Free to reprint, redistribute, and update for no profit. This is not legal or medical advice.
There are minor risks associated with HRT, such as a tiny increase in blood clots for E (in line with cis women) or polycythaemia for T. The latter can be tested for; it is a risk factor rather than its own illness (and can be fixed by donating blood or lowering dose). HRT itself does not cause serious harm when appropriate medications + doses are used.
Bad levels can increase the above risks, cause osteoporosis, mental health issues and other problems associated with menopause. Unfortunately, not all guidelines / doctors are good at giving patients optimal levels. Blood tests allow you to know your levels and react accordingly to protect your health.
If wishing to feminise, patches, pills and gel are the only options for oestrogen. You may also be prescribed GnRH agonists or other blockers. If wishing to masculinise, injections (Sustanon or Nebido; TE very rarely, often only when allergies apply) and gel are the only options given.
When it comes to HRT most doctors just look at a blood test result and compare your results to official guidelines. There is nothing special about what they do, they are simply comparing numbers.
If taking oestrogen, just before your next dose your E should be between 370–740 pmol/l (100–200 pg/mL), T below 1.8 nmol/L (50 ng/dL). If taking testosterone, you should be between 10–25 nmol/L (300–750 ng/dL) with your FBC in male range.
Many sites just resell pharmaceutical products- other than a doctor signing off on it there is no difference between what’s inside medication bought from a pharmacy overseas and what you’d get from your local pharmacy in GB. If you are using sites known to be good the risk is practically zero: these sites rely on repeat customers!
The community has a vested interest in reviewing sources as we want to keep each other safe.
You can stay safe using homebrew medications (usually injections, spray, gel) by using peer reviewed sources. People with experience evaluating homebrewing procedures can confirm whether a production method has any significant safety oversights. Trusted sources have lab tests confirming that there is only the listed active ingredient inside the product.
For T injections specifically: many sites listing a pharma resell are lying, because people will pay more for a product that looks like a resell instead of homebrew.
If you are using a source that is well reviewed and well known you are very unlikely to encounter any issues. Substituting T for something else would lose customers; the market for T is extremely big so there are dozens of competitors.
There is no motivation for a seller with a good track record to substitute any product for something dangerous. They would be spending money to ruin their income.
Disclaimer: the author is not a lawyer, this is not legal advice.
The law states it is legal to buy and import prescription-only medicines to GB without a prescription if it’s not controlled and is for personal or household use. This does not cover selling medicine or giving it to non-household members.
Testosterone is controlled, but an exception in the law makes it legal to buy and possess for personal use. It is legal to import into the GB so long as it is on your person (i.e. not via the post).
Customs in GB often struggle to do basic checks of incoming parcels.
Regulation 17 of The Human Medicines Regulations 2012:
Para 1: A person may not except in accordance with a licence […] import a medicinal product into Great Britain BUT
Para 6: Paragraph (1) does not apply to a person who imports a medicinal product for administration to himself or herself or to any other person who is a member of that person’s household.
For anabolics Schedule 4, Part 2 of The Misuse of Drugs Regulations 2001 applies; the full name is Controlled Drugs Excepted From the Prohibition on Possession; Excluded from the Application of Offences Arising from the Prohibition on Importation and Exportation when Carried Out in Person and Testosterone is listed.