That's debatable. And if you want a serious rant, ask me what I think of the current classification of some OTC meds. Because there's plenty that shouldn't be OTC.

But I didn't say estradiol, or testosterone, or spironolactone, or any other hormone or hrt related meds were dangerous, I said they came with risks that are too high for them to be reclassified as OTC. Said it differently, but since that part didn't translate I figured I should rephrase.

I'm not sure what level of terminology you're familiar with, so if something isn't what you've run into before, holla at me and I'll rephrase things.

The point is that every substance we take into our bodies has some effect on it, no matter how minor. Medications, which are just substances that have a non-minor effect that is being applied to some form of illness, disease, disorder, or just to adjust normal function to a more desirable state, have higher risks than substances like water or cheese.

Medications all (or so near all as to be irrelevant) have interactions, and contraindications.

One of the ways medications are classified is by the degree of risk. Those classifications are far from perfect (again, I have strong opinions about many, many drugs needing to be reclassified), but an OTC drug needs to meet a standard that is a much lower threshold for risk than prescription only drugs.

The threshold of risk for something like estradiol is absolutely higher than that of paracetamol, aspirin, sodium bicarbonate, even something like topical lidocaine. None of those are risk free. They don't meet the threshold of dangerous (nor does estradiol), but the level of risk is low enough that OTC status is reasonably acceptable overall.

Estradiol, since that's the example you chose, comes with a non trivial contraindication for people with liver disease, clotting issues, history of stroke or dvt, and some forms of cancer. There's a list of medications hundreds long that it can negatively interact with, not all of which are obvious

And that's just one specific medication from that class of meds. I can't even rattle off all the known detrimental interactions for that one drug, and I'm a medical nerd/geek with decades of experience and training.

I can do that the acetaminophen, for fexofenadine, famotidine and dozens of other OTC meds because the lists are so much shorter.

And that's why reclassification of those meds is a horrible idea. There's other ways for trans people to have open access. And, being real, those options are better than campaigning for reclassification of HRT meds because they'll apply to other aspects of transition and healthcare.

Every single trans person on this planet deserves to have their right to access recognized, codified, and enforced.

That is not the same thing as reclassification of a medication. It just isn't. There's absolutely no upside to reclassifying estradiol instead of just making sure than the people that need it can not only expect to have that need addressed, but to also ensure that they have access to the full suite of healthcare that should be just as fundamental a civil right.

The only risks from HRT are that your medical risk profile undergoes a sex change. In other words, your risks for various diseases flips from the male-level risks to the female-level risks, or vice versa. However, in some circles, this simple risk profile flipping gets slandered as some horrible side effects that must be avoided at all cost.

No doctor has ever told an otherwise healthy cis man to go on testosterone blockers simply to lower their long-term heart attack risk. But trans men get fear mongered about the heart attack risk of testosterone, when all it does is raise their risk closer to the male range than the female range.

It's utter horse shit. Obviously if you take like, 10x the recommended dose, then you start getting into real risks. But HRT is an incredibly user-friendly set of medications to DIY. They're very forgiving medications. Hell, trans women can take 10x the regular doses for months and have no negative effects.

The connection between politicized medical disinformation surrounding COVID-19, and potential disinformation campaigns targetting trans people is interesting. Is there something in particular you're referencing, or is this more speculation on a potential issue?

I know my biggest barrier to care was indeed medical clearance and medication/tools restriction. Even with socialized coverage, it was about a thousand dollars and five months of my time to get started; let alone the years I spent waiting to even start the process because I knew that would be the most expensive hurdle. Hardly had to go through the same process for ibuprofen, which also carries fairly severe side effects if abused.

The people doing bleach and ivermectin were not doing their own research. They were screeching "do your own research" while denying the actual research and reading confirmation bias entertainment.

Bioidentical hormones are safe, the big risks come from the older derivatives like premarin (synthetics with high blood clot risk) or taking hrt levels of birth control type estrogen- there's some parts of the world that's what they still prescribe. Another big avenue of risk is infection/contamination with injectibles, due to this a lot of DIY people are making transdermal gel.

Anti androgens are expensive, estrogen is cheap. Anti androgens have high risks and dangerous side effects. Bioidentical estrogen has none. Doctors love to microdose the E and macro dose the AA. But mono therapy estrogen levels are enough to suppress testosterone without AA.

I've read the research from a trans girl who simulated pregnancy hormones and took her body through it.

Everything is risk assessment and reduction; cis people and trans people have different priorities on what those risks and reductions are. Such as the medical community wanting to give us the bare minimum, in dose, in care, in practice, in understanding.

I'm not spreading fud. I'm not asking questions.

I'm making a statement that drug classifications exist for a reason, even when flawed.

In the case of the various hormones, while I absolutely insist that access should be open and free, they are a class of medications that should be screened for contraindications. To a degree that simply doesn't match the level of risk that is acceptable for an OTC medication.

Being real, or isn't about trans access at all. Nobody needs to run into them OTC. Little old ladies with hot flashes, guys wanting to boost muscle gains, whatever. They just aren't a good OTC candidate.

That is completely separate from how horribly unfair and biased the medical community can be about access to meds for trans people. It's separate from trans people deserving total access to whatever treatment regimen they and their providers determine is safe enough and useful for their needs. It's about the mind numbing list of contraindications. It isn't "just" breast cancer or coronary risks. Both of which are far from trivial, but you know those risks going in because they're the common, well known ones.

Like estradiol and some anticonvulsants, or benzos. The possible outcomes from that kind of interaction aren't likely to kill anyone, but they're going to have an unpleasant experience and need to change either their hrt regimen, or the other meds until a combination is found that's both effective and safe.

You can't do all that on your own. Nobody can because it's not only unsafe, it's a hit into the resources that are sometimes already limited. You get randos just deciding they need to switch from valium to, I dunno, xanax, and even if that was a perfect switch to make, now you've got their supply of valium that's in the trash or whatever because you can't just return them. Or vice versa, they switch the estradiol and now that's either trash or is an unverified drug floating around which is a whole nuther kettle of fish being spilled.

The problem is that trans people need to be given the respect and decency to have access to transition resources without the bullshit, not what the meds are classified as. You, me, Terry down the street, we all have a fundamental right to equal access to services and medications. It I can get testosterone provided as a cis man, so should you as a trans man. Period. No buts. This is a separate thing from testosterone being an over the counter med.

It's throwing the baby out with the bathwater. People seem to forget that most of the drug classifications and regulations came about because without them, shit was horrible. Those classifications and regulations aren't always accurate representations of anything other than the stupidity of legislators, but that just means we need better methods of changing them, not that they don't work at all.

Seriously here, I have seen, first hand, too fucking many times exactly what happens when people start taking shit that they shouldn't. I was very often the first person to notice that kind of thing coming into a new patient's home and observing their medications. People taking way too high a dose, or not enough. Taking things that absolutely shouldn't have been taken together. I have seen some fucked up shit because of medications being used inappropriately. So, when I say that the various HRT meds should not be OTC, it isn't bigotry, it isn't fud, it's first hand experience combined with training and knowledge.

I'm not talking out of my ass here, I've seen exactly what can go wrong when someone takes estradiol while also taking thyroid meds. It isn't going to kill most people (and didn't my patient), but it was absolutely something that would happen with it OTC, because that poor, half dementia swallowed old lady got the estradiol from her sister, not her doctor, who would have been able to find the right combination of meds for her case.