to low-dose, I would’ve had to.”
RA said that low-dosing was taboo at the time due to its rarity. But still, to a “broke activist” like him, he needed to make his $75 vial ($114.16 adjusted for inflation) go as far as it could take him—especially considering that being employed was “a huge ordeal” for anyone who was visibly trans. “No different from today,” he added.
Eventually, RA “butch[ed] it up” to get a prescription from a local doctor, a “total jerk.” RA said obtaining T became pretty “uneventful” after that; it beat driving to Chicago, but he was constantly afraid of losing his access given how regular and necessary his lying was.
“Despite all the shit that comes with being trans, coming out was the best thing I’d ever done for myself, not like I had a choice,” RA said. “With T, I always thought it was a choice… one shot at a time… it was understood within me to be a requirement. It makes my life better somehow. I don’t know what it is. Hormone magic I guess.”
RA isn’t alone in constantly fearing that his prescriptions may be stripped away from him. In a poll conducted by The Wake to accompany this article, over 50% of respondents on HRT reported that they fear losing their HRT access “several times a day.” An additional 33% reported worrying too, but not as frequently. Every respondent in this poll reported accessing their HRT through clinics and pharmacies, though a few participants expressed desire for a community “hormone-share” so everyone can access HRT through mutual aid instead.
This brings us to Lilith Cooks (pseudonym), a 26-year-old trans woman with a biochemical bachelor’s degree and a dream: DIY (do-it-yourself) HRT, specifically estrogen.
“Since I started researching transitioning, it’s something I was always aware of,” Cooks said during our interview. “Because back in the day, that was the only way to go for a lot of people. And now, looking at the state of things… I [realized] I could do this myself.”
Cooks cites discriminatory insurance companies, potential medical abuse, and high price points as trans folks’ main barriers to HRT—she is correct. According to a 2021 report from the Center for American Progress, in the last year (2020), 46% of respondents (all of whom were trans) said their insurance company denied them access to gender-affirming care. An additional 47% said they were mistreated by a health care provider, and 20% said their doctor was rough or physically abusive. The statistics above are 10% to 20% higher for trans BIPOC.
Though there are trans-specific clinics like Family Tree and Planned Parenthood in the Twin Cities, traumatic memories and high prescription costs can still keep trans folks away.
So Cooks started doing the math: She could either keep paying $50 for a three-month supply, or, factoring in all the sourcing and shipping costs, $2.40 for a 50-dose vial (almost a year’s supply). Estrogen is the only medication she needs, as estrogen “monotherapy” already has a “testosterone-suppressing effect,” especially when injected.
Considering DIY testosterone, Cooks isn’t as well-versed due to its status as a controlled substance. But she says browsing bodybuilding forums online should get you some of the information you need.
Domestically, U.S.-based labs charge $200 a gram for raw estrogen. But through Cooks’ chemical supplier in China, Cooks pays $1,200 for 500 grams (including shipping). “If a tariff goes in place—even a 100% tariff—I’m still miles ahead,” Cooks said.
Cooks stumbled upon Hubei Vanz, her trusted source, through someone posting about DIY HRT on Twitter. Cooks sent the user a message, and the user replied with lists of public Google Drive “master docs” with information. According to Cooks, this process of community sourcing, vetting, and testing estrogen from various labs is par for the course when it comes to safety.
“It's not terribly hard to find at this point,” Cooks said. “If you ask around within the community enough, you'll find someone who knows someone who knows.”
All the equipment aside, Cooks said the process is as easy as mixing your estradiol valerate “in with your solvent, in with a stabilizer, and in with a carrier oil”—but, of course, with a lot of sanitizing, filtering, and steam-sterilizing.
“Anyone who can make bread from a recipe can probably do this,” Cooks said. “Everything else is just a matter of keeping yourself tight and making sure that you're not contaminating anything.” Cooks’ favorite resources concerning avoiding cross-contamination are from the mycology community.
Chemically testing your homemade HRT is still remarkably expensive. So, to assure her own operations’ efficacy, Cooks uses her own supply for about a month, then does her own bloodwork.
“Provided your levels look good, that tells you did it right. If your levels don't look good, obviously something's wrong, and you need to stop,” Cooks said. “Like, if you see cloudiness in your vials, don't inject that. Be smart. This is your health you're dealing with… Treat it with the respect it's due.”
Though it was slightly stressful at first, Cooks said practicing informational security is pretty manageable. Her main tips are to use secure, encrypted communication channels like Signal or Proton Mail, and to keep services off social media.
“I’m not a big fish, it doesn’t really matter,” Cooks said. “There are a billion reasons that someone may be buying these things: analytical lab work, just civilian chemistry, [and] having fun with it. Hell—just for personal use—it’s totally fine. But then again, I have no idea, I’m not a lawyer.”
Overall, Cooks is excited to continue her work providing life-changing and potentially life-saving access to HRT—afterall, HRT saved her own life:
“Before I figured out I was trans and started transitioning, I had attempted suicide five times. I had actively engaged in self harm from about the age of five to about the age of 21. I didn’t plan to live to see 25. And eventually I, through friends of mine… figured out that transition was an option… all of these things that I had been feeling my entire life weren’t wrong or stupid or bad, it was just a thing about me… And so then it was a process of figuring out who I actually am, and HRT has gone such a huge way into reshaping who I am physically to match… It’s self-realization in its purest form… I'm not going to let that be taken away from me for political clout, no matter what.”
Cooks encourages folks to protect their own lifestyles too, urging everyone to “get active in [their] communit[ies].” From offering a friend a home-cooked meal or donating money to a trans organization, organizing protests yourself or creating some art for organizations for free, Cooks says anything goes.
“Anything that you do, anything that you are passionate about, you can turn that into something to help… Anything [will] go miles in this current climate… We protect us.”
Through past and present, the story of HRT is a story of mutual aid—the oldest methods of prescription-sharing and DIY still prove to be the most effective. And you don’t even have to be trans yourself to participate!
According to psychologist Dr. Sebastian Mitchell Bar in his infographic “Totally Legal and Easy Ways Cisgender People Can Access Testosterone & Estrogen Replacement Therapy Prescriptions,” cis people can gain access to HRT through virtual clinic apps like Blokes, Hone, Evernow, or Defy. These prescriptions are intended to treat symptoms of low testosterone and menopause in men and women respectively, but also… who doesn’t get confused sometimes and accidentally donate their entire stockpile?
“As for the climate now, I honestly don’t know what to say about it,” RA said, concluding our interview. “I naively thought they’d mostly ignore us once they got power for more significant matters of destruction. Turns out they did both.
“I just think about how trans people have always been here, and always will be here. No matter what, there will always be more of us. It’s hard to stop a community like that.”