Hormones via internet
Let’s be honest: hormones have been available online for many years. There are at least five huge disadvantages to getting hormones from the Internet:
1) Sometimes the dosage isn’t accurate. The quantity of active medicine may match what is announced on the package, but it doesn’t have to be. Sometimes it’s more, sometimes it’s less. There may also be other ingredients than announced on the package. See also the report by Transvisie for the implications this can have.
2) The pills may also contain different active ingredients or contaminations. This isn’t visible to the naked eye. Medication may have the same packaging, the same labels, the same shape, the same blister strips as medication from the pharmacy... and yet contain pills with different active ingredients and/or contaminations. We once saw a German documentary in which pills from England were supplied via South America and produced in India. They were produced in pitiful circumstances by people working at home.
3) Importing medication from abroad is not allowed in the Netherlands, the customs office can confiscate the packets. For more information look at the custom office website.
4) Because this way to acquire medicine is illegal, there usually is no reimbursement by the health insurance. The costs can be quite substantial. For example: testosterone for men costs about € 100 per month.
5) Patients have to find a place to have the hormone levels in their blood tested. (In the Netherlands this is now possible at VUmc, but also at http://www.bloedwaardentest.nl/). Some patients choose not to have their blood levels tested (maybe because they cannot afford it). Patients who get their medicine prescribed by a doctor usually get their blood tests free of charge.
But let’s look a bit further than these disadvantages. Let’s look at the case stories of Anke, Bea, and Christel.
Case story on self-determination: Anke
Anke (*) ordered hormones via internet because she wanted to grow breasts. She ordered the hormones via a website in England. When she started taking them, her breasts started to grow. This made Anke very happy, but... the breasts became visible. They still couldn’t be seen when she was wearing clothes, but Anke was living as a man and things might become difficult in the men's changing room at her sports club. She got very scared: would the men accept her when she would have to start wearing a bra? She stopped taking hormones and after some thinking and hesitating, she went to see the gender team psychologist. Her request to the psychologist was for assistance for her social transition from man to woman.
We think that being able to get (good quality) hormones (and blood tests) first and seeing a psychologist voluntarily is a much more practical order of succession than being required to see a gatekeeper before hormones can be prescribed. In this way transgender people are free to see a psychologist if they want to and only make use of the help they need. Some of them just need a transgender support group. Or their next-door neighbor. Or their general practitioner. There are also transgender people who do not need any help from others. If help is needed there are good alternatives for a psychologist specialized in gender issues, only the transgender person can decide what the best solution in their situation is.
Finally: Anke told me her breasts were really still very small at the moment this all happened. She wouldn’t have needed a bra yet for a long time and the men in her sports club had never noticed anything special. Even years after starting a hormone therapy trans women’s breasts often remain smaller than those of men who take a lot of alcohol. Many trans women who start taking hormones at a later age never become fully passable. The idea that very soon after starting hormone therapy there is no way to go back to living as a man is a fear that is often abused.
(*) Not her real name
Case story on self-determination: Bea
Psychologists like to create the image that many things will go wrong if hormones are prescribed too early. They see it as their role to ensure patients get hormones at the right moment (especially not too early). But it is difficult to determine when the right moment is. In Bea’s (*) case, the moment was not right. The psychologist decided it was time to give permission... but Bea didn’t feel ready yet. She delayed her own transition process. The hormones stayed unused on her bedside table for a few months and she decided to take them back to the psychologist. Some years later, she went to the hospital again, and she had to go through the diagnostic phase again. She also got hormones again and this time she did take them. Bea is living as a woman now.
One can wonder what would have gone wrong in this case if there hadn’t been any diagnostic phase... Why did Bea have to go through a long series of sessions with a psychologist twice?
(*) Not her real name
Case story on self-determination: Christel
Transgender people regularly organize social evenings. They get together and they talk about many subjects, including hormones. One of the participants in such an event, let’s call her Christel (*), desperately needed hormones. The host of the event had her doubts about this. Had Christel really considered all the consequences? But Christel was sure: she had to get her hormones, no matter what the rest of the world thought about it. The event host did have a solution: she opened a cupboard, took a package of hormones and put them on the table in front of Christel. And then she asked only one question: "Do you still have any questions?” This action made Christel think: yes, she did have hormones now. But what about fertility? And what about erections? The host explained. And she started to have doubts: would her partner still love her if she wouldn’t be able to have an erection?
At the end of the evening the hormones remained on the table and the host put them back into the cupboard. The same thing occurred on several occasions, it was her experience people did not take the medication home with them when they weren’t ready for it. Because Christel came up with her own questions, the information was more tuned to what Christel needed to know. This way of working produced better results than working as a gatekeeper...
Just to prevent witch hunts or similar problems: the transgender evening where this occurred has been discontinued by now.
(*) Not her real name
Our conclusion is that gatekeepers often act as if transgender people just want to rush ahead and almost by definition want to go faster than they can handle. And sometimes that seems to be true (look at Bea and Christel), but transgender people are better in taking their responsibility than may appear at first sight. And that makes the guarding role a psychologist sees for himself usually unnecessary.