The information on this page is intended for healthcare professionals. You can find information for trans patients on our How to access medical transition page.
In our 2022 survey on trans healthcare, 25% of respondents indicated that they had resorted to self-medication.
Why patients self-medicate
Patients currently being seen at NHS gender clinics have in many cases waited in excess of five years, and patients currently on the waiting list often anticipate that their wait time will be longer. In our 2022 survey on trans healthcare, the majority of respondents indicated these extreme waits for gender affirming healthcare significantly impacted their mental health, physical health, relationships, and work life.
While alternative private services exist, many trans people are unable or unwilling to pay out-of-pocket for gender affirming care.
Risks of self-medication
Metastasio et al describe the potential risks of self-medication:
- Counterfeited products: Counterfeit medications can contain ingredients or contaminants that cause significant health issues. Patients may be unable to distinguish genuine pharmaceutical manufacturers from ‘home-brewers’ who compound medications in home environments.
- Route of administration: Many medications used as part of hormone self-medication are administered by IM injection and your patient may not be aware of safe injection practices.
- Lack of monitoring: Patients may be unable to titrate dosage correctly so may end up significantly overmedicating themselves, which risks serious cardiovascular side effects.
With such a widespread prevalence of self-medication, and the normalisation of the practice in many trans communities, your trans patients may perceive the level of risk involved in self-medicating to be low.
Options for risk reduction
If a patient discloses to you that they are self-medicating, options you can consider are:
- Bridging prescriptions: if you feel comfortable to do this, you may offer your patient bridging prescriptions while they are waiting for the NHS gender clinic. You can find more information about how to do this on our Prescribing page.
- Offering blood testing: if you do not feel comfortable prescribing, another option available to you is to offer blood tests. You can find guidance from NHS gender clinics on our Prescribing page which contain details of the typical monitoring tests required. It is important to ensure you are aware which medications your patient is taking, as some medications are not typically used by NHS services and have specific associated risks and tests to mitigate them (e.g. spironolactone).
- Patient education: you may wish to explain to your patient the risks involved in using unprescribed medications, self-injection, and lack of monitoring. It is important that you maintain a non-judgmental approach when speaking to your patient – they may have already thought carefully about these risks and made an informed decision.
- Alternative medications: you may consider offering medications that may help reduce the effects of specific triggers for dysphoria, such as finasteride for hair loss or medroxyprogesterone acetate (Provera) for stopping periods, while the patient is waiting to be seen by the NHS gender clinic. You can find more information about this strategy on the Tavistock and Portman Gender Identity Clinic site.
- Signposting: Your patient may be unaware of services and information available to them, such as:
- Private sector gender services: detailed information about these services can be found on our private care page.
- Private blood testing services: patients are able to use a variety of private services to have blood testing performed for them.
- Injection supplies and disposal: patients can make use of services that supply safe injection supplies. Search tools are available for England, Northern Ireland, and Scotland; in Wales look for information on the website of your Health Board.
- Injection guidance: Some NHS gender clinics have information about safer injection practices available on their websites.
- Harm reduction clinics: harm reduction clinics exist in London (THNX), Bristol (Dandelion), and Sheffield.
Further guidance
- Leeds Gender Identity Service have produced guidance on managing self-medication.
- NHS Wales have produced guidance for non-specialist prescribers which includes advice for handling self-medication (page 28).
- The General Medical Council has advice on managing self-medication on their Trans healthcare ethical hub.
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Disclaimer: TransActual do not provide medical, health, or legal advice. The content of this page is intended to be read by healthcare professionals and is for information purposes only. Use this information in conjunction with your professional judgement and expertise. Information on this page is not a substitute for advice from a legal professional, and we strongly suggest you consult a legal professional for specific legal advice about your situation. TransActual do not advocate or recommend the purchase of any specific product or paid healthcare service. We do not endorse or guarantee the credentials or appropriateness of any health care provider, any product or any provider of insurance and legal services.
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