Legal Risks
Estradiol is not a controlled substance and so far as we can tell what we are doing with it is legal given that what we are offering is not intended to diagnose, treat, prevent, or cure any medical illness. Nevertheless, the fact that something is legal has never stopped the state from harassing people. This is especially true given that trans people have unfortunately become a hot button political issue. The prospect of people handing out estrogen on the street is ripe to get blown out of proportion by the right wing media and politicians looking to score points by hating on trans people.
Testosterone is a schedule III controlled substance in the U.S., on par with Ketamine. There is case law of people getting in real legal trouble for selling it, but no case law that we know of regarding giving it away for free.
If you aren’t comfortable with these risks consider helping existing BnB efforts by donating and/or contacting us to see how you can help. If you decide you are willing to take these risks watch this video on why you should NEVER speak to the police. You may also want to read this zine about security culture, though much of it is overly stringent for these purposes.
Risks of DIY
We bought estrodiol and testosterone via the gray market as raw powder and had it tested via Fourier-Transformed Infrared Spectroscopy and Gas Chromatography-Mass Spectrometry to confirm that it was indeed 17b-estradiol.
No test is guaranteed to be 100% accurate, but we feel confident that we weren’t ripped off and sent baking soda or even a different form of estrogen than 17b-estradiol. That being said, there is risk of impurity or contamination for grocery store supplements as well. Companies might get investigated if they’re accused of putting dangerous chemicals in their supplements but otherwise supplements are not regulated by the FDA. So, it’s our opinion that this estrogen is about as dangerous as a standard supplement. This is not to minimize this fact, though. If you get prescribed estradiol from a doctor it will undoubtedly be higher quality due to having to pass certain standards. If you are able to get estradiol prescribed and you can afford it we recommend you do this, especially so your provider can monitor your bloodwork over time. Nevertheless this isn’t possible for many people, which is where we come in.
Risks of Estradiol
For clarity’s sake this is written for AMAB people. For AFAB people the risks and rewards may be different.
For all people estradiol is associated with coagulation. Coagulation can lead to a number of adverse events such as heart attack, stroke, and blood clots, also known as thrombosis. Of particular concern are venous thromboembolisms, or VTE events. These are blood clots that form in veins moving blood towards the heart. For AMAB people that take estradiol the increased risk is dose and route of administration dependent. This means your risks are greater with higher levels and that some ways of taking estradiol (“route of administration”) are more associated with VTE events than others. Exactly how much your risk increases is not precisely known, as research on trans people is poorly funded. However, based on the available data it seems that transdermal estradiol levels within 100-200 pg/ml, and perhaps as high as 300 pg/ml produce little or no additional risk of clotting events. For a fuller overview of the research see here.
Another risk to consider is breast cancer. Like blood clots there seems to be a causal link between exposure to estrogens and breast cancer. This also seems to be dose dependent, so higher doses of estradiol will result in an increased risk of breast cancer. As with blood clots the exact amount of risk isn’t precisely known and for AMAB people taking estradiol the risk level is likely to be somewhere between the risk levels for cis men and cis women.
Lastly, the primary effects of estradiol itself – feminization and suppression of your body’s reproductive processes – could be considered risks depending on your perspective. For better or worse the vast majority of effects from estradiol are temporary. Things like smoother skin and fat redistribution will reverse. However some effects like breast development and possibly infertility are permanent. If you’re okay with these risks, enjoy your estrogen!
Risks of Testosterone
For clarity’s sake this is written for AFAB people. For AMAB people the risks and rewards may be different.
Taking testosterone will likely lead to infertility, possibly irreversibly. Though anecdotally there are a number of transmasculine people who have paused their testosterone regimen and been able to become pregnant and deliver healthy babies, we have not seen large scale data collection on how common or uncommon this is. On the flip side, it can take a year or longer for testosterone to fully suppress menstruation. If you menstruate and are not on any kind of birth control you should assume that you could still become pregnant via unprotected front-hole/vaginal penetrative sex with someone who produces viable sperm (in addition to the risks of STI’s).
Testosterone can cause thinning/atrophy of the front-hole/vaginal wall tissue, leaving it more susceptible to tearing, abrasion, infection and irritation. Some transmasculine people get a Nuvaring-type birth control ring which releases a localized (limited to that specific area) amount of progestin and estrogen to the surrounding front-hole/vaginal tissue to prevent thinning/tearing (this shouldn’t counteract the masculinizing effects of testosterone other than maintaining the integrity of the front-hole/vaginal tissue).
Testosterone can increase the risk of high blood pressure, heart disease and stroke, particularly for smokers and those with a family history of heart disease. Most of the research on this is focused on cisgender men who are taking extremely high doses for athletic performance. For transmasculine people who are taking testosterone to bring their levels up to the “normal” range for cisgender men, it seems like the risk of cardiovascular complications is similar to that of cisgender men, but there is very little research on this.
For a full list of potential increased risks of certain health issues associated with transmasculine HRT, you can refer to Hudson’s FTM Guide. This page should not be considered a comprehensive guide to the potential risks, rewards, or side effects of taking testosterone.
Most of the serious side effects are extremely low in absolute risk. Polycythemia (high concentration of red blood cells in the blood) is a unique risk for transmasculine people taking any testosterone therapy. CBC (complete blood count) tests to monitor your hematocrit (red blood cell count) are recommended.
What should my CBC look like?
Polycythemia is defined as serum hematocrit (Hct) or hemoglobin (HgB) exceeding normal ranges expected for age and sex, typically Hct > 49% in healthy adult males. So there is no need to worry if you have Hct levels lower than that.
Aromatization
In all people, a small portion of the testosterone in their bodies is converted into estradiol (estrogen) through a process called aromatization. However, in healthy cisgender males, the testosterone levels typically remain within a range that does not cause a significant increase in estradiol levels, thereby mitigating any unwanted feminizing effects.
As a transmasculine person, it’s important to not take too much testosterone (please stay within recommended dosage guidelines) to prevent estradiol levels from getting too high (which can cause unwanted feminizing effects). As long as you take reasonable dosages of testosterone and do not go over the recommended dosages, you are unlikely to deal with excessive aromatization.
Hormone therapy in general is very safe and effective as long as you take reasonable doses.
Lastly, the primary effects of testosterone itself – masculinization and suppression of your body’s reproductive processes – could be considered risks depending on your perspective. For better or worse some of the effects from testosterone are temporary if you stop taking it. Things like rougher skin and fat redistribution will reverse. However some effects like lower voice, body hair growth and possibly infertility are permanent. If you’re okay with these risks, enjoy your testosterone!