“Not just rebellious, it's revolutionary”: Do-it-yourself hormone replacement therapy as Liberatory Harm Reduction

For some transgender people, hormone replacement therapy (HRT) is “an ontological necessity for a livable life” (Fondén, 2020, p. 29). Some trans people engage in do-it-yourself (DIY) HRT (aka “DIYers”) because of care barriers, including medication costs, difficulty accessing healthcare providers, and mistrust in professionalized medical systems. Although DIY HRT is often framed as highly risky, we analyzed in-depth interviews with 36 U.S. DIYers to understand how they themselves perceived their goals, challenges, and risk mitigation using the Liberatory Harm Reduction and lay expertise frameworks. Participants emphasized experiences of transphobia within medical spaces. In contrast, participants characterized DIY HRT as a community-driven, accessible, and empowering practice. Through self-organized online forums and mutual aid, DIYers constructed adaptive health-promoting practices that challenge biomedical conceptualizations of risk and affirm trans agency. •Some trans people take hormone replacement therapy without prescription (“DIY HRT”).•DIY HRT has been framed as “high risk” in medical and public health research.•Trans people practicing DIY HRT (“DIYers”) argue DIY HRT can be empowering.•DIYers engage in Liberatory Harm Reduction to reduce risks of DIY HRT.•Liberatory Harm Reduction affirms trans agency and can improve trans medicine.