Mirjam Faissner

Institute of History of Medicine and Medical Ethics, Charité – Universitätsmedizin Berlin

Hormone replacement therapy (HRT) is a central component of gender-affirming healthcare and is of great importance for the wellbeing of many trans* and non-binary people. Decisions about starting HRT are embedded in a tension between different temporalities. On the one hand, there is the subjective experience of urgency, particularly in the face of progressive physical changes – for example, in adolescents – or the persistence of a body perceived as unsuitable, whereby simply waiting can itself be experienced as harmful to one’s health. On the other hand, there is the need for careful decision-making, in which individual wishes and doubts can be weighed up. These individual decision-making processes take place within institutional frameworks that cause delays, for example due to the need for a medical referral, a shortage of specialist staff, complex reimbursement procedures and other barriers to access.

Against this backdrop, many people resort to so-called ‘do-it-yourself’ (DIY) HRT. This encompasses a range of informal practices involving hormone intake, with varying degrees of medical supervision. The spectrum ranges from taking prescribed hormones according to one’s own regimen to taking hormone preparations that have been passed on or produced by the individual themselves. These practices have scarcely been studied to date, and there are no recommendations for healthcare professionals on how to deal with DIY HRT.

One possible approach is harm-reduction strategies, which aim to minimise risks without judging or preventing the use of hormones itself. These include, amongst other things, testing hormone preparations, conducting accompanying blood tests for the early detection of adverse effects, providing sterile injection equipment, and offering information on the low-risk use of DIY HRT.

Based on a participatory, community-based research project, this article examines harm-reduction approaches as a possible way of dealing with DIY HRT from a medical ethics perspective. The centre is on the question of what ethical obligations arise for healthcare professionals from the tension between subjectively experienced urgency and institutionally imposed delays. It is argued that temporal aspects must be taken into account in the normative assessment.