Nonprescribed Sex Hormone Use Among Trans Women: The Complex Interplay of Public Policies, Social Context, and Discrimination.

Trans women are systematically excluded from basic human rights, possibly due to social contexts of transphobia. In health care, such barriers may result in nonprescribed sex hormone use and lead to significant health complications. As few studies investigated this phenomenon, we analyzed factors associated with nonprescribed sex hormone use by trans women in seven municipalities of São Paulo, Brazil. Muriel was a cross-sectional study (2014/2015), in which 673 transgender people answered a face-to-face survey. This analysis focused on trans women (=616). Poisson regression models were used to assess factors associated with nonprescribed sex hormone use. A direct acyclic graph was built with knowledge on the matter and was used for covariate selection. A total of 90.7% of participants reported ever taking sex hormones. Most of those detailed nonprescribed use, which was associated with sex work, starting to use hormones before 18, identifying as and lower education. Having the chosen name honored in public health services was found to be protective against this outcome. A high proportion of nonprescribed sex hormone use was observed in our sample. Our findings suggest barriers to health care and the need for trans women to resort to medically unsupervised transition procedures. Among sex workers, this may also be due to higher economic and access needs than other groups. Ensuring social rights and providing adequate health care services may lessen nonprescribed sex hormone use, preventing subsequent risks and resulting in better health outcomes for trans women.