JEFFERSON CITY, Mo. — With her insurance about to run out and Republicans in her home state of Missouri ramping up rhetoric against gender-affirming health care, Erin Stille nervously visited a foreign pharmaceutical site as a "last resort" to ensure she could continue getting the hormones she needs.
Stille, 26, sent a $300 bank transfer to a Taiwan-based supplier for a 6-month supply of estrogen patches and androgen-blocking pills. For three weeks she feared she'd been scammed but breathed a sigh of relief when a package arrived at her home in St. Peters.
"It's definitely a little scary," Stille said. "Taking a chance like this, I could have my money stolen and there's not much I can do about it. But I figured, at this point, that the benefits outweigh the risks."
Stille, and others nationwide, are scrambling to form contingency plans as Republican politicians erode access to the gender-affirming treatments many credit as life-saving.
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Erin Stille, a transgender woman, poses for a portrait Friday in St. Peters, Mo., holding a package of androgen-blocking pills she ordered from a Taiwan-based supplier.
Those fears accelerated recently when Missouri Republican Attorney General Andrew Bailey issued a first-of-its-kind rule that places strict restrictions on that care for minors — and adults. A judge on Monday temporarily blocked the rule just hours before it was set to take effect.
"Do-it-yourself hormone replacement therapy" has become an increasingly common way for trans residents of restrictive states to avoid involuntarily stopping hormone treatment. Trans people like Stille have discreetly circulated a comprehensive guide and digital master list of hormone suppliers, some more reliable than others, through social media.
This online marketplace, known as the gray market, consists of unregulated suppliers who sell legitimate medications, sometimes name-brand, outside the distribution channels authorized by manufacturers. Some trans people in GOP-controlled states that have not yet enacted bans are buying from these suppliers to build an emergency stockpile.
Self-administering hormones without adequate supervision can be "extraordinarily dangerous," especially for those taking testosterone, said Dr. Robert Lash, chief medical officer at the Endocrine Society, which represents specialists who treat hormone conditions.
Although taking testosterone can help trans men develop some desired physical features, it also increases their risk of a blood clot or stroke. Lash said doctors need to closely monitor a patient's red blood cell count, lipids and liver function and adjust their dosage accordingly. Estrogen use also can increase risk of blood clots, he said.
"These are powerful medications with a lot of effects on a lot of body systems, not all of which are good," Lash said. "Taking these hormones on your own is just an invitation to running into problems. People need to be extraordinarily careful when using them and really shouldn't without medical supervision."
He cautioned against taking hormones from any unregulated pharmacy, veterinary source or overseas provider.
Transgender woman Stacy Cay displays some of the hormone therapy drugs she has stockpiled in fear of losing her supply, Thursday, April 20, 2023, at her home in Overland Park, Kan. (AP Photo/Charlie Riedel)
Even for those willing to assume the risks, not all trans people have the same level of access. Trans men like Levi Sobel, a 30-year-old from Springfield, are finding it much more difficult to source testosterone than other hormones.
Testosterone is classified in the U.S. as a Schedule III controlled substance, along with ketamine and some opioids, and is subjected to more regulations that the typical prescription drug.
Sobel said unregulated testosterone providers are "pretty much nonexistent" in the U.S., and it's unwise to buy from international sellers because of the higher likelihood of the hormone being seized by U.S. Customs and Border Protection.
"This makes it essentially impossible for me to stockpile in the same ways my transfeminine friends can," Sobel said. "The best I can do to stretch it is to make sure I'm using every last drop from every vial."
Stacy Cay, an autistic trans woman and comedian in Kansas City, has already saved up enough injectable estrogen to last about a year.
"This feels like the end of Kansas City being my home," Cay said. "It feels like it's being taken away."
Others, like Ellie Bridgman, a gas station attendant in Union, are employing a unique strategy to stockpile hormones. The 23-year-old started injecting only a half dose of estrogen before her routine blood tests so her hormone levels would read low.
This led her doctor to increase her prescription.
Bridgman said she may consider decreasing her dosage to conserve medication or supplement her supply with an unregulated purchase. Stockpiling is her "No. 1 priority." Without hormone replacement therapy, she said, "the suicidal thoughts and ideation comes back stronger than ever. This is my lifeline."
