Obtaining hormones and antiandrogens as a minor: overview

I have a general overview on feminizing hormones elsewhere, but I felt there was a need for specific information on obtaining hormones for minors. This is a first draft. I hope to expand this; suggestions and personal experiences are very welcome.

This is a critical step if you are under 18. I strongly urge each of you who know you are women to figure out what's right in your unique situation after you read this information.

Intro, disclaimer, health and legal issues

Any medical decisions for minors are supposed to involve a parent or guardian. You will probably not be able to find a healthcare professional willing to assist you without parental consent.

If you do not believe this is an option in your case, you will need to decide if you are willing to take steps to circumvent these rules. I strongly urge you to take these steps with parental consent and with medical supervision. This section is medical talk, not medical advice and is subject to the Terms of Use you agree to by viewing this site.

Dosage and brand guidelines

I am a major advocate of the importance of anti-androgens (androgen blockers) for minors. Androgens are male hormones like testosterone. They contribute to lowering the voice, body hair growth, muscle growth, male pattern baldness, increased sex drive, and a bunch of other unwanted effects for young women in transition. You can help stop this from happening by taking an androgen blocker.

Even if you do not think you can start feminizing yourself yet, you should consider taking an androgen blocker to delay your puberty. Stopping the effects of testosterone is one of the most important things you can do at your age. Try to find a way if at all possible.

Below is a reliable resource by a doctor on dosage and brands:

http://www.transgendercare.com/medical/hormonal/hormone-tx_assch_gooren.htm

I personally recommend looking into an androgen blocker and oral estrogens for minors. Injectable estrogens are often considered more effective, but they are more of a hassle to use by yourself because of the needles, etc.

Guide for supportive parents (coming soon)

If your family is supportive, share the tips on on this page about how to help you get started.

In upcoming months, I hope to write a short pamphlet you can give to your parents or guardians as a guide for helping you find what you need. It will cover two ways parents can help you:

With medical supervision (finding a doctor, etc.)

Without medical supervision

Succeeding without knowledge of parent/guardian

Some parents will not respond well if you come out to them. If you think your parents will punish you or throw you out of the house, you should consider whether you should do this without their knowledge or not. Obtaining hormones without parental knowledge or permission is more difficult for minors and requires some extra planning.

Via adult friends and peers

You might ask a trusted friend or family member who is over 18 to help you. This will probably require confiding in someone. There's a chance they might tell your parents, so consider this carefully before talking to someone.

If you know other women in your area who are transitioning and 18 or older, you may be able to get one of them to assist you. Again, be cautious when meeting people, even other people who are (or claim to be) transitioning. Some of them may be more interested in sex than in helping.

Via your personal physician

Though this is rare, some women have been able to get this by simply asking. You should tell the physician that you wish to ask something that you do not want to discuss with your parents. If your physician agrees not to tell your parents, then ask about what you want. It is unlikely this will work, but if you trust your physician, it can't hurt to ask. Some might be more open to prescribing an antiandrogen if you say you hope to reduce your sex drive. You can say that there is some evidence that this can make interest in transition go away for some people.

Another possible option is to start hormones from another source, and then tell your physician that you are worried about doing it without medical supervision. Some doctors will assist you in order to reduce the chances of harming yourself. This is even more likely if you pass and present to the doctor as a girl. They may want to do blood tests and maybe a gene test (karyotype).

Via a family planning clinic

Some young people have been able to obtain birth control pills or other medications through a family planning clinic or through a public health clinic. Birth control pills have low doses of hormones and must be taken in larger doses to get the desired levels. They also do not provide much anti-androgen, which is important for stopping you from becoming more male-like (deeper voice, muscles, height, skull shape changes).

Though it can be better than nothing, I do not recommend birth control pills unless that's your best available option.

Traveling to Mexico

Many people in LA, San Diego, Phoenix, and other towns near the border make the trip to Mexico for drugs without a prescription. For minors, leaving the country requires appropriate documentation and can be difficult to do if you don't speak Spanish well. The best option is to have an older friend do this for you. Many women make little field trips down there a few times a year to stock up. Tijuana is not as easy as it used to be, and many pharmacies there no longer carry larger vials of injectable estradiol valerate.

Ordering online or by mail

This is an increasingly popular option, though you need to take a few extra steps if you are trying to keep this from your parents.

Step one: Choosing a shipping address

Friend or relative

If you have someone you absolutely trust, you might consider this option, but I do not recommend it.

Private mailbox

You might set up a private mailbox to accept packages at a local UPS Store or similar type of store. I recommend that over the Post Office if possible, since the Post Office can scrutinize shipments more carefully. This will probably cost $50 to $100 a year. Some private places may say they do not give them to minors. If that happens, head over to the post office and set one up.

Post office mailbox

Post office box service may be provided to a minor (a person under 18 years of age) unless the minor’s parent or guardian submits a written objection to the appropriate postmaster.

I have written a separate page on obtaining a post office box for minors

Step two: Choosing a payment method

Credit/debit cards (best option)

If you have a checking account of your own (which you should if possible), you can probably get a debit card that can be used to order online. Many online places will require a credit card to place an order. There are a lot of scams out there, so it is important to research before sending anyone any money or financial information. You could become a victim of identity theft. Only use a place that is recommended by someone who successfully made an order.

Cash by mail (not recommended)

This is not a good idea. They can just pocket your money and say they never got it. Many places won't even accept cash, especially if it's from another country.

Check (OK option)

You may be able to mail a personal check for your order. This will take longer, but is an option. I recommend getting a money order instead.

Money orders (better option)

You can get a money order from your bank, or from a lot of retail outlets like Western Unions, 7-Elevens, currency exchanges, etc. You will need to know the exact amount and who to make the money order out to.

Online payment services (good option)

Some places may allow you to pay via PayPal or Amazon if you have an account set up to send and receive money through them.

Step three: Choosing an online pharmacy

Ordering hormones from outside the country requires up-to-date research. Do not rely on information more than a few weeks old. Many of these pharmacies move frequently or go out of business. You will need to confirm any information by doing your own research. Reliable online pharmacies at the time of this update include:

Inhouse Pharmacy

Note: In October 2010, Inhousephamacy.com was blocked by competitors from importing drugs to the US, affecting many trans people. They moved their site to:

http://www.inhousepharmacy.biz

They have also written up a good overview on hormones:

http://www.inhousepharmacy.biz/transgender/transgender.html

As of October 2010, this workaround appears to be working.

1-Drugstore Online

http://www.1drugstore-online.com

Obtaining hormones without a prescription involves violating federal regulations. Most enforcement is targeted at the distributors, not the end users, and FDA has been cracking down on some of these online resources for selling drugs without a prescription. You might want to read what they have to say.

Importing Prescription Drugs
http://www.fda.gov/importeddrugs/

Buying Medicines and Medical Products Online
http://www.fda.gov/oc/buyonline/default.htm

Buying Drugs Online: It's convenient and private, but beware of "rogue" sites
http://www.fda.gov/fdac/features/2000/100_online.html

Basically, the worst that would probably happen to you is that you pay and never receive your order. You need to consider that when ordering.

DO NOT order anything from the following disreputable websites:

http://www.crissywild.com
http://www.albany-gender-clinic.com
http://transformation.co.uk/

They are designed to rip off older crossdressers.

Success story from a reader

I got the following in April 2005:

Hello Andrea,

Thanks for all of your help on everything! I read back at an article I wrote a year ago - I noticed that you have not written much on
http://www.tsroadmap.com/early/transsexual-hormones.html

I was just hoping to add more to it, as a personal experience. I wrote a short letter of advice about coming out to parents as a kid about a year ago.

I started to see an endocrinologist back in September discussing ways to halt my puberty, then worry about taking estrogen at a later time. A few requirements were needed, and all were easily met with one thing: the support of my parents.

I met my endocrinologist through my therapist. She told him the situation and he easily understood that medication at my age would be crucial to assure that I didn't become too masculine.

I started on provera, or medroxyprogesterone. The dose increased every 4 weeks. I soon intend to start on estrogen, again increasing after each visit. However, it isn't something a child can just jump right into. The sad thing was that I actually agreed. There are many decisions to make, even if you know 100% that you want to do this. For example - having children ? I attempted to bank my sperm but proved unsuccessful. Adopting is what i agreed to. Dr. Hembree also asked to see xrays of my bones to see if they closed up, as weakening in bones is a major concern to hormones in a minor. After 18, you're long past this which is why they don't even have to worry about it. There were then other concerns of kids in my school noticing. All my friends know im atleast gay and VERY feminine, which none of them care. (i have a lot of my friends only for this reason...) If i get breast development, that will be something to hide. Totally worth it. If I won't be able to reproduce, so be it. Alternatives and solutions to everything which NEED to be discussed before starting. He would start me off on a low dose such that we can turn back, but that is the main concern of any doctor performing medical work on a child.

Once we decided we're done with all preparation, and my parents/therapist agree this is what we will deal with, I will FINALLY get to start on estrogen... YAY! :)

Anyway, if you want to make public anything I said - feel free to do so. I just felt that it would help if other kids knew what they would be looking at if they made it to this stage. I remember trying to find more on transitioning experience when i was younger, but only found undetailed stories on finding hormone treatment.

Thanks again for your hospitality!

~ Jessica, 14 Years Old (New York)

Hormone assistance

If you are soon to be 18, you may qualify for reduced cost prescriptions. A reader writes:

For those who have lost their job/insurance or insurance won't pay the cost of hormones there are prescription outreach services if you meet the income guidelines. www.rxoutreach.com and www.rxassist.org are 2 resources. I recently received a 90 day supply of estradiol and spirolactanone for $20 each. Big savings when you have a limited budget.

Primary net resources

I do not answer questions about hormones or their effects. For those wanting more practical information, please go to these hormone pages:

Henk Asscheman, M.D. and Louis J.G. Gooren, M.D. Hormone Treatment in Transsexuals

http://www.transgendercare.com/medical/hormonal/hormone-tx_assch_gooren.htm

Sexuality.org Hormone FAQ

http://www.sexuality.org/l/transgen/hormone.html

Trans-Gender Expressions Hormone FAQ

http://www.tg2tg.org/forums/lifestyles/therapy/mtf-faq.htm

Endocrine Therapy for Transgender Adults in British Columbia: Suggested Guidelines (PDF)

http://www.vch.ca/transhealth/resources/library/tcpdocs/guidelines-endocrine.pdf

Anne Lawrence's hormone page has good information about dosage.

http://www.annelawrence. com/twr/hormoneindex.html

Obtaining hormones and antiandrogens as a minor: overview

http://www.tsroadmap.com/early/transsexual-hormones.html

The Student Residence at GenderPeace has frequent threads about this (registration required):

http://forum.genderpeace.com/index.php?t=thread&frm_id=16&

The Information Exchange at Calpernia.com has a forum with discussions about this (registration required):

http://www.calpernia.com/ubbthreads/postlist.php/C at/0/Board/hormones