* High costs for consultations, labs, and hormones force many transgender individuals in Cebu to navigate gender-affirming hormone therapy (Gaht) through unsupervised do-it-yourself self-medication.
* Twenty-three-year-old Ethaniel Dawn Daro injected prescription-free testosterone for two years without regular medical oversight, resulting in side effects such as painful cystic acne and leg bruising.
* Medical experts and advocates warn that unsupervised therapy carries serious health risks like liver damage and blood clots, while calling for greater access to monitored gender-affirming healthcare.
Gervie Paluga, UP Cebu Intern
ACCESS to affordable gender-affirming hormone therapy (Gaht) remains a challenge for many transgender in Cebu, leaving some to navigate their transition largely on their own.
For 23-year-old trans masculine, Ethaniel Dawn Daro that meant injecting testosterone without regular medical supervision for two years, after the cost of medical consultations, laboratory tests and the hormone itself became too expensive to sustain.
With his parents’ support, Daro decided to transition at the age of 18. He first consulted a psychiatrist and then underwent an initial medical consultation.
Unable to afford regular medical monitoring and laboratory tests, he continued the rest of his transition through do-it-yourself (DIY) hormone therapy.
“Our first consultation was costly. The blood work is costly. Checking the dosage is also costly. Then I still have to pay for the testosterone itself,” Daro told SunStar Cebu.
DIY transition
Using a 23 gauge sterile needle, Daro injected 0.5 milliliters of testosterone cypionate or enanthate into his thigh once a week during the first two months.
Over the following 18 months, he adjusted his regimen to 2.5 milliliters each month, before gradually reducing it to 0.5 milliliters every two to three weeks during the final six months of his transition.
Daro stressed that his regimen was based on his own research and advised from the Trans Masculine Equality Movement (Team), a Cebu based support group rather than from medical experts.
Each vial cost him around P2,500 and lasted about four months. Through the money he earned from art commissions he was able to sustain his transition for two years.
Daro said he purchased testosterone without a prescription from suppliers who primarily catered to cisgender men and bodybuilders used for performance enhancement because it was not readily available in pharmacies.
He added that he felt anxious every time he injected himself, but still continued because the result gradually affirmed the identity he had long struggled to express.
Barriers to transitioning
Kesha Elle Gonzaga, community center administration and finance officer of LoveYourself Cebu, said many clients who seek consultation have already begun taking hormones or birth control pills before approaching the organization.
Rather than consulting physicians or endocrinologists, some relied on online information or recommendations from friends who had already undergone hormone therapy, she said.
For Daro, it was through the Team and research that he learned more about transitioning and where to access testosterone.
According to Gonzaga, many transgender are unaware that the organization offers free Gaht consultations until after they have already started self-medicating.
Although LoveYourself Cebu offers free consultations with doctors, Gonzaga emphasized that clients still have to shoulder the cost of laboratory tests and hormones.
As a result, some clients continue self-medicating after their initial consultation, despite understanding the potential health risks, she added.
Why medical supervision matters
Dr. Mike Dilla, a physician from Cebu United Rainbow LGBT Sector (Curls), said doctors should first review a patient’s medical history and conduct laboratory tests to determine whether hormone therapy can be safely initiated.
Dilla said treatment plans differ from one patient to another depending on their health condition, transition goals, and how their body responds to hormones.
Even the type of testosterone can vary for female-to-male transitioning. These factors help doctors determine how aggressive or gradual hormone therapy should be.
“Transitioning is personalized, so we’re simply here to guide our clients and help them choose the safest and healthiest options,” Dilla told SunStar Cebu in a phone interview.
Dilla explained that injectable testosterone is generally preferred over oral preparations because it is absorbed more efficiently.
By contrast, oral testosterone passes through the liver before entering the bloodstream, making regular monitoring and proper dosing essential, he added.
Daro chose injectable testosterone because according to his research it was more likely than oral testosterone to produce the physical changes he wanted.
Testosterone gel was another option, but he said it was difficult to access, making injections the more practical choice.
Health risks
Dilla said hormone therapy requires regular check-ups to monitor hormone and cholesterol levels, assess liver and kidney function, and adjust treatment as needed.
Without regular check-ups, Daro developed painful cystic acne and experienced mood swings. He also bruised his leg after improperly administering an injection.
“At that time, the general mindset was that if you could still endure it, you just kept going,” Daro said in Cebuano.
Gonzaga also said some transgender become impatient with their results and mistakenly believe that taking higher doses will speed up physical changes.
Dilla warned that people who self-administer hormones without medical supervision may face health risks, including allergic reactions, injection site irritation, shortness of breath, hormonal imbalances, blood clots, and liver and kidney damage.
He added that although taking hormones do not directly cause mental health conditions, hormonal imbalance may affect some patients’ emotional well-being.
“How about inside? You may achieve the physical changes you want, but we also have to make sure your organs are still functioning well,” Dilla said in Cebuano.
Calls for an accessible Gaht
Despite the health risks, Daro said self-administering testosterone eased the gender dysphoria he had experienced since childhood and gave him the confidence to return to school, socialize, and interact more comfortably with others.
“Having access to hormone replacement therapy really changed my life. It made me more confident to go out there,” he said.
Although he did not regret taking testosterone, Daro temporarily stopped treatment while he was in college because of academic demands, the cost of hormone therapy, and a later diagnosis of generalized anxiety disorder that made self administering testosterone more difficult.
Looking back, Daro said he wishes someone had told him earlier that there was nothing to be ashamed of about seeking gender-affirming healthcare. He even hopes to resume hormone therapy under proper medical supervision in the future.
“I really wish more people understood that gender-affirming care can truly change your life. It can save you and help you break free from a very dark place,” he said.
Daro also called for more research, greater access to transgender healthcare services, and increased public understanding to improve gender-affirming care in the Philippines.
“The more we make this inaccessible, it doesn’t stop people from trying. It only makes it harder,” he said.
