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. 2026 Feb 26:1–12. doi: 10.1080/26895269.2026.2634170

Current status and characteristics of self-medication with gender-affirming hormones among individuals with gender dysphoria in China

Yueting Cai a,*, Xu Chang b,*, Yulin Dong a, Rucan Li a, Yunyang Wang a, Xiuyi Li a, Yinuo Chen a, Bailin Pan b, Tianpei Hong a,✉, Ye Liu a,✉
PMCID: PMC13352525

Abstract

Objective

Gender-affirming hormone therapy (GAHT) is an effective treatment for gender dysphoria. However, a substantial proportion of transgender individuals resort to self-medication with hormones. This study aimed to investigate the current status, characteristics, and associated factors of self-medication among individuals with gender dysphoria in China.

Methods

In this cross-sectional study, data were collected from the Gender Clinic of Peking University Third Hospital between January 2016 and November 2024. Demographic information, hormone treatment history, laboratory test results, scores from the 7-item Generalized Anxiety Disorder Scale (GAD-7), and scores from the 9-item Patient Health Questionnaire (PHQ-9) were analyzed.

Results

Among 826 transgender individuals with gender dysphoria, 60.4% had self-medicated before their clinic visit, with 85.4% obtaining hormones from nonmedical sources. The average age at first use was 20.1 years, and the youngest user was 10 years old. The proportion of transgender women was significantly higher in the self-medication group than that in the no self-medication group (90.4% vs. 59.3%, p < 0.001). Multivariate analysis identified being a transgender woman (OR 6.10, 95% CI 4.17–8.95) and the use of psychotropic medications (OR 1.36, 95% CI 1.00–1.86) as independent factors associated with self-medication. No significant differences in GAD-7 or PHQ-9 scores were observed between the two groups.

Conclusion

Informal self-medication with GAHT is highly prevalent among transgender individuals in China. Identifying as a transgender woman and using psychotropic medications were independent risk factors associated with self-medication behavior. These findings highlight the need for improved health education and the development of standardized hormone distribution systems to reduce potential risks.

Keywords: Gender-affirming hormone therapy, gender dysphoria, self-medication, transgender

Introduction

Gender dysphoria arises from an incongruence between an individual’s gender identity and the sex assigned at birth (Davy, 2015; Poteat et al., 2023). Research has demonstrated that gender-affirming hormone therapy (GAHT), a core component of transgender health care, can reduce gender dysphoria, anxiety, and depression, thereby improving the mental health and overall well-being of transgender individuals (Colizzi et al., 2014; Gómez-Gil et al., 2012). However, access to formal health care for transgender populations varies considerably worldwide due to cultural, systemic, and policy differences. Consequently, some individuals with gender dysphoria engage in self-medication, defined as the use of hormone therapies without supervision from qualified healthcare professionals (Defreyne et al., 2023; Hembree et al., 2017; Rotondi et al., 2013). The barriers underlying this behavior include institutional and informational factors such as discrimination, lack of professional guidance, limited medical information, financial constraints, age-related restrictions, transportation challenges, and self-perceived knowledge of GAHT principles (Kirey-Sitnikova, 2024; Xie et al., 2024).

Our previous study based on China’s first national online survey in 2017 revealed that more than half of transgender individuals in the country desired hormone or surgical treatment, and 67.6% had obtained medications from informal sources and used them without professional medical supervision (Liu et al., 2020). In 2016, we established the first multidisciplinary gender clinic in China to provide formal GAHT. In this study, we utilized data from our clinic’s database to describe the current status and behavioral characteristics of informal self-medication, thereby providing clinic-based evidence to enhance understanding of self-medication among Chinese transgender individuals. Furthermore, we examined the factors associated with self-medication to offer insights for individuals engaging in this high-risk behavior and to inform the delivery of formal, professional medical care for people with gender dysphoria.

Materials and methods

Participant selection

Participants were individuals with gender dysphoria who visited the gender clinic in Peking University Third Hospital between January 2016 and November 2024. The inclusion criteria were as follows: (1) transgender women or transgender men diagnosed with gender dysphoria; (2) a desire for gender transition; (3) age 16 years or older; and (4) clear documentation of medical history. According to international guidelines and the Chinese multidisciplinary consensus on transgender care, mental health professionals play a crucial role in evaluating gender dysphoria and ensuring appropriate, ongoing health care (Hembree et al., 2017; Lu et al., 2022). All participants were diagnosed with gender dysphoria by qualified psychologists or psychiatrists and were referred to our clinic for further evaluation and initiation of GAHT. Cases were excluded if they (1) had unclear gender identity or identified as nonbinary; (2) lacked information regarding previous medication use or other essential details; (3) had inconsistent records across different time points; or (4) declined participation in the clinical study. During the initial consultation, transgender visitors were asked whether they would like to participate in our clinical study. Those who agreed provided written informed consent. Individuals who declined were not enrolled; however, their decision did not affect their access to standard care, including prescriptions and follow-up visits. This study was approved by the Ethics Committee of Peking University Third Hospital (M2021186).

Data abstraction

This cross-sectional study utilized data collected during participants’ initial visits with a standardized form. The form included demographic information, mental health history, hormone medication history, scores from the 7-item Generalized Anxiety Disorder Scale (GAD-7) and the 9-item Patient Health Questionnaire (PHQ-9), as well as laboratory test results.

Statistical analysis

Quantitative variables with normal distributions are expressed as the mean ± standard deviation (x̅ ± s), whereas non-normally distributed variables are presented as the median with interquartile range. Categorical variables are summarized as frequencies and percentages. Laboratory results below the assay sensitivity were recorded as the lower limit of detection for analytical purposes. Statistical analyses were performed using the independent-samples t test, Mann-Whitney U test, and chi-square test, depending on the data type. Univariate and multivariate logistic regression analyses were conducted to examine associations between self-medication behavior and related factors, including gender identity, age at first awareness of gender incongruence, comorbid mental health disorders, and use of psychotropic medications. Results are presented as odds ratios with 95% confidence intervals. Statistical analyses were conducted using SPSS Statistics version 27.0 (IBM Corp., Armonk, NY, USA). Two-sided p values < 0.05 were considered statistically significant.

Positionality statement

The research team comprises clinicians and medical students with experience in transgender health care and related research. All authors are Chinese and identify as cisgender. Although none of the authors are transgender, the team has collaborated closely with community-based organizations for many years, which has informed and enriched our interpretation of the data.

Results

Self-medication behavior and types of related medications taken by transgender individuals

A total of 1,297 cases of transgender individuals who attended the gender clinic of Peking University Third Hospital between January 2016 and November 2024 were reviewed, and 826 were ultimately included in the analysis (645 transgender women and 181 transgender men) (Figure 1). Demographic characteristics, gender identity developmental milestones, and histories of gender-affirming care are presented in Table 1. Among the participants, 60.4% (451 transgender women and 48 transgender men) reported having used gender-affirming hormones without professional medical supervision. The prevalence of self-medication was significantly higher among transgender women than among transgender men (69.9% vs. 26.5%, p < 0.001) (Figure 2). The mean age at first self-administration of hormones was 20.1 ± 4.8 years. Among these individuals, 13.8% (68 of 492) initiated self-medication before the age of 16, with the youngest being 10 years old. Furthermore, 85.4% (416 of 487) reported obtaining hormone medications from nonmedical sources.

Figure 1.

Figure 1.

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Participant inclusion flow chart.

Table 1.

Demographics, gender identity developmental milestones, and history of gender-affirming care in individuals with gender dysphoria with and without self-medication history.

Variables Na No self-medication Na Self-medication P valueb
Transgender woman, n (%) 327 194 (59.3%) 499 451 (90.4%) <0.001
Age at visiting our clinic, years 327 22 (19, 26) 499 22 (19, 26) 0.128
Living in first-tier citiesc, n (%) 148 64 (43.2%) 268 109 (40.7%) 0.610
Junior college degree or higher, n (%) 317 237 (74.8%) 483 345 (71.4%) 0.300
Gender identity developmental milestones          
 Age at first awareness of gender incongruence, years 324 10 (6, 13) 492 11 (8, 13) 0.008
 Age at first experience of gender dysphoria, years 274 13 (12, 16) 406 14 (12, 16) 0.462
 Age at first exposure to transgender-related medical information 324 16 (14, 19) 492 16 (14, 18) 0.124
Receiving information about gender dysphoria from mental-health professionals or public educational sources, n (%) 321 81 (25.2%) 490 107 (21.8%) 0.262
Lack of parents’ understanding and support, n (%) 309 19 (6.1%) 473 47 (9.9%) 0.062
Comorbidity or previous comorbidity with psychological disorders, n (%) 324 129 (39.8%) 491 256 (52.1%) <0.001
Previous or current use of psychotropic medications, n (%) 324 141 (43.5%) 489 285 (58.3%) <0.001
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a, Total number of each group with detailed documented results for each variable; b, p values for difference between participants with and without self-medication history based on Mann-Whitney U test for continuous variables and Chi-squared test for categorical variables; c, First-tier city includes Beijing, Shanghai, Guangzhou, and Shenzhen.

Figure 2.

Figure 2.

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Self-medication of hormone therapy among individuals with gender dysphoria.

A total of 479 transgender individuals reported the specific types of medications used for self-medication. Forty-one transgender men (8.6%) used testosterone, whereas 438 transgender women (91.4%) used a broader range of medications (Figure 3). These medications were categorized into four classes: estrogens, antiandrogens, progestogens, and combined oral contraceptives. Among them, 86.8% (416 of 479) followed medication regimens consistent with recommendations from relevant medical guidelines, whereas 13.2% (63 of 479) used other medications not covered by such guidelines (Supplementary Table S1) (Coleman et al., 2022; Tangpricha & den Heijer, 2017). Additionally, 114 transgender individuals reported the specific dosages of their self-administered medications, and 21.9% (25 of 114) indicated using excessive doses.

Figure 3.

Figure 3.

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Regimens of self-medication among transgender women. Data are presented with case numbers and proportion (%). The category criteria were as follows: (1) estrogen formulations include oral, transdermal and parenteral estrogen; (2) antiandrogen includes cyproterone acetate, spironolactone and long-acting gonadotropin-releasing hormone agonist; (3) progestogen includes progestogens other than cyproterone acetate; (4) contraceptive includes ethinyl estradiol cyproterone tablets (Diane-35®), estradiol valerate and cyproterone acetate tablets (Climen®), levonorgestrel, etc. Apart from what is shown in the figure, there were 5 cases using “estrogen + antiandrogen + progestogen”, 9 cases using “estrogen + antiandrogen + combined contraceptive pill”, and 1 case using “estrogen + antiandrogen + progestogen + combined contraceptive pill”.

Clinical characteristics and related factors in self-medicated transgender individuals

Of the 499 transgender individuals who reported self-medication, 451 (90.4%) were transgender women—a significantly higher proportion than in the no self-medication group (90.4% vs. 59.3%, p < 0.001). There were no significant differences between the self-medication and no self-medication groups in residential location or educational background (first-tier city: 43.2% vs. 40.7%, p = 0.610; junior college degree or higher: 74.8% vs. 71.4%, p = 0.300). The median age at first awareness of gender incongruence was significantly higher in the self-medication group than in the no self-medication group (11 [8, 13] vs. 10 [6, 13] years, p = 0.008). No significant differences were found between the two groups in age at first experience of gender dysphoria (14 [12, 16] vs. 13 [12, 16] years, p = 0.462), age at first exposure to transgender-related medical information (16 [14, 18] vs. 16 [14, 19] years, p = 0.124), or age at first visit to our gender clinic (22 [19, 26] vs. 22 [19, 26] years, p = 0.128).

Regarding the sources of information about gender dysphoria, no significant differences were observed between two groups in the proportion who obtained information from mental-health professionals or public educational sources (21.8% vs. 25.2%, p = 0.262). Similarly, there were no significant differences between the two groups in the proportion reporting lack of parental understanding and support (6.1% vs. 9.9%, p = 0.062). Among transgender individuals who self-medicated, the proportion with a history of psychological disorders was significantly higher than in the no self-medication group (52.1% vs. 39.8%, p < 0.001). Furthermore, the proportion reporting current or previous use of psychotropic medications was also significantly higher in the self-medication group compared with the no self-medication group (58.3% vs. 43.5%, p < 0.001).

Among the 499 individuals who engaged in self-medication, 492 reported their age at first self-medication. We compared individuals who initiated self-medication before the age of 16 with those who began after the age of 16 (Supplementary Table S2). The results showed that the younger-age group was significantly younger at the time of their first clinic visit (p < 0.001) and had a lower proportion of individuals with a junior college degree or higher (p < 0.001). They also first experienced gender dysphoria (p < 0.001) and received information about transgender-related medical care (p < 0.001) at earlier ages. Additionally, the younger-age group demonstrated a higher prevalence of comorbid psychological disorders (p = 0.016) and a higher rate of previous or current psychotropic medication use (p = 0.041).

Logistic regression analyses were conducted to examine potential risk factors associated with self-medication behavior (Table 2). Univariate logistic regression identified four significant factors: identifying as a transgender woman, later age at first awareness of gender incongruence, a history of comorbid psychological disorders, and psychotropic medication use. Given the strong correlation between mental disorders and psychotropic medication use, multivariate logistic regression analyses were performed using two separate models. Model 1 adjusted for transgender woman identity, age at first awareness of gender incongruence, and comorbidity or previous comorbidity with psychological disorders; Model 2 adjusted for transgender woman identity, age at first awareness of gender incongruence, and previous or current psychotropic medication use. The results indicated that identifying as a transgender woman was an independent risk factor for self-medication among transgender individuals, and that psychotropic medication use independently increased the likelihood of self-medication.

Table 2.

Logistic regression analysis of factors associated with self-medication among individuals with gender dysphoria.

Related factors Univariate regression analysis
 Multivariate regression analysis
Model 1a
 Model 2b
OR (95% CI) P value Adjusted OR
(95% CI)		 P value Adjusted OR
(95% CI)		 P value
Being transgender woman 6.44 (4.45–9.33) <0.001 6.10 (4.17–8.95) <0.001 5.95 (4.06–8.73) <0.001
Age at first awareness of gender incongruence 1.04 (1.01–1.07) 0.019 1.01 (0.97–1.04) 0.644 1.01 (0.97–1.04) 0.745
Comorbidity or previous comorbidity with psychological disorders 1.65 (1.24–2.19) <0.001 1.29 (0.94–1.76) 0.110 – –
Previous or current use of psychotropic medications 1.84 (1.39–2.44) <0.001 – – 1.36 (1.00–1.86) 0.05
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OR, odds ratio; CI, confidence interval.

a, Multivariate logistic regression analysis Model 1 was adjusted by “Being transgender woman”, “Age at first awareness of gender incongruence” and “Comorbidity or previous comorbidity with psychological disorders”; b, Model 2 was adjusted by “Being transgender woman”, “Age at first awareness of gender incongruence” and “Previous or current use of psychotropic medications”.

Impacts of self-medication on the psychological and physical health of transgender individuals

No significant differences in GAD-7 and PHQ-9 scores were observed between the self-medication and no self-medication groups among both transgender women and transgender men (Supplementary Table S3). Among transgender women, estradiol and prolactin levels were significantly higher in the self-medication group than in the no self-medication group, whereas serum creatinine levels in the self-medication group were significantly lower (all p < 0.001). Among transgender men, testosterone, hematocrit, and serum creatinine levels were significantly higher in the self-medication group compared with the no self-medication group (all p < 0.05). No significant differences were observed in liver transaminase levels between the two groups.

We further analyzed the proportion of individuals in the self-medication group whose hormone levels were within or outside the recommended reference ranges. Among transgender women, only 36 of 331 individuals (10.9%) had estradiol levels within the recommended range (Coleman et al., 2022). Additionally, 12 of 331 (3.6%) had estradiol levels above the upper limit, with the highest value recorded at 1443.78 pmol/L. Regarding prolactin, 112 of 342 individuals (32.7%) exhibited concentrations exceeding 25 ng/mL, with a maximum level of 98.45 ng/mL. Among transgender men, only 9 of 36 individuals (25.0%) had testosterone levels within the recommended range (Coleman et al., 2022). Three of 36 (8.3%) had testosterone levels above the upper limit, with the maximum level reaching 37.41 nmol/L. In addition, 2 of 37 transgender men (5.4%) had hematocrit values exceeding 50%, with the highest level recorded at 52.2%.

Discussion

Gender dysphoria refers to the psychological distress experienced by individuals whose gender identity does not align with their assigned sex at birth. Previous evidence suggests that gender identity conversion practices are ineffective in alleviating gender dysphoria and may instead increase the risk of suicidal behavior and worsen mental health outcomes (Coleman et al., 2022; Y. Wang et al., 2023). In contrast, gender-affirming medical interventions, such as GAHT, have been shown to help reduce gender-related anxiety and improve psychological well-being among transgender individuals (Cooney et al., 2025; Nguyen et al., 2018; Reisner et al., 2025). Appropriate GAHT also enables individuals with a desire for transition to experience the effects of hormonal changes both physically and psychologically, thereby providing a relatively safe period for exploration (Coleman et al., 2022). Nevertheless, in practice, some transgender individuals who would benefit from GAHT may initiate informal self-medication without professional supervision. Based on data from outpatient registry of Peking University Third Hospital Gender Health Care, this cross-sectional study observed that 60.4% of participants had engaged in self-medication without medical guidance, including cases of self-medication among Chinese teenagers under 16 years old. Furthermore, transgender woman identity and psychotropic medication use appeared to be independently associated with self-medication behavior.

Prevalence and behavioral characteristics of self-medication

Previous studies, both in China and internationally, have suggested that self-medication among transgender individuals represents a matter of concern. In 2020, our team analyzed data from a 2017 nationwide online survey of 1,304 transgender individuals in China and found that 67.6% of hormone users had obtained medications from informal sources and used them without medical oversight (Liu et al., 2020). Similarly, a cross-sectional study in Japan involving 87 transgender women reported that 66.7% self-administered gender-affirming hormones, with nearly all medications acquired through e-commerce platforms (Baba et al., 2022). Beyond these regions, two large Russian surveys including 1,117 and 588 transgender participants, respectively, indicated that 53.6% to 59.4% initiated GAHT independently without prescriptions (Chumakov et al., 2022; Kirey-Sitnikova, 2024; Makarova et al., 2021). A smaller survey of 55 transgender participants in Brazil found that 30.5% of transgender men and 53.6% of transgender women reported hormone use without medical prescription. Notably, only 5.1% of transgender men and none of the transgender women obtained hormones through health institutions, underscoring the limited availability of formal health care channels for transgender individuals (Carrara et al., 2019).

Characterized by diverse and unregulated sources and regimens, self-medication appears to be particularly prevalent among transgender women and may contribute to potential health and social risks. In the 2017 nationwide cross-sectional survey in China mentioned above, 61.8% of hormone users were either not regularly monitored or were unaware of the need for monitoring, and 53.2% believed that they had experienced hormone-therapy-related health problems (Liu et al., 2020). Regarding the sources of medication, our findings indicated that 84.8% of participants obtained hormones through nonmedical channels, including offline pharmacies, online platforms, and community sharing. Similar patterns have been reported in other studies, where commonly described acquisition routes included purchasing from pharmacies without prescriptions, overseas procurement, online platforms, and peer distribution (Araujo et al., 2024; Gooren et al., 2015; Kirey-Sitnikova, 2024; Krüger et al., 2019; Maoto & Davis, 2024). Such unregulated exchanges of prescription hormones may further reinforce the social vulnerability and stigmatization against transgender communities. Moreover, our results suggested that transgender women displayed diverse self-medication practices involving 12 distinct regimens, many of which were neither guideline-recommended nor supported by clinical evidence. In a cross-sectional study of 253 transgender individuals, Eustaquio et al. reported that 59.7% used hormones outside standard reference regimens, with frequent use of combined oral contraceptives among transgender women and anabolic steroids among transgender men (Eustaquio et al., 2023). Similarly, a study by Salakphet et al. involving 527 transgender women with self-medication in Thailand found that 49.1% used oral contraceptives (Salakphet et al., 2022). Collectively, these findings suggest that the use of medications outside guideline-recommended protocols remains relatively common among transgender populations.

It is noteworthy that in our study, nearly 14% of participants who engaged in self-medication reported initiating GAHT before the age of 16. These individuals appeared to experience gender dysphoria during adolescence or even earlier, which may have prompted them to seek hormone medications independently as a means of delaying physical development. The emergence of self-medication among younger individuals may suggest that some adolescents lack adequate support from their families, schools, or social environments when coping with issues related to gender identity (Olson-Kennedy et al., 2019). Beyond early initiation, our observations indicated that more than 20% of participants who self-medicated reported using doses exceeding recommended levels. Baba et al. also documented occurrences of hormone overdosing among 87 Japanese transgender women, suggesting that excessive hormone use may represent a relatively common pattern across different transgender populations (Baba et al., 2022).

Relevant factors associated with self-medication

Previous research suggests that self-medication may be influenced by both external and internal factors. External influences include limited access to medical resources, social stigma, and marginalization, whereas internal factors may involve personal perceptions of illness stigma or a strong desire to expedite gender transition (Kennedy et al., 2021; Metastasio et al., 2018). In our study, gender identity, psychotropic medication use, history of psychological disorders, and age at first awareness of gender incongruence appeared to be significantly associated with self-medication practices, with the first two factors emerging as potential independent predictors.

Transgender women were found to be at a higher risk of self-medicating. Similarly, Mepham et al. reported a higher rate of self-administered hormone use among transgender women than among transgender men (Mepham et al., 2014). Considering psychological characteristics, Niu et al. observed that Chinese transgender women scored significantly higher on the F and Hs scales than Chinese cisgender men, whereas no notable differences were identified between Chinese transgender men and cisgender women (Z. Wang et al., 2025). The F scale assesses response validity, while the Hs scale measures hypochondriasis. These elevated scores in transgender women could suggest greater psychological sensitivity and possibly a heightened tendency to seek health-related interventions. Such characteristics might partly contribute to the relatively higher prevalence of self-medication in this group. Objective conditions may also play a role in facilitating self-medication among transgender women. Several studies have suggested that the availability of feminizing hormones, such as estrogens and antiandrogens, without prescription—particularly through online or community channels—may make self-medication easier compared with testosterone-based treatments (Araujo et al., 2024; Carrara et al., 2019; Kirey-Sitnikova, 2024).

Several previous studies have emphasized that future research should consider mental health variables that may be associated with higher rates of hormone self-medication (Mepham et al., 2014; Salakphet et al., 2022). In our analysis, both comorbid psychological disorders and psychotropic medication use were associated with an increased likelihood of self-medication, with the latter emerging as a potential independent factor. Regarding the higher prevalence of psychological comorbidity among individuals who self-medicated, existing evidence indicates that transgender individuals generally experience higher rates of mental health conditions than their cisgender counterparts (Hajek et al., 2023; Watkinson et al., 2024). One possible interpretation is that those with a greater psychological burden may be more inclined to self-medicate as a means of managing distress or unmet healthcare needs. By contrast, Moraes et al. reported that self-administered hormone use was associated with lower depression rates, which they attributed to improvements in mental well-being following gender-affirming hormone therapy (Moraes et al., 2024). Given the cross-sectional nature of both studies, these differing results may reflect distinct aspects of the relationship between self-medication and psychological comorbidity, underscoring the need for longitudinal research to clarify causality. Furthermore, psychotropic medications, such as selective serotonin reuptake inhibitors and benzodiazepines, may alter risk perception and lead individuals to underestimate the potential dangers of self-medication by affecting neurotransmitter activity and regulation (Ferreira et al., 2022; Mo et al., 2025).

Regarding the influence of age at first awareness of gender incongruence on self-medication, Topaz et al. found that later awareness of gender incongruence was associated with greater psychopathology; affected individuals were 1.62 times more likely to report depressive disorders and 1.60 times more likely to report anxiety disorders (Topaz et al., 2024). Additionally, another analysis found that transgender women tend to perceive gender incongruence at a later age than transgender men (Liu et al., 2020). Overall, the relationship between age at first awareness of gender incongruence and self-medication may be mediated by comorbid psychological disorders and gender identity, suggesting that it is unlikely to represent an independent risk factor.

Health risks related to self-medication

We also explored the potential health risks associated with self-medication. Among transgender women, those in the self-medication group exhibited significantly elevated estradiol and prolactin levels. The use of cyproterone acetate, as well as estrogen, can lead to hyperprolactinemia (T’Sjoen et al., 2019; Wilson et al., 2020). Among transgender men, it is well established that androgens play an important role in promoting erythropoiesis (Shin et al., 2016). Current hormone therapy guidelines for transgender individuals emphasize the increased risk of polycythemia associated with androgen treatment (Coleman et al., 2022). Consistent with these findings, our results indicated that transgender men who self-medicated had significantly higher testosterone and hematocrit levels.

International guidelines recommend that transgender women maintain estradiol concentrations between 100–200 pg/mL (367.1–734.3 pmol/L) and transgender men maintain testosterone concentrations between 400–700 ng/dL (13.8–24.3 nmol/L) during GAHT (Coleman et al., 2022). However, in our sample, the median hormone levels in the self-medicated group were below these target ranges (estradiol: 137.51 pmol/L in transgender women; testosterone: 5.62 nmol/L in transgender men). This observation may indicate reduced treatment effectiveness or challenges in monitoring when synthetic estrogens are used. Conversely, some individuals exhibited hormone concentrations markedly exceeding the recommended limits. Prior research has reported a potential association between elevated testosterone levels and non-suicidal self-injury behaviors, while large fluctuations in estrogen levels have been linked to depressive and anxiety symptoms (Kundakovic & Rocks, 2022; Ma et al., 2022). Collectively, these findings underscore the importance of recognizing both the physical and psychological risks that may accompany unsupervised self-medication, particularly in the absence of professional medical oversight.

Strengths and limitations

Drawing on the largest clinical registry database of transgender individuals in China, our study analyzed the characteristics, associated factors, and potential risks of self-medication among this population. To the best of our knowledge, it represents the largest sample to date examining self-medication behavior not only in East Asia but also internationally. Compared with data from previous national self-reported survey conducted by our team, all relevant data in this study were obtained through face-to-face clinical consultations, ensuring greater reliability and accuracy. Furthermore, our gender clinic records provided detailed documentation of self-medication behavior, including specific medications, dosages, and sources. Collectively, these methodological strengths offer complementary insights that deepen the understanding of self-medication practices among transgender individuals.

However, several limitations should be acknowledged in this study. First, as a cross-sectional design, it cannot establish causal relationships between associated factors and self-medication behavior. Second, our analysis included only transgender women and transgender men, excluding nonbinary individuals because of their small sample size and the absence of standardized GAHT protocols for this group in China, which may oversimplify gender diversity. The relatively smaller number of transgender men compared with transgender women also limits the generalizability of our findings to the transgender male population. Third, previous studies have shown that transgender women with low family acceptance are more likely to engage in self-medication (Gooren et al., 2015). Because our clinic requires family consent before initiating GAHT, the influence of family attitudes on self-medication may have been underestimated. Self-medication may be more common among those who have not yet gained family understanding, highlighting the need for further investigation.

Conclusion

Our study demonstrates a high prevalence of self-medication with gender-affirming hormones among individuals with gender dysphoria in China. These findings indicate substantial unmet medical needs and widespread engagement in high-risk behaviors within this population. They underscore the importance of strengthening health education, improving access to formal medical services, and regulating hormone supply channels. Transgender woman identity and the use of psychotropic medications were strongly associated with self-medication. Identifying these risk factors is essential for developing targeted educational programs, enhancing medical support, and ensuring appropriate follow-up, thereby reducing health risks to both individuals and society.

Supplementary Material

Supplementary tables_Revision.docx
WIJT_A_2634170_SM2373.docx (23.5KB, docx)

Acknowledgements

We appreciate all the transgender individuals for their participation in this study. We thank Prof. Hongsen Bi from Department of Plastic Surgery, Peking University Third Hospital for his support in establishing and running the gender clinic. We also would like to thank Editage (www.editage.cn) for English language editing.

Funding Statement

This study was funded by the National Natural Science Foundation of China (82370896), Clinical Cohort Construction Program of Peking University Third Hospital (BYSYDL2024020), the special fund of the National Clinical Key Specialty Construction Program, P. R. China (2023), Peking University Third Hospital Innovation and Transformation Fund (BYSYCY2024009) and Noncommunicable Chronic Diseases-National Science and Technology Major Project (2025ZD0549700).

Disclosure statement

The authors declare that they have no conflict of interest.

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