"If I was starting transition now, and knew what I know now, I would self medicate. Absolutely no question".
I read this quote a while back, referring to the practice of self-administering hormone treatment without any prescription. It came from someone well-known in this sphere whose stance I respect a lot. And it struck me, how unusual it is to see someone saying something like that in public, online for all to see.
You see, what normally happens if someone mentions self-medding on the internet is this: they are drowned out by a chorus of people anxious to point out that it's generally frowned upon, all sorts of nasty things can happen to you if you do it, it's illegal, it'll affect your future treatment, etc. etc. If the mention happens on a moderated forum or mailing list there's a good chance it'll be deleted too, because We Don't Encourage That Sort Of Thing.
Y'know what? We know.
We all know self-medding is a risky business, we don't need to be told again and again. What we do need within this community is the chance to talk about it in the open, because stifling any attempt to do so is stopping a conversation in this community
that both we and our medical practitioners need to have.
My local psychiatrist surprised me a while back when he told me that as many as 80% of his patients self med with hormones they've bought from the Internet. I knew a few people who were open about it, but never realised it extended to that many of us.
So, just out of curiosity, I asked a few friends. Got some funny looks, but assured them it was only for intellectual interest. My wife would not thank me for self-medding and I don't want to lose my fertility just yet, those are pretty good reasons not to do it if there weren't plenty of others.
I was reminded of a 1950s British film in which one of the protagonists - a terribly respectable middle-aged lady author - goes into a seedy pub to try to buy a Mickey Finn to incapacitate her blackmailer. She ends up trying to buy one from a man who turns out to be a policeman, saving herself only by claiming to be researching for a book. "Pssst - Where can I buy some Estrogen?".
If you ask people why they self-med, it always comes down to the gatekeepers. The medical profession don't make it easy for us to get our hands on the hormones for many very good reasons. Aside from the need for safety under medical supervision there are some people who seek hormones for whom they are an extremely unsuitable treatment. There are many arguments passionately made as to how the doctors could speed up their service and how their attitudes could be updated, but why they work the way they do is entirely understandable and in the best interests of their patients as they see them.
The trouble is, in doing this it seems from this viewpoint that the gatekeepers encourage self-medding. This isn't a tacit encouragement, but it happens in two ways. By raising the barrier to legitimate prescription they increase the incentive to simply bypass them. Thus they simply never see a great swathe of non-transitioning self-medders who don't need their other services. Then when they do encounter someone who self-meds their concern is to get them onto a safely prescribed dose as soon as possible so they forgo the usual RLE test before a prescription is issued. This encourages people at the start of transition to self-med while on the waiting list. I have more than one friend who has done just that, and I believe the quote at the start of this piece referred to it as well. Why spend an uncomfortable period as a bloke in a dress when you can hit the ground running?
This relaxation of the RLE requirement has a rather iniquitous parallel. Those patients who self-med are rewarded with a fast-track, yet those patients who present to NHS clinics having obtained legitimate hormones by private prescription seem to be required to come off them and serve the full RLE without hormones. I have personally encountered more than one person who has experienced this, as well as a couple of well-publicised people in the blogosphere. The dichotomy between a reward for dodgy hormones and a punishment for legitimate hormones is startling.
(Edit: Following clarification of the legal position in the UK, removed paragraph relating to dire punishments for those importing hormones. My source turned out to be wrong. It seems it's illegal to import testosterone in some circumstances but not estrogen. Well, those of us on the MtF side of the fence know testosterone is the dangerous one! :) )
I wonder if I'm alone in thinking the situation I've outlined above is a bit of a mess. A mess without clear fault or solution at that. It's difficult to fault desperate people for self-medding, equally you can't blame doctors for doing their job, however frustrating it might seem at times. But if it's a mess without a solution, one thing definitely makes it more of a mess. The self-censorship within our community whenever the subject comes up isn't helping anyone.
I'll repeat the point I made in the title of this piece: it's time for a grown-up conversation about self-medding.