Adolescent Gender Affirming Care – Sourcing Medications
Sourcing Guide
NOTE: This information is compiled from several sources readily available on the internet. To review the original sources, please see the footnotes. Nothing in this information resource should be construed as medical advice
DISCLAIMER: The information contained herein is for informational purposes only and is not intended to substitute for medical advice or constitute medical advice. The information contained herein does not create a health care provider-patient relationship between the reader and any of the authors. The information contained herein is not intended to be definitive or exhaustive, and is compiled from sources believed to be accurate, but the authors make no representation that it is accurate. Moreover, the authors and their agents make no warranties or guarantees, express or implied, concerning the accuracy or appropriateness of this information for any particular reader given the frequent changes in the practice of medicine as new information is learned through medical studies. Readers should consult with a knowledgable healthcare providers for medical advice, treatment, and additional information on gender affirming care options based on their specific health care needs and medical history.
Sourcing Medication
This informational guidance is intended to be used alongside expert medical care from qualified providers. This section includes information about conventional legal methods of obtaining medication. This section also includes information about gray or black market purchasing options. All of the information provided is readily available from multiple sources online. This information is not intended as legal or medical advice.
How can medication be obtained legally?
Getting a prescription from a healthcare provider and filling that prescription through a domestic pharmacy is the safest option, legally and medically. For those who have access to gender affirming healthcare (and live in states where gender-related care is legal for people their age), providers will write a prescription and either send it directly to a pharmacy or offer a paper prescription.
For people who have health insurance (that the pharmacy accepts) the pharmacy will typically charge a copayment or other costs remaining after insurance coverage. For people who live in states where gender affirming care is banned, it will most likely be difficult or impossible to utilize insurance coverage for gender care prescriptions. People who do not have health insurance will pay the cost of the whole prescription. People looking for coupons or assistance with insurance copays might find assistance at GoodRx and NeedyMeds. Once the prescription and payment have been processed, someone can usually either pick the medication up in person or have them mailed. Some medications must be administered by a healthcare provider and will require an office visit, some can be administered at home.
People who live somewhere where gender-related care is very difficult or impossible to access may not have the option of obtaining or filling a prescription locally. Check here to learn what states ban gender care for adolescents. The next-best solution would be to travel to a state without adolescent care bans for gender affirming care. Cost and other barriers can render this inaccessible; groups like Elevated Access and or mutual aid groups may be able to help.
Options for people with prescriptions who can’t access a pharmacy
Ordering prescriptions from online pharmacies originating outside of the US can be both illegal and unsafe. Before ordering online, research the pharmacy to ensure its legitimacy and be aware that orders can be confiscated while in the mail system. For people who choose to order the medications from international pharmacies, it is recommended to use Canadian options if possible. These resources can help people verify that the pharmacy is licensed and safe:
All pharmacies listed in links above are licensed pharmacies and are required to have pharmacists on staff. They will only fill orders that include a valid prescription. Additionally, Honeybee Health is a US based pharmacy that might ship into ban states.
Because testosterone is a Schedule III (3) drug and thus a controlled substance it has additional restrictions. This means that it can be difficult and expensive to source when purchased internationally through a licensed pharmacy or when purchased without insurance coverage, but people do manage this.
In terms of legality, the FDA has issued “Coverage of Personal Importations” guidance for consumers and enforcers. Someone can import a 90-day supply of some prescription drugs and medical devices if they meet the following conditions:
The medication is to be used to treat a serious condition and no effective treatment is available in the United States.
No-one will be selling or promoting the medication to others in the United States.
The medication doesn’t represent an unreasonable risk.
You affirm in writing that the drug is for personal use.
The quantity is no more than a 3-month supply and the person ordering provides the name and address of the doctor licensed in the United States who is responsible for their treatment with the medication; or, the user provides evidence that the medication is for continued treatment that was started in a foreign country.
Options for people who can't get prescriptions
There are gray and black-market sources available online. Buying from these sources has its own risks (legal concerns, variability in product, risk of losing money) and this guide aims to reduce harm associated with those risks. For some people the benefits may outweigh the risks, just as for others the risks may outweigh the benefits. See the Risks section below for additional information.
Hrt.coffee is a trans-run directory of sellers for people seeking to buy prescriptions online. It lists suppliers that are generally well-regarded and have been tested and verified multiple times. There is a list of suppliers on their main page, and sources are broken down by medication type on the sidebar. Some puberty blockers are listed in the “GnRH Agonists” section. Keep in mind that not every drug listed in this section is recommended as a puberty blocker.
While Hrt.coffee’s listing of prices and suppliers by medication is very good, it is not perfect. Click through to research and compare prices and dosages. Readers can also open suppliers from their main page and search for medications. Some medications have multiple names — for example Lupron, leuprorelin, Lupride Depot, Lupron Depot, and leuprolide acetate are all the same drug. Users should know the dosage and strength of the planned purchase, and check that against what products are available.
Hrt.coffee does not list testosterone suppliers. However, DIY HRT Wiki provides guidance about sourcing testosterone online without a prescription. In their Transmasc Guide there is a Sourcing section with links to suppliers based on location. If possible, a user will want to order from a supplier that ships domestically. This minimizes the package’s contact with agencies like the FDA and DEA.
Depending on what medications are being ordered, a user may need injection supplies. It is possible to buy syringes, needles, and alcohol prep pads online and in person, though depending on area it may be safer to purchase online. DIY HRT Wiki provides some Amazon links to injection supplies, and there are similar products elsewhere online.
International online purchases may take a few weeks to arrive.
Verifying online suppliers
There is a great deal of information in community forums. Like all online forums and internet purchase reviews, there is both helpful and unhelpful information.
Two communities on Reddit often field questions about online purchases and share experiences with sellers: Trans DIY and Ask Transfeminine Hormone Therapy (AskMtFHRT). Searching directly on Reddit’s website can be glitchy, so try some of the tips outlined in this articleto effectively utilize a search engine’s tools to search Reddit. Reddit communities for many medications/suppliers
Because of testosterone’s status as a controlled medication, most Reddit communities do not allow supplier information (or supplier reviews) to be shared. Instead, look to Eroids, a steroid review forum.
Shipping and payment
Shipping
Though it is uncommon for medications bought on the black or grey market to be discovered or seized by customs or mail carriers, it is possible. If a buyer is able to buy from a pharmacy whose shipment originates in their own country (as opposed to an international shipment) the package will not pass through customs. This is not always possible but can reduce some risk (and likely means the package will arrive more quickly, as it’s traveling a shorter distance).
Payment options
How someone pays for their order will depend on what payment options the vendor offers. Some vendors take credit or debit cards, but more often require bank transfer like Western Union, Zelle, or MoneyGram or cryptocurrency payment. Any transactions made through a bank or credit card will leave a digital trail. While cryptocurrency has a learning curve, it is the most anonymous option among these. Some vendors state that they prefer cryptocurrency transactions and may even offer a discount to buyers using this payment method.
Using cryptocurrency
For those using cryptocurrency to make a purchase, there are several preliminary steps, and budgeting in extra time may prove helpful. Additionally, many cryptocurrency exchanges or peer-to-peer sellers require ID verification (also called KYC, or ‘know your customer/client) to ensure the account holder is over 18 and fulfills legal requirements. They may ask for a social security number, physical address, date of birth, and a photo of ID. Processing that verification can take a few minutes to a few days. There are ways to buy cryptocurrency without undergoing KYC, though those details are outside the scope of this document.
First, check what type of payment (and specifically what type of cryptocurrency) the vendor accepts. They may have this information in a FAQ on their website or it may not be available until proceeding through the checkout process to see the options listed. Crypto comes in different currencies — Bitcoin, Monero, and USDC for example.
A buyer will then need to purchase a type of cryptocurrency that the vendor accepts in a quantity that is sufficient for the purchase. It can be helpful to buy slightly more cryptocurrency than needed to account for transaction fees. There are many legitimate exchanges online but like any online transaction there are also scammers. Choosing a large platform with a good reputation will reduce risk.
There are many guides out there to using cryptocurrency (and a great many opinions on the specifics). Here are two guides written by people in the community sharing the steps they took:
This post describes using the cryptocurrency Bitcoin. It gives some background on Bitcoin itself, virtual wallets, and how to buy and use Bitcoin for online purchases either using the website Moonpay or through an exchange.
This comment describes using the exchange Coinbase to purchase from a supplier called Otokonoko. They buy and use the cryptocurrency USDC and describe how to transfer funds from their virtual wallet to that of the supplier, completing the payment for their transaction.
Risks to consider
If the state a buyer is in currently has laws that ban adolescent gender care it is possible that providing gender medications has been deemed a criminal act and someone could face charges. Check state by state bans on adolescent gender care here.
The package could be seized by Customs and Border Patrol or the FDA. This is uncommon but still a risk. Anecdotal evidence says that smaller orders of medication (3-month supply or less) are less likely to be seized. In most cases, if a package is seized in the United States the buyer will receive a letter sent to the shipping address stating that the package has been seized and offering a choice of either doing nothing (in which case they will destroy the contents of the package after a short period of time), or contesting the seizure and starting a formal legal process to reclaim it. Do not put anything in writing or speak to law enforcement without a lawyer present. Contact the online supplier, as some will re-ship packages or offer refunds in case of a seizure. Do be aware that sometimes packages are delayed due to regular mail delays rather than anything concerning.
Buying testosterone without a prescription is illegal, as it is a Schedule 3 (III) drug.
Please be aware that it is possible to get into additional legal trouble beyond what is described above, particularly given the rapidly changing legal landscape of gender care in the United States.
Legal rights. If approached by law enforcement in the US, everyone has the right to remain silent - say “I am exercising my right to remain silent” and do not offer any additional information, no matter how harmless-seeming. Don’t answer any questions or give any explanations or excuses. No-one has to consent to a search of their belongings, but police may pat someone down if they suspect the individual is carrying a weapon. Officers do not have to be allowed into an individual's home unless they can show a warrant signed by a judicial officer that lists that address as a place to be searched or that has the individual's name on it as the subject of an arrest warrant. If arrested by police, a detainee has the right to a government-appointed lawyer if they cannot afford one. Don’t say anything, sign anything, or make any decisions without a lawyer.
There are risks that individual online purchasing activities will be monitored or investigated. Diminishing online footprints can be achieved through:
-purchasing with cryptocurrency instead of with a bank or credit card
-downloading and using the TOR browser for all web activity that needs privacy (see these guides for mac and windows)
-creating an email account with privacy-focused service like ProtonMail to use for all new accounts and communication with sellers
-using messaging services with end-to-end encryption like Signal for communicating about plans rather than by phone call or regular text messages
-creating and using strong passwords
-and using the privacy-focused search engine DuckDuckGo.
Find out more about tips, tools, and how-tos for safer online communication at the Electronic Freedom Foundation’s Surveillance Self-Defense website. Importantly, please be thoughtful about sharing plans in speech or in writing and think carefully how public to be about about activities posting online.
There is an inherent risk that when buying medication online that it may not be genuine. Products offered on Amazon or other large marketplaces, or herbal supplements purporting to have HRT-like effects are likely fake. Consider only buying from online retailers that are well-reviewed by trans communities (or in the case of testosterone, gym-based communities). There have been some efforts to test HRT available from online sources, but they are limited in scope.
For buyers who live in an unsupportive environment, there can be risks to receiving packages to their address.
Most suppliers have discreet packaging. Know that not all offer tracking on packages, though some do.
Consider shipping to a supportive friend or family member if the risks of receiving a package where you live are too high.
It may be helpful to have the name on a package match the name on an identification document). If the package isn’t able to be delivered and needs to be picked up from the carrier it’s useful to have a name listed that matches the ID of the person claiming the package.
While PO boxes can offer a certain level of privacy, not all mail carriers will ship to PO boxes.