“Not just rebellious, it's revolutionary”: Do-it-yourself hormone replacement therapy as Liberatory Harm Reduction

Abstract

For some transgender people, hormone replacement therapy (HRT) is “an ontological necessity for a livable life” (Fondén, 2020, p. 29). Some trans people engage in do-it-yourself (DIY) HRT (aka “DIYers”) because of care barriers, including medication costs, difficulty accessing healthcare providers, and mistrust in professionalized medical systems. Although DIY HRT is often framed as highly risky, we analyzed in-depth interviews with 36 U.S. DIYers to understand how they themselves perceived their goals, challenges, and risk mitigation using the Liberatory Harm Reduction and lay expertise frameworks. Participants emphasized experiences of transphobia within medical spaces. In contrast, participants characterized DIY HRT as a community-driven, accessible, and empowering practice. Through self-organized online forums and mutual aid, DIYers constructed adaptive health-promoting practices that challenge biomedical conceptualizations of risk and affirm trans agency.