Informed Consent Doesn't Go Far Enough: The Case for Hormones Over-the-Counter

The following article was originally posted to Assigned Media. It has been syndicated with the permission of the original publisher.

Certain terms have been changed to better reflect the original intent of the author. In particular, the word 'transsexual' has been added back to the text.

Originally published Oct. 23, 2025

By Jane Migliara Brigham

Why do we rely on doctors to address our basic medical needs?

We are taught that doctors are there to help us understand what is wrong with our bodies, and that they can help us get better.  In doing so, they provide a noble service.

Living as a transsexual proves that this is a lie.

We transsexuals need external medicine to live with dignity.  This medicine is easy to use and hard to mess up.  In some parts of the world, including Brazil, Spain, and Thailand, estrogen and other hormones for trans women can be purchased without a prescription.  After all, half the world’s population produces estrogen naturally, so it’s hard to argue that it’s dangerous. 

Despite this, in much of the developed world, obtaining bioidentical estrogen and testosterone through legal channels requires a prescription.  That means going through a doctor.  

When doctors come between you and your medicine, they get to set the rules.  They get to provide the medicine they want, at the dose they want, and with whatever requirements they want.  The doctor holds a monopoly of medicine over the patient.

This is a big problem for transsexuals.  When doctors can come between us and our transition, our rights are in their hands.  For decades, they used this power to only allow those of us to transition who would assimilate into the wider society.  They expected patients to be heterosexual, to pass as cis, and to avoid associating with fellow transsexuals.

As a result, the vast majority of people who wanted to transition were prevented from doing so.  

Rather than follow the doctor’s demands, a small group of trans women began taking medicine into their own hands.  This was the rise of the Do-It-Yourself Hormone movement, where transsexuals made and distributed our own hormones. 

It was so successful that orchiectomies were widely available, such as in Washington state’s “Testicle Barn”, where trans women could get procedures done that they couldn't get anywhere else.

Doctors in the United States, seeing that they were losing control of their patient’s medicine, and that this might harm their monopoly over said medicine, began to implement an informed consent model for transsexual medicine.  In this model, patients that met a set of preconditions, such as being adults, not being deemed mentally unsound, not having an interfering medical condition, and the like, were given access to cross-sex hormones. 

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This gave doctors control over access to medicine while still allowing for some limited measure of bodily autonomy.  The result was that transsexuals could get their medicine, but the doctor had the right to dictate what medications were given, in what doses they were given, and reserved the right to revoke access to this medicine if their instructions were not met.

This half-assed implementation of bodily autonomy isn't good enough.  The longer you transition, and the longer you talk about hormones with other transsexuals, the more you hear complaints and horror stories about mistreatment at the hands of the medical system. 

The most common complaint is that the hormones given are not enough to create the medical changes that are desired.  Trans women I know have taken to calling this ‘menopause dosing’, since low doses of estrogen create a hormonal profile similar to menopausal women. 

Other times, accessing hormones at all through official channels is prohibitively difficult or bureaucratic, as is the case in the UK, where wait times might be longer than your entire life.

This is unworkable.  Having the means of our dignity in the hands of bureaucracies that are not accountable to us will never be a system that brings freedom.  If you want to have dignity in your own hands, you have to Do It Yourself.

In much of the world, access to estrogen and progesterone, the two main pieces of transfem medicine, can be obtained over the counter at pharmacies.  This allows trans women to start transition on their own timeline and in their own way.  They can ask for the advice of doctors if they wish, but since doctors lack a monopoly of medicine, they cannot act as gatekeepers. 

Sadly, this flexibility has not been afforded to trans men, as testosterone, the main piece of transmasc medicine, is a controlled substance in most of the world, largely due to its use by athletes as a performance enhancing drug. Testosterone does have a slightly higher risk profile, but with access to regular blood tests and the information needed to interpret them, it can be managed safely as well.

The model of free access to transsexual medicine should be expanded.  Everyone, no matter where they live, or what hormones they need to live with dignity, should have their medicine freely available.  Just as no one can tell us what we can and cannot do with our bodies, neither should they be able to restrict the tools we use to mold our bodies.  Without the tools to change our sex, the right to change our sex cannot be secured.