A recent investigation has raised concerns that some minors in the United States may be able to obtain cross-sex hormones such as estrogen or testosterone from online pharmacies and other sources without prescriptions or age verification.
The report, published by the Do No Harm medical advocacy organization, examined online vendors, discussion forums, and digital marketplaces that appear to provide access to hormones commonly used in gender-transition treatments.
They reported that several vendors did not appear to require prescriptions or information verifying the age of purchasers.
These findings have prompted calls for increased oversight of online pharmacies and digital distribution networks that sell prescription medications.
Cross-sex hormones refer to medications used in hormone therapy during gender transition.
Examples include:
Estrogen, often used in male-to-female transition
Testosterone, often used in female-to-male transition
These hormones affect the body’s endocrine system and can alter physical characteristics over time.
According to the investigation, minors seeking hormone therapy may encounter online communities and resources that provide guidance on purchasing and using hormones without medical supervision.
A review of online discussion forums, including communities on platforms such as Reddit, found users discussing vendors that ship hormone medications internationally.
Researchers also identified websites that list online pharmacies and “homebrewed” hormone suppliers, some located outside the United States. These platforms sometimes provide instructions for self-administration of hormones and tips for purchasing medications without prescriptions.
One website cited in the report lists vendors across several continents that sell hormones online, while also acknowledging that purchasing prescription medications without authorization may violate regulations.¹
Medical experts generally recommend that hormone therapy be conducted under clinical supervision due to potential health risks and the need for ongoing monitoring.
Possible health effects associated with hormone therapy may include:
Changes in fertility
Increased risk of cardiovascular events such as heart attack or stroke
Hormonal imbalances affecting metabolic or endocrine systems
Potential increased risk of certain cancers depending on treatment type
Without medical oversight, individuals may face risks related to incorrect dosing, drug quality, or interactions with other medications.
In the United States, medications such as estrogen and testosterone typically require a prescription from a licensed healthcare provider.
The U.S. Food and Drug Administration (FDA) regulates prescription medications and oversees pharmaceutical manufacturing and safety standards.
The report recommends that states review existing laws and enforcement mechanisms addressing online drug sales that may bypass regulatory safeguards.
The availability of pharmaceuticals through online marketplaces has expanded in recent years, raising broader questions about regulatory oversight and patient safety.
Health authorities have previously warned that purchasing medications from unverified online sources may carry risks related to counterfeit products, contamination, incorrect dosage, or lack of quality control.
Researchers note that the increasing presence of online drug vendors and digital communities may complicate efforts to regulate prescription medication distribution.
Reference
Do No Harm, Lack of Barriers to Online Hormones (Washington, DC: Do No Harm, March 2026), https://donoharmmedicine.org/wp-content/uploads/DNH-Lack-of-Barriers-to-Online-Hormones-March-2026.pdf.
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