Beyond anxiety: Autonomy and harm reduction approaches to DIY Hormone Replacement Therapy.

Transgender individuals in India face significant barriers to accessing medically supervised hormone replacement therapy, leading some to pursue DIY approaches.

• The paper uses the case of Roshni, a researcher at a Hyderabad-based science institution who began identifying as a transgender woman in 2018 and sought medical transition
• The case illustrates structural barriers faced by transgender people in accessing formal medical pathways for hormone replacement therapy in India
• DIY HRT refers to transgender individuals obtaining and self-administering hormones outside of formal medical supervision

The paper argues that autonomy and harm reduction frameworks provide more ethically appropriate responses to DIY HRT than anxiety-based approaches.

• The paper critiques 'anxiety' approaches that focus primarily on the risks of DIY HRT without adequately weighing the benefits to transgender individuals
• Autonomy-based approaches center the rights of transgender individuals to make informed decisions about their own bodies and medical care
• Harm reduction approaches are presented as a practical ethical framework for addressing DIY HRT when formal medical access is unavailable or inaccessible
• The paper frames DIY HRT not merely as a medical risk issue but as an issue of gender self-determination and healthcare justice

The paper identifies ethical tensions between medical gatekeeping of hormone therapy and the rights of transgender individuals to access gender-affirming care.

• Medical gatekeeping structures require transgender individuals to navigate psychiatric and medical evaluations before accessing hormone therapy
• These gatekeeping structures can delay or deny access to gender-affirming care, motivating DIY approaches
• The paper situates DIY HRT within broader debates about transgender healthcare access and medical authority over transgender bodies

The paper concludes that ethical analysis of DIY HRT should move beyond risk-focused anxiety frameworks toward approaches that respect transgender autonomy and minimize harm.

• The paper advocates for harm reduction as a guiding ethical principle for clinicians, policymakers, and researchers engaging with DIY HRT practices
• Respecting autonomy is presented as a core ethical obligation when transgender individuals make informed choices about self-administered hormones
• The paper calls for healthcare systems to reduce barriers to medically supervised HRT as a means of addressing the conditions that make DIY approaches necessary