I don’t know exactly what I was expecting when I went to the Do-It-Yourself estrogen-making workshop. I’m not even totally sure why I went. Though I transitioned medically nearly 13 years ago, I’ve been lucky enough—privileged, really—to have relatively easy access to supervised hormone replacement therapy for most of that time. Even when I didn’t have a doctor’s oversight, I was always able to get prescription-grade medications (dolls sharing their prescriptions with the less fortunate is a time-honoured transfemme tradition).
Despite all that, one hot summer night in July, I found myself sitting on the floor of a yurt in the middle of the woods in rural New York with over a dozen transfemmes, learning to make injectable estrogen. The woman running the workshop was part of a collective that had taught hundreds of workshops just like this, and she guided us through the steps of the process with the cheerful self-assurance of someone who’d done it countless times before.
I definitely wasn’t expecting the synthesizing of hormones to be so, well, easy. It took only three ingredients to make injectable estrogen, all measured out and mixed together with simple equipment. There was a sterilization process, which was equally straightforward. Under the helpful guidance of the workshop facilitator, the whole process took no more than twenty-five minutes.
I had thought it would be much more complicated, somehow. Scarier. I had imagined arcane chemical formulae, beakers marked with the universal sign for POISON and maybe also the universal sign for FEMALE, bubbling test tubes full of glowing green liquid. Instead, the scene was something much more akin to spending a night in a community cooking class, right down to the plastic measuring cups. In the end, brewing up a vial of the Essence of Womanhood was easier than learning to bake chocolate chip cookies. But was it safe?
***
Access to gender-affirming care is always relative and always conditional. With recent anti-trans legislation and a growing political push to ban healthcare for trans youth and adults, it’s also becoming increasingly precarious. It was only in the mid-2010s when the informed-consent model—gender-affirming care that isn’t contingent on a mental health diagnosis nor psychiatric evaluation—became the dominant model of care for trans folks in some parts of the world. While it enjoyed a brief period of growing popularity, that model is now under vicious attack.
Even in the most privileged of spaces, the fear is always there: trans people understand how easy it is for the state, the medical industrial complex and the people who want to wipe us out of existence, to deny us access to who we are. How quickly they can seize control of our bodies in the name of “safety.”
Perhaps this is what drew me to the workshop. As a trans person who works in both political advocacy and the wellness industry, the ongoing effort to strip trans people of our legal rights is never far from my awareness. I’ve been hearing about DIY hormones for my entire career, but lately I’d noticed them being mentioned much more frequently. Workshops like this one, and networks of trans folks who teach them, are becoming more culturally prevalent as more trans people find ourselves interested in—or in need of—alternatives to a medical system that is growing increasingly hostile toward us.
To be honest, the medical system was never a great place for trans people: even at its “best,” the medical establishment has a fraught relationship with us. Healthcare can be confusing and disempowering. The medical paradigm sets us up as problems to be solved by nurses and doctors—and frames trans people as being incapable of taking care of ourselves.
The workshop rejected this premise. The facilitator gave us information about how estrogen impacts the body, as well as basic safety tips. There was no fear in her matter-of-fact voice, no cowed disclaimer in her presentation that we should only pursue DIY hormones as a “last resort” if legitimate medical care was unavailable. She was simply giving us knowledge and letting us decide how to use it.
Having spent half my adult life working in mainstream healthcare, where DIY hormone therapy is treated as extremely dangerous and highly stigmatized, the difference was shocking. When I was a social worker, I had been trained to warn against DIY care. I spent many years in a health advocacy paradigm where the main goal was to make gender-affirming hormone therapy a common part of primary care, and to get more trans people access to it. In social work, DIY care was seen as suspect; it came with an air of malpractice and danger and—worst of all— extreme legal liability for health professionals who discussed it with their patients.
Today, as some of the world’s richest and most powerful people devote their lives to destroying trans people (an absolutely absurd sentence to write that is nonetheless true), and the medical establishment that my colleagues and I spent so long trying to change for the better seems poised to abandon us, I have to wonder: What did we accomplish, in the end? What was any of it worth?
Since the inception of medical “standards of care” for trans people, access to hormone therapy and gender affirming surgeries has been fraught with politics and power dynamics. Throughout most of the 20th century, trans people who wanted to access gender-affirming medical care were required to undergo extensive psychological evaluation, sometimes lasting multiple years, as well as the highly criticized “Real Life Test”—an extended period of living in one’s identified gender role without access to hormones or surgery.
These procedures, often described as humiliating and psychologically harmful by trans patients, have created an intense, inextricable and deeply complex relationship between trans people and the medical professions. Even in my position of relative privilege, I still felt the pressure to perform in order to access care as a young woman in early transition: to answer the doctor’s questions about my childhood, my sexual history, even my masturbatory fantasies and to answer them “correctly” based on a criteria that was both subjective and externally decided. There was, it seemed to me, something sordid about it, something prurient. It didn’t seem to be about me or my safety, to be honest. It seemed to be about something else.
When the paradigm offered to trans people by the medical-care system is invasive, humiliating and disempowering, why wouldn’t we want an alternative that puts the control back in our own hands?
***
Writing for the public about DIY hormone therapy is challenging. The practice has long been classified as high risk in medical literature and mainstream health promotion, and legally speaking, some exogenous hormones (mostly testosterone and other androgens) are controlled substances in some jurisdictions.
Even beyond this, there is equally a cultural stigma and controversy around DIY hormones among trans people, many of whom also have strong concerns about safety even as they recognize that DIY care may be the only accessible care for many people. Still other trans folks extoll DIY hormone therapy as revolutionary and view the risks as both lower-level and manageable with adequate safety procedures.
Liability, stigma, safety and ethical debates make it so that describing specific ingredients, preparation processes, groups and individuals in an article is tricky. Suffice it to say: the information is out there for those who are looking.
Writing about it now, I am reminded of the times that I have done work with feminist groups providing DIY and underground contraception and abortion care. It occurs to me that the parallel between underground networks of hormone therapy for trans people and underground networks of contraception and abortion care are striking and not coincidental.
The central politics are essentially the same, as are the controversies. It all comes down to questions of autonomy and access: Who has the right to provide medical knowledge to others? Who has the right to control their own body, and to take risks in asserting that control? And who has the right to decide?
***
The biggest surprise in the DIY estrogen workshop was how I felt at the end, holding my little vial of gender fluid in my hand. Until then, I’d spent most of the workshop in a thoughtful mood, listening to the facilitator’s bubbly voice, taking notes, reflecting on my past as both a healthcare professional and a patient.
I’d gone to the workshop not knowing what to expect. I’d gone in telling myself I might learn something that would come in handy as a community organizer, that it was good “general knowledge” for someone interested in trans culture. I suppose that some part of me didn’t want to own up to the fact that my being at the workshop was actually about me and my life, my relationship to medicine and the power that doctors, therapists, nurses, the government and the law have always claimed over my body, and all the ways I’ve had to submit to painful and humiliating things as a trans woman in this world.
But there, in the room with all those other transfemmes, I couldn’t hide from the feelings welling up within me. I couldn’t hide from the fear, the excitement, the grief of all those times I’d given up the right to control and define my body to someone or something else. That night, I felt almost giddy, and going off of the excited chattering and giggling of the other women and femmes in the room, I wasn’t the only one.
When I’d finished mixing those three ingredients and sterilizing my tiny bottle of estrogen, I was filled with an undeniable rush of emotion. What had I just done? What was I really holding in my hand? Was it poison? Or was it a potion, the key to unlocking another way of being?
It was power. It was danger. It was freedom. It was me.
