Ireland’s Trans Healthcare Crisis Is Driving DIY Hormone Use

For those unfamiliar, DIY is a community-built system for Trans people to obtain hormones and other gender affirming care without prescription, usually through online pharmacies and grey market websites. Using sites like X,  Bluesky, Reddit, and Discord, the community has managed to spread a variety of comprehensive guides and wikis on the topic which provide those in need of healthcare with an alternative pathway towards it. 

For Mia, a 22 year old Trans Woman living in Waterford, DIY Oestrogen was better than nothing. After coming out in 2020 and being referred by her GP to the NGS, she spent 2 years on their waiting list. 

During that time, she watched testosterone continue to shape her body in ways that intensified her gender dysphoria, making the wait for treatment feel unbearable. Gender-affirming hormone therapy can work by reducing the effects of testosterone while introducing Oestrogen, so delays can mean continued physical changes that feel deeply at odds with a person’s gender identity. Feeling desperate and anxious, Mia began to explore other options.

“I spent nearly every night for several months looking up how to transition in Ireland, obsessing over what testosterone was doing to my body and mental health at the time,” she told District. “The resources were either vague, only related to legal transition or impossible for me to access at the time, so DIY was the only route I had.”

“I spent nearly every night for several months looking up how to transition in Ireland, obsessing over what testosterone was doing to my body and mental health at the time,”

Lucy, another 22 year old Trans woman living in Dublin detailed her own experience.

“I was terrified of the testosterone in my body and what it could do to me, and even though I was a consenting adult, the HSE and NGS simply wouldn’t provide me the treatment I needed to relieve that. For me, DIY was an urgent, difficult decision. I did not enjoy injecting myself with unprescribed estradiol , or spending my allowance on cryptocurrency to order it online. I would’ve much preferred having the oversight of a caring doctor, but at the time, it was not an option. I saw a lot of amazing changes when I started HRT, but it was also quite scary doing it on my own.”

“I did not enjoy injecting myself with unprescribed estradiol , or spending my allowance on cryptocurrency to order it online.”

Mia and Lucy are among many Trans people unable to access the care they need and forced to look into alternative sources. 

Ireland’s trans healthcare is currently rated as the worst in the EU, with the NGS being consistently criticised by trans advocacy groups such as TENI (Trans Equality Network Ireland), Transgress the NGS (A Trans healthcare reform group), and Trans and Intersex Pride.

The Irish system has become a cautionary tale within the Trans Community worldwide. A 2022 Ombudsman Report and Numerous testimonials highlighted 3-7 year wait times, as well as dehumanising questioning regarding sexual activity, pornography and masturbation habits. 

Accessing Trans healthcare usually means 3-7 year wait times

Patients are also dissuaded from seeking surgeries beyond what the HSE permits as “medically necessary”. These seemingly “unnecessary” procedures include mastectomies (top surgery), hysterectomies and phalloplasty (bottom surgery for trans mascs), and vaginoplasty (bottom surgery for trans fems). For trans women, these additional surgeries such as Facial Feminisation surgery, vocal cord adjustment and breast augmentation can be life changing and have incredible gender affirming results.

“Without access to healthcare to facilitate medical transition, trans and gender non-conforming people face increased mental health challenges”

Belong To’s LGBTQI+’s Youth Ireland report from 2024 points out this connection, stating that “Without access to healthcare to facilitate medical transition, trans and gender non-conforming people face increased mental health challenges, social isolation and continue to turn to alternatives that pose financial and health-related risks.” The report also highlighted declining mental health among Ireland’s trans community. Their 2014 survey of Trans people in Ireland revealed that 75% of Trans people have self-harmed, 82% have experienced suicidal thoughts and 39% have attempted suicide.

75% of Trans people in Ireland have self-harmed

Charlie, a 24 year old Trans Women living in Dublin highlighted her frustrations and experience with the NGS to District.

Having previously been with the private gender clinic, Gender GP. She was admitted to the NGS in 2023 after 4 years of waiting. 

“It’s less of a doctor’s appointment and more of an interrogation,” she told District about her initial appointment. “They try to trip you at every hurdle [with] any excuse not to provide treatment. Instead of trying to receive help, you’re trying to prove you’re good enough by their metrics to pass their selection of archaic expectations. It makes you feel lucky when you receive it. You almost feel hated for even seeking treatment for it, like you’re a problem for them as care providers. You don’t get to decide what you are, they will decide it for you.”

“It’s less of a doctor’s appointment and more of an interrogation,”

Experiences like this are well known within the trans community, which is the reason why those like Mia and Lucy have turned towards DIY in order to medicate themselves whilst they wait to be seen, or as an alternative to the current system. 

Which leads to the important question, is DIY illegal? The current legality regarding DIY depends on what hormones are being ordered and where. In Ireland’s case, importing and possessing Oestrogen without a prescription is generally not illegal, but possessing and importing testosterone is a criminal offence as it is a controlled substance and anabolic steroid under The Misuse of Drugs Acts 1997-2016. 

Bruce, a 24 year old Trans Masc currently residing in Dublin, spoke with us to highlight his own experience taking DIY testosterone.

“At the time, I was staring down a wait-list that was 5+ years long with no end in sight. That same wait-list is now over 18 years,” he told District. “During this time, my mental health was, quite frankly, in the bin. I was an active suicide risk and felt I had nothing to lose at that point, so I turned to DIY. I was lucky in that I had friends who knew what they were doing and could guide me in the right direction. Over a while, my mental health improved somewhat but it wasn’t until now, years later, I can say I’m stable, content and full of joy because every morning I wake up and see myself on the outside, how I feel on the inside.”

“I was an active suicide risk and felt I had nothing to lose at that point, so I turned to DIY.”

According to Gender GP, a private UK based gender clinic operating online, taking unregulated and unmonitored hormones can result in health issues such as blood clots and liver damage, and damage to the cardiovascular system. Even if this is relatively uncommon, health issues like these can crop up if unmonitored which is why a more formal system is preferable.

While DIY is not preferable to a monitored health service, for many it’s the only one they have. 

Stories like Bruce’s, Lucy’s, and Mia’s show the value of DIY as many within Ireland face a crisis of accessibility, DIY provides a valuable service, but that does not mean it is without risk. Without a country-wide shift towards an informed consent model,  Trans people will continue to put themselves at risk in order to access healthcare rather than receiving the support they desperately need.