The Trans Directory

FTM Access

9 min read

How you actually get testosterone varies enormously by country. This page walks through the main pathways (Australia first, since this site is Australian-made), the costs, the legal picture, traveling with T, and a frank harm-reduction section on self-sourcing.

details can change FAST, if any of this is out of date please reach out! transinfo@aria.coffee

Australia

Australia uses an informed consent model, your doctor explains the effects and risks, and you decide to start. any GP can assess and prescribe testosterone, no psychiatrist letter, no mandatory therapy, no “real-life experience” requirement.12

  • The PBS step: for subsidized testosterone on the Pharmaceutical Benefits Scheme, a specialist (an endocrinologist, hormone specialist, sexual health physician, or urologist) must be involved once and a telehealth call, email exchange, or even a booked future appointment can satisfy it. After that, your GP prescribes and monitors ongoingly.1
  • Cost: about A$7.70/month with a Health Care Card to A$25/month which is the maximum cost of PBS medicines for Medicare card holders per script fill for medications on PBS.3 Primoteston (testosterone enanthate injection) is not PBS-listed, it’s available on a private prescription from any GP at full price.1
  • No gender-marker requirement: you don’t need to be registered as male with Medicare to get PBS testosterone.1
  • Public gender clinics exist in some states (e.g., Monash Health in Victoria, Royal Brisbane & Women’s Hospital in Queensland; no appointment fees) but have waiting lists; availability and state protocols vary.23
  • AusPATH (the Australian Professional Association for Trans Health) publishes the national guidance clinicians work from; see Standards of Care.

United States

  • Informed consent clinics are the backbone: Planned Parenthood (one of the largest gender-affirming hormone therapy providers nationally) requires no therapist letter, criteria are capacity to consent, 18+, persistent dysphoria, and reasonably controlled co-occurring conditions. Many people get a prescription at the first visit or right after baseline labs.4 Example self-pay pricing: ~$120-150 per visit plus labs and medication.4
  • Telehealth: services like Plume (~$99/month membership, labs included, medication extra) and FOLX (~$40/month + per-visit fees) prescribe in most states though testosterone’s controlled status blocks it in some.5
  • Legal status: testosterone is a Schedule III controlled substance (a legally restricted drug) so a prescriber registered with the DEA (the US drug enforcement agency) is required, prescriptions are tracked in state monitoring programs, max 5 refills in 6 months, ~30-day fills in most states.6
  • Medication costs: with insurance, median out-of-pocket for testosterone cypionate was ~$10.71/month (2019 data); cash prices via discount cards start under $10/vial for injections, while gels run far higher retail ($220-460/month, ~$50 with discounts).7
  • The 2025-26 federal policy environment is volatile (funding pressure on clinics, state-level restrictions). Availability can shift quickly, make sure to check current state law and report back to me on any federal level changes if you can!

United Kingdom

  • NHS pathway: GP referral to a Gender Dysphoria Clinic then multidisciplinary assessment (by a team of clinicians) over at least two appointments into hormone recommendation and then your GP prescribes under a shared-care protocol (the clinic directs the plan, your GP writes the prescriptions) with the clinic.8
  • The waits are extreme. The NHS England Levy Review (Dec 2025) found people reaching a first appointment in Oct 2024 had waited an average of 296 weeks (~5 years 7 months), with >40,000 people on the list; most clinics projected 15+ year waits for new referrals if nothing changed.9 Reforms announced a single national waiting list (April 2026), referral threshold raised to 18, and an end to self-referrals.10 Scotland’s picture is similar (716 people waiting >5 years as of March 2025).11 Newer primary-care-led pilot clinics (e.g., TransPlus, Indigo) have markedly shorter waits.
  • Bridging prescriptions: GMC (the UK doctors’ regulator) rules let a GP prescribe a bridging dose only when all criteria are met, you’re already self-sourcing (or highly likely to), a gender specialist has been consulted, and it’s the lowest acceptable dose. Many GP practices decline bridging and private shared-care outright. It’s a postcode lottery (whether you get it depends on where you live).12
  • Cost: NHS care is free; England prescriptions are £9.90/item (frozen through 2026/27); free in Scotland, Wales, and NI.13 Private routes (GenderCare ~£600 initial; GenderGP subscription models) commonly total >£1,000/year.14

Canada, New Zealand, Europe (brief)

  • Canada: primary-care-led informed consent, any physician or nurse practitioner can prescribe; no therapist letter or “real-life experience” requirement (Rainbow Health Ontario guideline). Visits are covered by provincial plans; drug costs vary.15
  • New Zealand: PATHA primary-care guidelines support GP-initiated T with an informed consent process; note their protocol doesn’t check the first T level until 9-12 months (see FTM Community Knowledge for why that matters).16
  • EU: varies wildly. all member states except Hungary, Latvia, and Romania provide some access, but waits range from 1-3 months to >3 years (>10 years in Ireland), funding coverage is patchy, and many countries still require a psychiatric diagnosis.17

Legality & traveling with T

Testosterone’s legal status differs by country: Schedule III (US), Class C / Schedule 4 Part II (UK, personal possession is legal, supplying anyone, including giving to a friend, carries an up to 14 years sentence; it can’t legally be posted), Schedule 4 prescription-only (Australia), Schedule IV (Canada), mostly uncontrolled across the EU with exceptions (France requires a secured prescription; Romania restricts via anti-doping law).6181

Travel checklist:19

  • Keep T in original pharmacy-labeled packaging, in hand luggage
  • Carry a copy of the prescription and a doctor’s letter (drug, dose, prescriber registration)
  • Unused syringes/needles are permitted when accompanying the medication; essential medicines are exempt from liquid limits with documentation
  • UK travelers taking >3 months’ supply need a Home Office personal export/import licence (apply ~8 weeks ahead)
  • Some countries restrict or ban import so check the destination embassy’s rules before flying, and declare controlled meds where required

Self-sourcing/DIY

In TransActual’s 2022 UK survey, 25% of respondents had self-medicated with hormones bought online; NHS England itself names self-sourcing as a predictable consequence of its waiting lists.209

Risks:

  • Unmonitored erythrocytosis (too many red blood cells), the main dose-limiting risk of T is invisible without blood tests (see FTM Risks and Side Effects). High red blood cells have no symptoms until they’re a problem.
  • Unknown product quality. A meta-analysis (a study pooling many earlier studies) of black-market anabolic steroids found ~36% counterfeit and ~37% substandard, underdosed, overdosed, or contaminated, and you can’t tell by looking.21 Community lab-testing of testosterone specifically is nearly nonexistent (one published community test ever that I could find, vs dozens for estradiol).22
  • No baseline screening for contraindications (medical reasons testosterone might be unsafe for you), and no one to adjust the dose.

Making it safer:

  • Tell your GP. Many will run monitoring bloods (T level, full blood count/hematocrit) even if they won’t prescribe, Trans Harm Reduction keeps lists of cooperative GPs and recommended test schedules (baseline, 3/6/12 months, then 6-12 monthly).23
  • Ask about a bridging prescription if you’re in the UK, the GMC criteria exist precisely to move people onto regulated supply.12
  • Use sterile equipment every time, never share needles, and dispose of sharps (used needles) safely (free supplies exist via harm-reduction orgs in some regions, some hospitals and pharmacies will just provide you sharps containers for free and any pharmacy that doesn’t wont ask why you need to buy one).23
  • Watch for warning signs (see FTM Risks and Side Effects) and get bloods done at trough (right before your next dose).23
  • Disclose your use to any clinician treating you as it affects anesthesia, interactions, and interpretation of your bloods.

Related pages: FTM HRT | FTM forms of HRT | FTM Blood Testing | FTM Resources | Australian Legal | Standards of Care | Genderal Resources

Further reading

Access rules shift often, so cross-check with sources that keep their pages current.

Footnotes

  1. TransHub (ACON) - Endocrinology / accessing testosterone in Australia - https://www.transhub.org.au/clinicians/endocrinology/ ↩ ↩2 ↩3 ↩4 ↩5

  2. AusPATH / Cheung AS et al., position statement on hormonal care, Med J Aust 2019 - https://auspath.org.au/ ↩ ↩2

  3. Royal Brisbane & Women’s Hospital Gender Service - costs - https://metronorth.health.qld.gov.au/rbwh/healthcare-services/gender-service/information-for-patients/costs ↩ ↩2

  4. Planned Parenthood of Greater Texas - Gender Affirming Healthcare - https://www.plannedparenthood.org/planned-parenthood-greater-texas/patient-resources/gender-affirming-healthcare ↩ ↩2

  5. Plume - Services & Pricing - https://getplume.co/services-pricing/ ; FOLX vs Plume cost comparison - https://www.folxhealth.com/library/folx-vs-plume-a-cost-comparison ↩

  6. DEA Drug Fact Sheet: Steroids (Schedule III) - https://www.dea.gov/sites/default/files/2020-06/Steroids-2020_0.pdf ↩ ↩2

  7. Das RK et al., Gender-Affirming Hormone Therapy Spending and Use (2022) - https://pmc.ncbi.nlm.nih.gov/articles/PMC9849620/ ↩

  8. Nottinghamshire APC - Transgender prescribing position statement (June 2025) - https://www.nottsapc.nhs.uk/media/xo3lnhwi/transgender-prescribing-position-statement.pdf ↩

  9. NHS England - Operational and delivery review of NHS adult gender dysphoria clinics (Levy Review, Dec 2025) - https://www.england.nhs.uk/long-read/operational-and-delivery-review-of-nhs-adult-gender-dysphoria-clinics-in-england/ ↩ ↩2

  10. Hansard - NHS Adult Gender Services statement (Dec 2025) - https://hansard.parliament.uk/commons/2025-12-18/debates/25121840000018/NHSAdultGenderServicesIndependentReview ↩

  11. Public Health Scotland - GIC waiting times statistics (Oct 2025) - https://publichealthscotland.scot/publications/nhs-gender-identity-clinics-waiting-times-for-first-outpatient-consultation/nhs-gender-identity-clinics-waiting-times-for-first-outpatient-consultation-28-october-2025/ ↩

  12. BMA - Managing patients with gender dysphoria (GMC bridging criteria) - https://www.bma.org.uk/advice-and-support/gp-practices/gp-service-provision/managing-patients-with-gender-dysphoria ↩ ↩2

  13. Community Pharmacy England - NHS prescription charges frozen (2025) - https://cpe.org.uk/our-news/nhs-prescription-charges-frozen-for-the-second-year-running/ ↩

  14. TransHealthcareIntel - private healthcare comparison - https://www.transhealthcareintel.com/private-healthcare ↩

  15. Rainbow Health Ontario - Guidelines for gender-affirming primary care (4th ed.) - https://www.rainbowhealthontario.ca/wp-content/uploads/2021/09/Guidelines-FINAL-4TH-EDITION-With-2023-Updates.pdf ↩

  16. PATHA / RNZCGP - Primary Care GAHT Initiation Guidelines (NZ, 2023) - https://blogs.otago.ac.nz/rainbow/files/2023/03/Primary-Care-GAHT-Guidelines_Web_29-Mar.pdf ↩

  17. TGEU - Trans Health Map 2024 - https://tgeu.org/trans-health-map-2024-as-who-guidelines-approach-healthcare-for-trans-people-in-the-eu-still-hindered-by-stigma-and-long-delays/ ↩

  18. NHS - Anabolic steroid misuse (UK Class C law) - https://www.nhs.uk/conditions/anabolic-steroid-misuse/ ↩

  19. One Day Tests - travel advice for patients on TRT - https://onedaytests.com/blogs/mens-health/travel-advice-for-patients-taking-trt-medication-abroad ; The Health Suite - injectable TRT UK guide - https://thehealthsuite.co.uk/testosterone-injections-for-men-a-complete-uk-guide-to-injectable-trt/ ↩

  20. TransActual - Health professionals: prescribing (Transition Access Survey 2022) - https://transactual.org.uk/healthcare-professionals/prescribing/ ↩

  21. Black-market anabolic steroid quality meta-analysis (2022) - https://pmc.ncbi.nlm.nih.gov/articles/PMC9288681/ ↩

  22. Trans Harm Reduction - HRT source testing results - https://transharmreduction.org/hrt-testing ↩

  23. Trans Harm Reduction - blood tests & GP monitoring - https://transharmreduction.org/blood-tests ↩ ↩2 ↩3

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