this post was submitted on 02 Nov 2025
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Elsewhere in this thread I talked about a couple patients I have actually treated. One was a woman in her 60's that got mystery doses of estrogen from implanted pellets that now has to take blood thinners for the rest of her life because she got a DVT and pulmonary embolism because of the excessive estrogen. She's also at much higher risk for uterine and breast cancer too. Another was a man in his 50's that had to get coronary stents and start a pile of medications to try to mitigate his heart and liver damage from taking the doses of testosterone recommended by body building influencers. I actually care about HIPAA, so I won't be giving you any more specific information about these cases.
It really isn't the trans folks I'm worried about when it comes to HRT, but if it's freely available to trans folks, that means it's also freely available to cis folks that are more likely to do it wrong and suffer severe consequences.
I am concerned for the population at large, and unfortunately, safety regulations have to account for the lowest common denominator unless you think that uneducated or gullible people deserve to suffer. Prescriptions are a way to make sure that people are getting the medications they need in the appropriate doses for the correct indications. There's enough trouble with people hurting themselves with the medications that are already OTC. I don't think more OTCs (HRT or otherwise) are a particularly good fix for the disaster that is American healthcare.
Data is not the plural of anecdote. As has been pointed out elsewhere in the thread, many countries have OTC HRT and do not have significantly higher morbidity or mortality rates associated with those materials. Your experiences, in the form you've shared them, are NOT citeable. So, we're still at "Citation Needed" stage.
I think that uneducated or gullible people deserve full bodily autonomy, even if that means bad results from their choices.
Certainly, educated and sophisticated people can also get bad results from their choices; I see no reason to deny them to anyone else.
There is a difference between safety regulation and paternalism that I think you are failing to parse. As a society, we share a collective responsibility to build safeguards and fail-safes into the structures of our environment for the protection of those among us that need help. Unfettered freedom and rugged individualism with "full bodily autonomy" is a recipe for disaster.
And many of those countries have wildly different healthcare systems and health culture. The American population is so utterly bombarded with misinformation (including from our own government and regulatory bodies now) that I don't see phenomena or results from other countries as fully applicable to Americans. There are tons of studies about vastly different outcomes of treatments or interventions in other countries (especially Scandinavian countries) that I do not apply to my clinical practice because a lot of those results are heavily confounded by factors that the study doesn't account for like cultural diet, healthcare access, amelioration of poverty, and genetics that would skew the results into uselessness in America. So, I'd love to get a list of these countries you're talking about because if they're civilized countries with accessible healthcare, it's not even an apples to oranges comparison; more like apples to chunks of concrete.
There is a fundamental right to bodily autonomy that you aren't valuing.
You can call it whatever you want, if you prevent a person from self-administering any substance, you are violating their human rights.
On top of that, many, many OTC substances are much more lethal than HRT, so the risks of HRT cannot be great enough to justify them not being available OTC.
Besides acetaminophen (Tylenol) which I have already addressed as being problematic in its packaging and advertising, which other OTC medications are you talking about?
Here's a list of medications that are available OTC (and not behind the pharmacy counter) that I think should be more restricted in terms of packaging, quantity limits, or accessibility (i.e. put them behind the counter with the Sudafed so they're available without a prescription, but there's a strict limit on how much you can buy.)
Among many, many others.
There's also a huge list of vitamins and supplements that shouldn't be as freely available in such high doses, and others that shouldn't be allowed at all because of safety risks. Not to mention the fact that a bunch of energy drinks out there contain enough caffeine in a single can to cross the threshold of caffeine toxicity if consumed in under an hour. (Celsius is a good example)
Bleach, ammonia, nicotine, and ethanol were the dangerous substances I mentioned earlier in the thread.
Bleach and ammonia are cleaning chemicals that were never intended for human consumption, not OTC medications. Nicotine should be banned entirely, and ethanol needs to be heavily reined in, but again, they are not OTC medications.
They are materials that can be much more dangerously self-administered. Anything less dangerous can't be justifiably ~~banned~~ restricted solely on the dangers of self-administration.
So we should ban every cleaning product, gasoline, diesel, basically every other fluid that goes into a car, potting soil, fertilizers, every item that can be used as a weapon, every actual weapon, and water because those can all be used to harm oneself?
Your argument here boils down to "either everything needs to be completely freely accessible to everyone with no restrictions or every substance on the planet needs to be confiscated and controlled because people could use something to harm themselves"....and I'm only exaggerating your position by a smidge.
Do you also think the FDA should stop having standards for food and drugs? After all, if people want cheaper weight loss supplements, they're way cheaper to manufacture if they're contaminated with lead and toxic substitutes for the advertised herbal ingredients.
No. They should all be legal to acquire and self-administer.
No. They enforce accuracy of labeling, which is important for people to make informed (consent) decisions about what they self-administer. They should stop making it illegal for a willing recipient to acquire an accurately labeled substance and self-administrate said substance.
Oooooh you're an idiot, never mind my previous reply to you