In the United States of America, there are three primary methods for acquiring male to female (MTF) hormone replacement therapy: The WPATH method, informed consent, and DIY (I can only speak to the MTF experience, however most of these methods are similar for FTM. DIY is more difficult for FTM because of the controlled nature of testosterone). During the six month interim between deciding I wanted to transition and actually receiving HRT, I ended up trying all three methods.
I started by trying to get HRT through the WPATH method. The WPATH method is fairly straightforward: get a letter of recommendation for HRT from a therapist and then you can get an appointment for HRT. This is generally considered the “proper” way to get hormones and is the only method available to many. I was already meeting with a therapist and discussing gender dysphoria, so I figured that this would be the easiest option. I was wrong.
Upon requesting a letter of recommendation, I was immediately thrown into a bureaucratic hell. First, my diagnosis had to be changed to gender dysphoria. When I had first started seeing a therapist, I did not know that I was transgender and did not put it on any of the intake forms. My therapist was unable to write the letter until this was corrected. I had to go through patient intake again to correct the diagnosis. This process took an entire month. Then my therapist had to actually write the letter, which took several additional weeks. This letter had to then be reviewed by the head therapist at the counseling center, which resulted in rewrites. Following a rewrite and a second review, it went to legal for another review. It has sat with them for four months. At the time of writing this, seven months from the original request, I have still not received the letter of recommendation. Instead, I continue to be told the same thing that I have heard for seven straight months, that the letter is “only one month away”.
My next step was try the informed consent route. Informed consent clinics do not require a letter of recommendation, they only required that you give “informed consent” to receive HRT. After three months of waiting for the letter of recommendation, I decided to just go around the obstacles that the WPATH method had thrown in my way and made an appointment with an informed consent clinic. Unfortunately, informed consent clinics are pretty rare. My nearest one requires me to travel over an hour each way. I was able to get an appointment for two weeks later, however this appointment would never occur. The clinic rescheduled me, and then rescheduled me, and then rescheduled me again. I would not actually step foot into the clinic until 3 months after my original appointment date. In their defense, the last rescheduled appointment was due to the coronavirus, but the other two were not. At this point, I was becoming discouraged that even the “quick” option was taking months.
It was at this point that I tried option three: DIY HRT. DIY involved purchasing and taking hormones yourself while not under the supervision of a doctor. DIY HRT is often the last resort of many trans people who face gatekeeping and other barriers to transition. I was reluctant to try DIY at first because I would not have access to blood tests, however I ultimately decided that it was worth the risk. I ordered estrogen online (no anti-androgen, I figured just estrogen was safer for DIY) and waited for them to arrive. And wait I did, because it got stuck in customs. The hormones arrived 2 months after ordering, about one week after I finally had an appointment at the informed consent clinic and got hormones from them. In the end, DIY was the quickest approach, only taking 2 months, but it ended up not being necessary (although it does give me peace of mind to have extra hormones saved, just in case).
Overall, the entire system of getting HRT in the United States is a slow and often discouraging process. Even with trying all three methods, it still took me 6 months to get access to HRT. Compared to the experiences of some other trans people, that is a pretty quick turnaround, but it still feels like a long time. Trans people are not believed when they say they are trans, instead they are made to jump through hoops to meet often arbitrary guidelines, which delays the process. Only when we fit neatly into the medical definition of “trans person” are we believed and supported. DIY is the only method that gives trans people autonomy and puts us in control of our own transition. However, the legality of DIY HRT is questionable and it is almost completely unavailable to trans men. In a perfect world, transgender healthcare would trust trans people and make it easy for them to begin HRT. In my experience, this is rarely the case.