Herbal Hormone Supplements Can Change the Meaning of Trans Embodiment

Deep in the woods of central Tennessee, Josefine, a thirty-two-year-old trans woman, performs her daily endocrinal maintenance. She opens up a capsule of Pueraria Mirifica, a rainforest plant that produces phytoestrogens, and mixes it with almond milk or ginger tea. Throughout the day, she drinks water mixed with a tincture of chaste tree berry as well as a tea made of schisandra berry.

Josefine has curated these herbal supplements to support a hormonal ecology whose effects most would describe as female. The herbs make her hair longer and her skin softer. Over time, they’ve subtly shifted her body fat from her belly to her hips. But for Josefine, the herbs are more than their physical effects. As she’s wildcrafting on the land near her home, reading articles on the internet and making potions with friends, she’s not just trying to achieve the physical markers of womanhood.

In her words: “I’m really asking questions about what I need to nourish myself and what herbs will get me there.”

There are easier ways for Josefine to transition genders. Most trans people use synthetic hormones—lab-produced chemical compounds designed to replicate the effects of naturally-occurring physical hormones. The process of conventional hormonal gender transition has by now been codified: If you’re transmasculine, you take testosterone supplements, typically by intramuscular injection, which make your voice deepen, your muscle mass increase, and hair grow on your body. If you’re transfeminine, you take estrogen pills along with an anti-androgen (testosterone blocker)—typically the diuretic Spironolactone. These medications make your breasts develop, your skin soften, and your muscle mass decrease.

For many trans people, these medical interventions are literally life-saving. They can work a powerful magic, making a previously alien body feel like yours. I speak from personal experience: I’m a trans man who has taken synthetic testosterone for about five years. In addition to the expected physical changes—and because of them—I’ve become both more grounded and more joyful. I am, for the most part, a synthetic hormone success story.

But as all careful trans narratives emphasize, my story is not everyone’s story. It’s not clear how many trans people use herbal supplements in place of or in addition to synthetic hormones, but it’s clear they exist in significant numbers—on internet forums and in back-to-the-land communes and coastal apothecaries—and their stories of divergence from the medical transitioning norm bear exploring.

Societally, we’ve learned to check many of our gender-based assumptions. We know that you can identify as a gender without dressing in the stereotypical manner of that gender, for example, and we’re starting to understand that there isn’t one set of surgeries that make a gender transition possible. But we’ve rarely questioned our assumptions about what it means to hormonally transition genders. I know I hadn’t, even though I’ve spent more time than most thinking about the interaction of my gender and hormones. It took people like Josefine to explode my understanding of what it means to physically transition.

Josefine’s path to alternative hormones began, as it does for many, with a negative medical experience. She started her transition almost a decade ago taking Spironolactone. She had digestive issues and felt faint, but felt her doctor wasn’t taking those complaints seriously. Eventually she went to another doctor, who said her blood pressure was dangerously low and that she should stop taking the medication if she didn’t want to “pass out under the trolley tracks.”

This experience, along with a lifelong distrust of medicine stemming from a botched surgery that left her sister unable to walk, made her decide to pull away from doctors altogether. Josefine told me over Skype, “Something that really deeply impressed on me from my sister’s experience is that doctors don’t necessarily know what they’re doing or how best to do it.”

There is a long tradition of radical queer communities built on an intimate relationship with the land around them. Josefine’s interest in plants and distrust of Western pharmaceuticals cohered with both established and burgeoning radical ecological communities in Philadelphia, where she was raised, and rural Tennessee, where she lives now. It seemed only natural that she would use plants to support her gendered embodiment, too.

“I was at a stagnant point in my life,” Josefine said of the time before she started taking herbal supplements. Her chosen community performed “a ceremony where I washed away a lot of what's been imposed on me in terms of the way that I was raised and socialized about gender.” Within half a year, she’d started working with herbs.

At age seventy-two, a trans woman in central Virginia named Traci is of a very different generation than Josefine, but shares some similar attitudes towards health. “I’ve always endorsed and embraced a holistic lifestyle of sorts,” she told me over email. Whenever she was sick—“or just being preventative,” she said—she reached for herbs first. Like Josefine, Traci didn’t want to pursue a transition under a doctor’s supervision, though the primary motivation was privacy. “I was reluctant to bring up the subject,” she told me, saying she’d spent a long time doing research online to find “alternative means” of transitioning from male to female.

This led Traci to MyEvanesce, a now-defunct website that both sold proprietary feminizing herbal formulations and served as a discussion forum for the primarily older trans women who used it. “I just felt very comfortable in this community,” Traci told me. “In other sites, when I mentioned going the herbal route, I was slammed as others deemed themselves ‘more tranny’ than me by following doctors’ ‘cut and paste’ solutions for making a transition.”

Using the supplements sold by MyEvanesce and the advice of the community on the forum, Traci began her first feminizing herbal hormones in 2009, on Halloween, which she joked is a symbolically apt time for a transition. Every day, she took six Evanesce, four Feminol, and two Androease capsules—all herbal blends that include Pueraria Mirifica, as well as chaste tree, peony, and skullcap. Traci didn’t see many changes at first, and wondered whether the herbal supplements would have much effect. After about six months, however, she began to notice her skin was noticeably softer, as well as a “stirring” in her breast tissue, what she later learned was the beginnings of glands and ducts. At the time, she said, they felt like “chopped pieces of potatoes.”

After three years, her breasts reached the size of a small B cup. Her fat distributed itself over her hips and buttocks rather than her belly. She could, she said, “wear a two-piece bathing suit to the beach and not look silly.” Along with increased hair growth on her head and electrolysis treatments to remove facial hair, Traci was happy with the results of the supplements and was passing as a woman, which she insisted on proving by sending me a current selfie. The photo does indeed show her to be the type of athletic, younger-than-her-years woman who “takes care of herself” that Traci wants to be. In it, she wears a wig, gold hoop earrings, and a knit halter top bra that reveals small but full breasts.

“I was slammed as others deemed themselves ‘more tranny’ than me by following doctors’ ‘cut and paste’ solutions for making a transition.”

After eight years using only herbal supplements for her transition, Traci had to begin taking synthetic hormones. Her doctor, to whom she’d finally revealed her transition, was concerned about potential negative effects from the interaction of the herbs with a thyroid condition Traci has. Traci wanted to emphasize, however, that when her blood was tested before she started the synthetic hormones, she was in the typical range of estrogen levels for someone assigned female at birth. She says she didn’t even need to take a synthetic anti-androgen because the herbs worked so well—better, in fact, than prescribed estrogen.

Traci is now something of an ambassador for herbal supplements to her trans woman friends, not only because of the physical results, but because of her emotional transformation. She’s found “that mental happy place.” The longer she took herbal hormones, the more she felt herself “lose all of my former anger, anxiety, aggression, and angst,” supplanted by “a newfound sense of clarity.”

However, other trans women don’t share Traci’s experience. Those who haven’t had an orchiectomy, as Josefine has—the removal of the testes dramatically slows production of testosterone—often have difficulty seeing results with herbal hormones. Other online forums abound with cautionary tales describing herbal hormone regimens that produce negligible gendered effects, but plenty of adverse physical ones. A decade ago, a trans man named Tristan Skye made waves with his advocacy for masculinizing herbal and diet supplements, only to be met with derision for his lack of scientific rigor and promises of undeliverable results.

Then there are the safety concerns. Though most herbal supplement users I talked to were careful to follow recommendations for safe sourcing from ethical companies, the supplements are unregulated, which poses a significant risk. “You don’t know that what’s on the label is actually what it’s going to contain,” Katrina Hanson of Prism Integrative Acupuncture, a resource for herbal care for trans people in the Bay Area, told me over Skype. “I would never recommend going to Chinatown and picking up a bottle of herbs.”

Some trans people willingly take these risks because they have no other options. Hormone treatment can be expensive, especially without insurance. According to a 2015 landmark survey of over 27,000 transgender people in the United States, 25% of trans people who tried to obtain insurance coverage for their hormone treatment were denied. Herbal supplements can add up, too (Pueraria Mirifica typically runs around twenty dollars a bottle), especially at the quantity necessary to see results, but in the balance can favor the uninsured in certain cases. April Marrie, a trans woman on the Evanesce site, told me over email, “insurance is a no-no . . . just way out of my pay grade.” April says she’s made financing her hormone therapy work with regular shipments of Pueraria Mirifica capsules straight from Thailand, where the plant grows in abundance.

Geography can also prevent access. Trans people in rural areas may need to drive long distances to reach a clinic that can administer hormones. “i’m 19, i don’t think i can take this anymore,” reads a post on the r/TransDIY Reddit page. It continues, “i want to transition now. i don’t have the time or a ride to go to a gender therapist. pls help.” A fair amount of the posts on the subreddit are similar calls for advice or support. Many commenters respond with both ideas for unauthorized sourcing of synthetic hormones and herbal supplement websites.

In this case, “DIY” does not always mean herbal supplements; more commonly it refers to black or grey market synthetic hormones. These more familiar versions of DIY hormones are studied primarily in the context of transfeminine sex workers of color in urban areas. It’s an issue of access. The research says these unregulated hormones are born out of necessity; those who seek synthetic hormones illegally would typically use them legally, if able.

On r/TransDIY, therapists and medical professionals who post on the subreddit are typically there to ensure that consent is informed and medical risk minimized. However, other commenters sometimes disparage them as “gatekeepers.” It’s noteworthy that certain forum posters, more desperate than others, feel like they need to transition immediately, and that they perceive any kind of barrier to transitioning (whether well-meaning or not) as an obstacle. And to circumvent all obstacles, they are turning to alternative hormones.

Whether or not trans people are able to access herbal supplements depends on the systems in place for distributing them. Generally, these systems comprise a network of online for-profit distributors along with a sprinkling of apothecaries. Some systemic interventions into the world of alternative hormones, however, are more radical.

Whether or not trans people are able to access herbal supplements depends on the systems in place for distributing them.

On a dark, post-industrial block in East Baltimore lies a complex of several-storied brick buildings abutted by a concrete courtyard. The building is a former gasket and seal factory that is now home to start-ups, non-profits, and the Baltimore Underground Science Space, the location I was there to visit. Though metal gates surround the exterior, the inside of the space is homier, with the friendly clutter of a co-working space: couches, a refrigerator, a whiteboard with project schedules. Metal stools line a long table cluttered with pipettes in various stages of cleanliness.

Rian Hammond, the person I was there to see, handed me a Natty Boh, the beer of our shared city (at the time, I lived only a few blocks from the lab). Then they showed me a row of tobacco plants trembling under their spotlights. These tobacco plants, Hammond hoped, will eventually produce testosterone.

Hammond, in a polka dotted blouse and dangly earrings, patiently explained the basics of the science. A modified DNA plasmid is inserted into an agrobacterium in the soil of the plant. Tobacco, which is high in the cholesterol that is a precursor to steroid hormones, acts as a natural host for this plasmid. Once this genetically modified plant is available, people could, in theory, buy the seeds, grow the plant themselves at home, and then apply the hormone by rubbing it onto their skin.

Hammond is a scientist, artist, biohacker, and the creator of a project called Open Source Gender Codes, a provocative nod to the future of alternative hormones. The genetically modified tobacco plants are part of Hammond’s techno-utopian vision of an “open source platform” for sex hormone production: a future in which ordinary people have access to pharmaceutical tools. The project is speculative in the sense that making the plant available would trigger many legitimate questions about distribution, safety, and patenting—of which Hammond is very much aware.

They are in contact with patent lawyers, but hope to make the system available without a patent, as that is in keeping with their ethos of democratic access. “I see my work as playing into a conversation about who is allowed access to hormones, like who is really transgender,” Hammond said.

The current medical model that dictates who is “really transgender” is informed by a familiar media narrative: The trans person has known they were trans since the dawn of their consciousness; they suffer deeply from the disconnect between their assigned and desired genders; and they want to transition fully to the other gender in a way that prioritizes visual passing. Many of those trans people do exist, and it makes sense for them to seek medical services to manipulate their hormones to the levels of a cis person.

This model, however, leaves out non-binary people, who may feel that their ideal gendered embodiment isn’t predicated on “passing” as a man or woman. Herbal hormone supplementation can be a way to achieve a non-binary medical transition. The r/TransDIY subreddit is full of queries from people identifying both as non-binary and those that don’t identify as such but simply want a more expansive physical gender. “I am a bisexual male who identifies as a man, but I want a more feminine body,” writes one poster on the forum. Herbal supplementation can be a way to achieve this transitional, ‘either way’ state.

I’ve experienced the difficulty of putting gender into medically comprehensible terms myself. I spent years exploring my gender privately and socially in ways I didn’t necessarily feel the need to define. But once I began interacting with medical providers, I knew I needed to use language that spoke to the standards codified by Harry Benjamin, founder of medical treatments for transsexuality in the United States, who wrote that a “true transsexual” is asexual until transition, “despises” their genitalia, and exhibits the behavior and tastes conventionally associated with their desired gender.

I began my medical transition in a more conservative time (seven years ago—change happens quickly in the realm of trans care) and place (Nebraska, where I went to grad school). I simply wouldn’t have been able to access hormones without assuring my providers that I wanted to go ‘all the way’ to manhood, with all the assumptions that entails. The weight of these assumptions delayed my transition for years.

What did it mean to really be a man? Did I want it badly enough? Was I suffering enough without it? What if I’d been able to gradually shift my hormones towards a desired embodiment, without necessarily claiming that embodiment to be “man,” with all the pressure that comes with it?

What if I’d been able to gradually shift my hormones towards a desired embodiment, without necessarily claiming that embodiment to be “man,” with all the pressure that comes with it?

Important as philosophical discussions of the definition of gender are, they can feel abstract. It helps to remember people like Josefine and Traci, at home in their kitchens, web browsers open to forums of people all over the world like themselves, mixing teas and sourcing herbs from Thai rainforests, trying in their own ways to figure out their own ways of transitioning; like people and patients working with Katrina Hanson of Prism Integrative Acupuncture when I interviewed Hanson in 2018.

One of Hanson’s patients, assigned male at birth, wanted to have another child using their own sperm. They approached Hanson seeking herbs that would help them “have less gender dysphoria without reducing fertility.” After conceiving, the patient planned to medically transition using Western medicine.

The norms of conventional hormonal transition would typically make this person choose: Look like a man and produce sperm, or look like a woman and don’t. But what if it’s possible to have it all? Through herbal interventions, it’s possible that Hanson’s patient could begin to feminize their appearance while retaining their ability to inseminate. Hanson’s patient illustrates the limits of traditional trans care, which so often prevents trans people from achieving our full embodied potentials through enforcing limiting ideas of what men and women should be.

Scholars in the last two decades have illuminated the ways in which gender hormones have traditionally been used as agents of control. Estrogen and testosterone have historically been deployed to produce gender compliant citizens: women who are fertile, men who are virile. What if, instead, they were agents of autonomy? What if they enabled someone with a penis to make a baby and be a woman? The prospect is threatening to any establishment which relies on pathology rather than autonomy to justify care. Josefine and Traci and others who use herbal hormone supplements are taking plenty of risks. But sometimes risk is what it takes to see a different future.

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