The popular website Reddit is home to thousands of message-board communities, on which users discuss everything from TV shows to sports teams to science and technology. But Reddit also hosts a “TransDIY” (for “do it yourself”) forum dedicated to at-home gender medicine that facilitates hormone transitions without doctor supervision. To prevent grave harm to vulnerable children—and to comply with state law—Reddit should shut down this forum of more than 76,000 users.
The TransDIY “subreddit” is an online message board where members share information on illegally obtaining hormones, manipulating doctors, and concealing hormone use from their parents. The unifying belief animating Reddit’s TransDIY community is that individuals should have unrestricted access to gender-affirming hormones without medical oversight if they feel dysphoric or identify as transgender. That notion has gained traction in underground online circles.
Reddit’s TransDIY is one of many online echo chambers that understates the risks of DIY gender medicine and takes for granted the existence of benefits. Consider the “DIY HRT Directory,” a transgender hormone therapy encyclopedia frequently linked on the TransDIY Reddit page. (HRT stands for hormone-replacement therapy.) The directory assumes a favorable risk-benefit profile for the self-administration of testosterone, telling readers that “if you are willing to attempt DIY, it is a preferable option to not being on [Testosterone] for many.”
Patients seeking “gender-affirming” treatment through legal means are often relatively uninformed about the risks of medical transitions. If the information vacuum in the TransDIY Reddit page is representative, those attempting at-home transitions are even less aware.
Consider the following from a trans-identified male Reddit user who celebrated his first shot of estradiol, an estrogen hormone: “I just wanted to share this achievement but i have a question as well ! i just . . . idk what to expect I know it’s a long process but still, what changes or side effects should I expect in the near future?” Commenters chimed in to ask questions or offer advice on dealing with erectile dysfunction. The male Reddit user had clearly begun a regimen of cross-sex hormones before inquiring about potential changes or side effects, many of which are irreversible.
The Reddit forum hosts a “frequently asked questions” page that contains many falsehoods. It declares cross-sex hormones “generally safe” and claims that, while “any sort of medical procedure carries some risks, and HRT is no different,” in general “the risks are not that substantially different to the cis population as long as sensible guidelines are being adhered to.” That refers to the World Professional Association for Transgender Health’s (WPATH) misleading, politically motivated SOC-8 guidelines.
The Reddit page is rife with medical confusions. It claims that the risks faced by members of the TransDIY community resemble those incurred by the sex they identify with (i.e., that males taking estrogen have similar breast-cancer risk to females). Males and females experiencing gender dysphoria are otherwise physically healthy; they are not accustomed to supraphysiologic doses of cross-sex hormones. Setting aside the masculinizing and feminizing effects of hormones, studies find that hormone therapy is associated with a greater risk for strokes in trans-identified men. While non-conclusive, evidence suggests that hormone therapy is associated with elevated heart attack risks in trans-identified females. Moreover, cross-sex hormones are associated with increased cancer risk, fertility complications, and changes in mood and behavior, particularly elevated aggression in women.
Other risks stem from the self-administration of hormones and a lack of monitoring by qualified physicians. Members of Reddit’s TransDIY community must worry about things like contaminated hormone vials, many manufactured by private individuals and unregulated by pharmaceutical companies. They therefore must remain alert to bacterial and skin infections from self-injecting, or potential poisoning risks from additives. Because TransDIY members use various administration methods and follow different dosing protocols, those who do undergo blood testing are often alarmed to discover that the hormone levels in their blood register dramatically outside the target range. Instead of consulting with doctors about the risks or implications, many simply survey the TransDIY Reddit page for additional advice and support.
More troublingly, Reddit’s TransDIY page is used as a tool to facilitate the acquisition of sex-trait-modification drugs. Consider the following selection of posts that—as readers can see for themselves—represent a sizeable portion of the material on the forum. On August 3, a Canadian user asked the subreddit, “Does anyone know any non-injection [estrogen] sources that can be found in Canada?” The user continued, saying, “it’s hard to go through doctors . . . and there are huge waitlists for specialists.” The next day, an American user asked which online pharmacy has the “Fastest shipping to Oregon for pills?” Another user lamented, “I cannot for the life of me find an online pharmacy that sells bicalutamide tablets [an anti-androgen puberty blocker],” asking, “does anyone know a way for me to get my hands on bicalutamide?” Multiple users responded with advice, offering links to legally questionable overseas online pharmacies—such as Amazing4Health, an online pharmacy run by “a group of sellers from Thailand”; Astrovials, an underground online pharmacy that seeks to provide “safe and effective HRT for transgender people in a way that the medical system has failed to do so far”; and something called the Russian OTC Online Store.
Why would Reddit—a publicly traded company with revenue exceeding $800 million in 2023 and which frequently bans disfavored forums—permit such a troublesome website? On its face, much of the content in TransDIY violates Reddit’s terms of service. Except in the form of permitted advertisements, Reddit does not allow content that “[solicits]” or “[facilitates]” the “transaction or gift” of “drugs . . . or any controlled substances.” What better characterizes the above interactions than the prohibited solicitation and facilitation of the sale of prescription hormones?
An addendum to Reddit’s terms of service clarifies that users do not violate the policy by providing links to “appropriately licensed pharmacies for FDA (or equivalent) approved medications.” But that exception doesn’t help TransDIY’s case: these pharmacies lack appropriate licensing, and puberty blockers and cross-sex hormones are not currently approved by the FDA or most other international regulatory bodies for “gender-affirming” purposes.
The moderators of the TransDIY forum seem aware that their community skates on thin ice. They police the forum’s content using a list of prohibited topics based on Reddit’s terms of service, which chiefly forbids providing “sourcing for Testosterone” and “Direct transactions between users.” All the same, Reddit’s broad policy encompasses a wider range of conduct that clearly includes the content habitually posted on TransDIY. Though estrogen is not a controlled substance like testosterone, soliciting or facilitating the transaction of gender-affirming synthetic estrogen would presumptively violate the Reddit policy.
Content in TransDIY also may violate state laws against helping a minor obtain “gender-affirming care.” Twenty-six states have passed laws regulating, in some capacity, such medical interventions for those under 18. Several of these laws include aiding-and-abetting provisions that make it a civil offense for health-care providers—or, in some states, any persons—to assist a minor’s procurement of cross-sex hormones or sex-trait-modification surgeries. Mississippi’s H.B. 1125, for example, broadly prohibits any person from knowingly engaging “in conduct that aids or abets the performance or inducement of gender transition procedures to any person under eighteen (18) years of age.” Though the TransDIY thread is nominally restricted to those 18 and older, Reddit lacks age verification. That leaves the door open for youthful eyes to wander unchecked.
Reddit should immediately investigate whether TransDIY violates the company’s terms of service. Attorneys general should consider investigating whether specific user activity violates their respective state’s law. If either is true, the subreddit should be shut down. Enforcement agencies like the DEA need to crack down on the online pharmacies that flout consumer protection laws to supply Internet users with the means to transition medically, including the distribution of controlled substances like testosterone. These illicit pharmacies are the ultimate enablers of DIY gender medicine.
All do-it-yourself medicine is fraught with dangers. The risks are heightened when digital communities operating in the shadows welcome minors into their orbit. TransDIY has, in effect, provided a medium for the sourcing and exchange of prescription hormones from dubious and potentially unlawful channels—placing vulnerable individuals, especially impressionable children, at risk. It’s time for both Reddit and public officials to take action.
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