With DIY HRT website HRT Cafe being taken down, what's next for DIYers?

Last month, a well-known website that directs users to online pharmacies and homebrewers selling transfeminine Hormone Replacement Therapy, HRTCafe.net (archived), went dark.

This occurred off the back of a report by an anti-trans, anti-racial-equality advocacy group, so-called "Do No Harm", whose stated goals are to "eliminate the influence of DEI and gender" in medicine.

The report, arguing the FDA should act against unregulated HRT access in the USA, led to increased media attention, with far-right outlets such as the UK's GB News reporting on the website, alleging that children are accessing medication online.

The report argued for more FDA warning letters to overseas providers of HRT, and "oversight" to prevent children accessing medication. In case you haven't caught it, it's not about children, every major adult restriction is being sold with child-safety language, and the policy targets named in the Do No Harm report are adults.

Safety & Availability

The HRT Cafe website, focusing solely on transfeminine HRT, was an invaluable resource for women looking for online pharmacies that would dispense estrogen and progesterone.

The real question being raised is, is DIY safe? For me, when I lived overseas for 9 months, it was safer (physically, mentally, emotionally) than not. I accessed HRT in three different ways: Over the counter. By convincing a private GP to prescribe it for me in the UK. And by importing it from an online pharmacy into the country I was in. I experienced no issues whatsoever with any of the HRT or with switching between them, and it was life-preserving for me.

Realistically, nothing has changed about the availability of oestrogens and other pharmaceuticals. Websites such as Inhouse Pharmacy, which originated in 1996, have been filling this need for decades. Less established providers like 4RNX are more fly-by-night operations, dropping domains and reappearing only to those in the know.

These operators do not care for anything but the incentive, and the financial incentive for these operators is just too great, with drugs like Ozempic, Viagra, Wegovy and cancer drugs always being in high demand.

It's not just us

The websites aren't just lifesaving for transfeminine people. Sorafenib, a medication to treat kidney cancer, costs $2700+ a month in the US – even via medicine discounting programs. However, via these unregulated pharmacies, a 30-day supply costs $250–300 US. For cancer patients with no other option, these pharmacies are an invaluable, albeit unregulated, lifeline.

We find a way

Those who know trans women in or from the global south will understand that we always find a way. Transfeminine people in the Philippines, up to quite recently, historically used female birth control to increase their bodies' progesterone and reduce their testosterone in order to facilitate their transitions, even though this method carries risks and side effects that modern HRT does not have.

Some may argue that writing this article risks exposing us, trans people, to further harm. This is fundamentally untrue. There is already huge pressure from pharmaceutical companies to shut down these websites for financial reasons. Plus, the US Drug Enforcement Agency is already trying to take down pharmacies through Operation Meltdown, but all it can do is seize domains that are controlled by US Registries (.com, .org, etc.). And finally, anti-trans groups have already mapped out all the DIY HRT websites. Everything I've linked here was discussed in the "report" written by "Do No Harm". Not talking about this only harms trans people.

If you're relying on these websites, the only foreseeable real risks are increased mail inspections in your country and the criminalisation of the possession of HRT.

Will we get to that extreme? Many trans women in countries hostile to transgender people, like the UK and US, have been stocking up on HRT for this eventuality.

There are transfeminine chemists today who are synthesising bioidentical estrogen in their home labs, selling it to others and sustaining a living doing it that way. These women will continue to do just that, the ones I know of are in the global south, somewhat insulated from the Western anti-gender backlash. Groups like transharmreduction.org test medicine (donate to them if you can) to ensure quality and reduce the risks of harm for women forced to use DIY HRT.

And overseas pharmacies will always have a financial incentive to figure out how to get us medicine.