Cross-sex hormones designed to masculinise or feminise a person’s body can be purchased online for less than £11 a month, with experts warning that more and more under-18s could be turning to the hidden drug economy.
Last month, the groundbreaking Cass review into the gender treatment of children in England concluded that there was a lack of reliable evidence to support the use of cross-sex hormones and puberty blockers by young people who are questioning their gender identity.
As a result, the provision of cross-sex hormones to young people under the age of 18 is being reviewed. The report states that while they can still be made available to patients aged 16 and over, they should only be prescribed with extreme caution and with a strong clinical rationale for not waiting until a person turns 18. The recommendations apply to the NHS and private sector. sector.
Although trans adults are often prescribed such hormones, it is illegal in Britain to supply the drugs to adults or young people under 18 without a prescription.
Guardian research found that online pharmacies in places ranging from India to Hong Kong and Portugal are offering hormone treatments without a prescription, typically ranging from around £10 to £30 for a 28-day starting dose of feminising hormones.
Although some suppliers claim that their websites should only be used by people aged 18 and over, there appear to be few, if any, barriers to young people making purchases.
There is also a wide range of online sellers, some based in the UK, who prepare their own mixtures of hormones – often for injection – in a process known as ‘homebrewing’.
Cross-sex hormones are medications used to change the body. In women registered at birth, testosterone can be given by injection, through patches, or through gels applied to the skin to induce changes such as facial hair growth and deepening of the voice. Hormones, including estrogen, can be given as tablets, injections, gels, sprays or patches to registered men at birth to promote changes such as breast growth.
According to the Cass review, around 500 young people were taking these hormones when they were discharged from the NHS Gender Identity Development Service (Guide) between April 2018 and December 2022.
Now concerns have been raised about the easy availability of ‘do-it-yourself’ hormones online, and whether young people will increasingly turn to the hidden economy, including drug dealers, to obtain the hormones illegally.
Dr. Alison Cave, chief safety officer at the UK Medicines and Healthcare products Regulatory Agency (MHRA), said: “Patient safety is our top priority, and we strongly advise people not to self-prescribe medicines or attempt to obtain them through an unregulated agency. source.
“A prescription drug may only be legally sold or supplied in accordance with a prescription issued by a licensed physician. It is also illegal to sell or supply unauthorized medicines.” The MHRA had not approved any drugs to treat gender dysphoria, she added.
Dr. Aiden Kelly, a clinical psychologist who left Gids in 2021 and has since set up a private service, said he was concerned that “people in despair will access care in unsafe ways”.
“We are already seeing patients come to us where matters are not properly managed and therefore have poor results. These are people who have sought treatment abroad or online,” he said.
The Bayswater Support Group, which works with parents of children who have a transgender identity but opposes a ‘gender-affirming’ approach, said a public information campaign was needed.
“Vulnerable children and young adults need to be told the truth about puberty blockers and cross-sex hormones: the evidence base is very weak and there are known risks,” a spokesperson said.
Maria*, whose teenage daughter bought testosterone online and later from a drug dealer, said hormones should not be given without a prescription. “That doesn’t mean that the NHS route should therefore be made easier, and that all safeguards should be thrown aside,” she said.
Maria added that her daughter has since transitioned. “The point is that my daughter has suffered permanent physical damage from the testosterone she illegally obtained from the prescription – permanent damage that will never go away, and that she will have to live with for the rest of her life.”
The Trans Safety Network said that since the sharp reduction in referrals to hormone experts for young people from 2020, there had been several investigations into suicides by young transgender people, including verdicts concluded that lack of access to health care was an aggravating factor.
“The near disappearance of these routes will lead to young people being exposed to risks and taking measures into their own hands,” a spokesperson said.
The group also raised concerns about a crackdown on the ‘do-it-yourself’ hormone therapy market, saying it exists because of the inability to provide safe, timely, monitored and supported access to treatment.
“Any attempt to ban online distributors will further push young people away from the commonly used gray market online pharmacies with legitimately manufactured medicines, through countries where these medicines are available without a prescription, to less established sources, with unknown additional risks,” the statement said. spokesman. .
The Department of Health says the MHRA is monitoring online channels and working with partners where possible to disrupt the illicit trade in human medicines. “We are closely examining what can be done to reduce any loopholes, including in the legislative area,” a spokesperson said.
*Name is changed.