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Am J Public Health. 2013 Oct;103(10):1830-6. doi: 10.2105/AJPH.2013.301348. Epub 2013 Aug 15.

Nonprescribed hormone use and self-performed surgeries: "do-it-yourself" transitions in transgender communities in Ontario, Canada.

Author information

At the time of the writing, Nooshin Khobzi Rotondi was with the Health Systems and Health Equity Research Group, Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario. Greta R. Bauer is with the Department of Epidemiology and Biostatistics, The University of Western Ontario, London, Ontario. At the time of the study, Kyle Scanlon was with the 519 Church Street Community Centre, Toronto. Matthias Kaay is with the Addictions Program, Centre for Addiction and Mental Health. Robb Travers is with the Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario. Anna Travers is with Rainbow Health Ontario, Toronto.

Erratum in

  • Am J Public Health. 2013 Nov;103(11):e11.



We examined the extent of nonprescribed hormone use and self-performed surgeries among transgender or transsexual (trans) people in Ontario, Canada.


We present original survey research from the Trans PULSE Project. A total of 433 participants were recruited from 2009 to 2010 through respondent-driven sampling. We used a case series design to characterize those currently taking nonprescribed hormones and participants who had ever self-performed sex-reassignment surgeries.


An estimated 43.0% (95% confidence interval = 34.9, 51.5) of trans Ontarians were currently using hormones; of these, a quarter had ever obtained hormones from nonmedical sources (e.g., friend or relative, street or strangers, Internet pharmacy, herbals or supplements). Fourteen participants (6.4%; 95% confidence interval = 0.8, 9.0) reported currently taking nonprescribed hormones. Five indicated having performed or attempted surgical procedures on themselves (orchiectomy or mastectomy).


Past negative experiences with providers, along with limited financial resources and a lack of access to transition-related services, may contribute to nonprescribed hormone use and self-performed surgeries. Promoting training initiatives for health care providers and jurisdictional support for more accessible services may help to address trans people's specific needs.

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