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Transfem @lemmy.blahaj.zone
winter (she/it) @lemmy.blahaj.zone

should I do diy?

I've been getting more comfortable with the idea of starting hrt. The 2 main reasons I havent yet are the current US politics and also I'm not ready for my parents to know about that yet and as far as I am aware they would know because I'm on their insurance and it would be in the bill. Diy avoids both of those things though. The one thing idk about is actually paying for it. I'm in college rn and while I did make a good amount of money over the summer, spending $20 per month or however much it is doesn't really sound great but because it is something I genuinely need im not sure and I just want to avoid going through my parents and the medical system

Edit: Also realized I should mention that I am an adult because that's probably important with informed consent stuff

19 comments

  • Given the US government is actively banning all trams healthcare, yes. There is a high likelihood there will be no other option in like, a month or two. Amd even if it isnt banned that soon, personally wouldnt want that on my medical records at this point.

  • Go for it

  • There are positives and negatives to DIY. This website has good info. It has never been more feasible to access DIY and a lot of good resources and groups exist to help you figure it out.

    Make sure to focus on suppliers that are reputable and follow safe injection practices. There are websites around that keep track of suppliers and availability. They really only take payment in crypto, but most suppliers have guides on getting the crypto and paying them.

  • Personally I would talk to your parents, they support your queer sister and you have already come out to them as trans and they support you with your name change - you need the medical support, so talk to them. If that doesn't go well, then looking into DIY becomes more necessary - but don't start with DIY when you have a much better and safer alternative right in front of you.

    It's scary, but many aspects of transition are scary, unfortunately.

    One way to deal with the fear is to organize yourself, do lots of research, and then present your parents with an educated and reasonable argument. Preparation is one way to deal with anxiety and fear, basically.

    To help, here is a literature review that summarizes the clinical outcomes of gender affirming care:

    https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/

    You can also point to the fact that every major medical association endorses gender affirming care for minors and adults:

    https://glaad.org/medical-association-statements-supporting-trans-youth-healthcare-and-against-discriminatory/

    And I also found this article by a bioethicist useful - it lays out some of the history of gender affirming care in the U.S. and debunks common misconceptions about gender affirming care and in a moderate tone - would be helpful for parents I would imagine:

    https://www.openmindmag.org/articles/care-not-controversy

    You could also try to find a trans-affirming therapist and see if they would be willing to moderate the conversation with your parents for you.

    • part of what makes having that conversation so difficult is that I already have been presenting as nb to them and they assume I'm fine with that and I don't want to have to come out to them again

  • Just a guess without looking anything up, it will probably cost more than $20/month. Personally, I recommend going the clinical route since you are in the US and the quality of care is generally good. Opinions vary on monotherapy (which DIY generally is) vs E and spiro. In general, you'll want your levels checked every now and then, and you'll want to avoid smoking anything as that can interfere. (I'm in a town where everyone is kinda sketchy so I'm biased to assume people might have addictions, eating disorders, or other issues that complicate things.)

    • the issue with being in the US is with his things are right now I'm worried that the "good care" could get taken away very soon bc of the current politics situation. I don't really know much about how the clinical stuff works besides if you dont get it through planned parenthood you have to be diagnosed and it's a huge wait but I might be completely wrong

  • DIY generally should only be used as a last resort. There are lots of risks involved in HRT that you really should have a doctor for. Also, you'll be unlikely to get dosages right if you can't get blood levels tested periodically.

    As for parents knowing about clinical HRT due to insurance, you might want to check into if your insurance company allows an adult dependent to have confidentiality. A few do, though with consolidation of insurance companies lately, that may no longer be an option in most people's cases for all documents they produce. You'll need to ensure that both the EOB/EOP documents that the your parent receives can have diagnosis and lab procedures codes hidden and that prescription claims do not show the prescription name. But the most difficult one to hide usually is the authorizations if you get patches or any other option that is a drug that's normally only covered in dosages that are used by cis people and requires authorization for higher dosages required by trans people.

    And assuming you can get all of that, you need to make sure you use a local pharmacy and not a mail-order one connected to your insurance as they often leak the information, and make sure you talk to the pharmacist to ensure that they will keep your records confidential, even from a parent.

    Unfortunately, all of these things are difficult to control, so you could try to find a clinic whose fees work on a sliding scale based on income to get monitoring and blood tests, and do the DIY.

    Also, $20 is a pretty small amount. To get good quality, safe DIY HRT, you likely will need to spend more unless you grow some of the plants yourself and learn how to properly test, process, and use them. The supplement industry is full of fakes or outright dangerous products. And DIY can only provide supplementation, not androgen blockers.

    For me, I'm lucky enough that I've never needed androgen blockers, but that's not true of everyone. Tangent, but there's not good data on how often people need them since trans care is all off-label drug usages and so have little to no funding for research. But it's becoming more widely practiced to wait to start the blockers to see if they are needed or not, now that it's better understood how the body often chooses which hormones (estrogens or androgens) to produce by which is more prevalent after the blood is flooded with one over the other for some time. It used to be thought that testosterone was dominant, but it's looking like that idea might have just been patriarchal medicine at work. Unfortunately, once you start blockers, you are likely to need them indefinitely unless you have some surgeries. This is likely due to a poorly understood feedback loop that's created likely similar to how overuse of artificial sweeteners confuses the body into not producing the right amount of insulin when consuming real sugar. Once the body gets stuck in those kinds of loops with hormone production it's difficult to get out of them.

    But I'm not a doctor, so don't take any of this as medical advice, just my 2 cents as someone deeply involved in trans issues and the health insurance industry.

  • Taking a look at Quest's website, hormone tests are about $225 if you aren't going to go through insurance. Ideally, you'd get these done every 3 months until you figure out your dosage levels. So ideally, you would budget ~$1000 for that. Also, these would still leave medical records that would clearly indicate something is up if you are worried about like worse-case scenario (and getting around that may require access to equipment with costs over $100k and would require some training? idk really know what option their are for this, but assuming something like LC-MS). Technically not strictly necessary, but there is so much variation in how people respond to doses that you pretty much have to do some testing to make sure you are in target ranges. If you manage to get an antiandrogen, those might require additional testing (ie: checking potassium levels if you are on spiro, which would ideally be done before starting)

    The hormones would be far cheaper than that afaik, although you may want to get that in bulk upfront if you are concerned about the political changes limiting supplies. And I think I heard a rumor that getting antiandrogens from the grey market in the US is harder right now? So monotherapy may be the only option.

    I think anyone starting HRT in the US now should consider DIY and think its probably better than nothing. But I think if I were starting again today, I'd go through informed consent again if at all possible and only switch to DIY if that became the only option. And by that point, hopefully I'd have a decent idea how dosing works for me that going a while without testing wouldn't be a problem.

    Also, if you use injections, they tell you to only use the vial for a month, but a single vial can technically last far longer (the trade-off being the more its used, the more likely there are to be contaminants - one month is sorta like a best sell-by date used by companies to cover their ass). So stockpiling is viable via non-DIY.

19 comments