Online community support
Transgender people may be self-treating, obtaining drugs or other products not ordinarily available or recommended in UK guidelines, or using them alongside officially prescribed therapies. Their actions may be influenced by bloggers or online support forums, or because a medicine is not available through NHS gender services.
Online discussions can be around ‘masculising’ or ‘feminising’ effects which may not be immediately obvious at first thought. For example, changes in body odour, voice tone, mood, or the enhancement or diminution of parts of the body – breast, buttocks, facial or body hair, genitalia, skin texture – may influence the use of a drug.20
Trans men may be using finasteride to counter head hair thinning/loss caused by testosterone treatment. In the UK, finasteride is only “indicated for the treatment of men with male pattern hair loss (androgenetic alopecia) to increase hair growth and prevent further hair loss,” and “is not indicated for use in women or children and adolescents.”21,22,23
However, some trans men may still have a risk of pregnancy, or may decide to come off testosterone, with a possible risk of pregnancy and subsequent birth defects. Bloggers mention reports of trans men’s periods returning or breakthrough bleeding recurring after using finasteride, but a more likely reason for not using finasteride is that it may reduce facial hair.25,26
Progestogens are another example, used by some based on its anecdotal reputation for enhancing breast growth in trans women. Clinical guidelines do not recommend the use of progestogen as there is inadequate clinical evidence for a role in enhancing breast growth, but there is good evidence that thrombosis risk increases. 7,14
Spironolactone use highlights an international difference in clinician endorsement which may prompt self-treatment. It is recommended as an anti-androgen in the Endocrine Society guidelines but is not supported in NHS guidelines. This is, in part, due to potential adverse events through its potassium-sparing diuretic properties, but also because more effective anti-androgens are available.7,14