In 2014, Time announced the “Transgender Tipping Point.” The perilous conditions trans people are facing right now probably weren’t the progress the publication had in mind. In the US, state legislators and even the president are on the attack, while in the UK, J.K. Rowling is proudly bankrolling hate campaigns and the government just issued the Cass Review, a sloppy and ideological hit piece targeting trans youth.
Trans people simply want to be left to their own devices and engage in boring activities such as using restrooms, being allowed to work in peace, and posting on social media, but apparently, such is not to be.
Trans joy, ingenuity, and pride are lifelines of survival. So is access to information about trans health, whether public or private, from openly on social media to locked away in encrypted Signal chats with disappearing messages. Trans people rely on that information to advocate for themselves with providers who are often not equipped to address their needs and are sometimes actively resistant to the notion that people with lived experience may have expertise that they lack.
“People are taking science to their doctors who don’t know how to work with them,” a transgender health researcher told The Verge. “There’s no curriculum for [trans healthcare]. They’re teaching doctors. There’s always a lot of heavy lifting for a trans patient.”
(Several of the researchers I talked to for this piece requested anonymity to protect themselves from harassment.)
Online communities can be hubs of critical healthcare information and advice from lived experience, but without clear accountability, they also have the potential to harbor bad actors and bad data. The line between who is safe, what is real, and what is not is becoming increasingly hard to find. Trans people are looking out for one another not just with information, but with tools to verify sources, which can be incredibly challenging in an era of AI slop and misinformation.
Avery Edenfield, a researcher who focuses on transgender communities and communication, reported in a 2019 paper that the way trans people communicate in these spaces is distinctive. Edenfield found that many people engage in the time-honored internet practice of “tactical technical communication,” which includes sharing “medical information or instructions” rooted in personal experience as well as linking to similar resources, a form of lay expertise. He also, however, describes “tactical referrals,” which point people toward peer-reviewed professional resources.
The current grift economy on social media in particular explicitly rewards people for spreading fear and confusion
With tactical technical communication, trans people are directly talking about their own experience and providing information based on their lives, ranging from warnings about drug interactions to suggestions for questions to ask doctors. Many are offering lengthy, detailed, and constantly evolving guides to trans health; they are in a very real sense technical documents. With the high numbers of trans people in STEM and communications, it’s perhaps not surprising that engineers and communicators apply their talents to this particular arena. Many of these guides discuss the use of gender-affirming hormones, for example, with information on dosing and modes of delivery that patients can take to their doctors, who may take a conservative approach that some patients argue is outdated.
TH, a trans person in the UK who spoke to The Verge via Signal, commented that after a lengthy waiting period to access care, “they didn’t prescribe me T until after March [2025], and even then, it was too low a level.” The guidance they accessed through online communities was extremely important when they pushed back on this dosing.
Tactical referrals are links to vetted and reliable resources, including scientific research, guidelines to gender-affirming care, lists of providers, and information about laboratories. Trans people who are more comfortable slogging through academic papers and documentation use that skill to empower others. Some of these sources may come from transgender people who have lived experience, but those trans people are also professionals with scientific, medical, and other relevant training.
Another researcher who studies communication and storytelling in healthcare contexts told The Verge, “A lot of the people in this community are very up on reading all kinds of scientific papers. They are smart, committed, loving people that are fighting to do good.”
Sometimes you have to know a person who knows a person. These webs of care, which start with building trust through personal relationships, echo the Jane Collective of lay abortion providers that operated from 1969 to 1973. Trans people are relying on word of mouth to vouch for people, disseminating information in a highly distributed format that makes it effectively impossible to silence. Where one resource may fall, others rise, ensuring trans people can make informed choices about their transition and overall health. Seizing autonomy and self-determination in a culture that wants to kill you is a powerful application of lay expertise.
Things aren’t all roses in these communities. The anonymity and pseudonymity some participants rely upon to stay safe can also obscure necessary information about someone’s background, especially with transphobes who may attempt to infiltrate to advance their agendas. Whether knowingly or accidentally, people may circulate misinformation — the current grift economy on social media in particular explicitly rewards people for spreading fear and confusion over those who are more measured and thoughtful, a failing of flash over substance. The spread of misinformation isn’t limited to bad intentions: People who mean well sometimes also share incorrect news, making it all the more important to provide people with the tools they need to verify information.
A community with a deep history of bodyhacking and retaking control of their bodies believes that knowledge is power
Moderators do their best to identify and remove misinformation, or warn visitors about potentially unsafe recommendations or practices, users of several online resources told The Verge. In a closed community, some members may know each other offline, or have demonstrated that they are trustworthy. This word of mouth isn’t always enough to protect people, though. Many crowdsourced documents do note that they are not medical advice or replacement for seeing a doctor, but trans people used to experiencing harassment and abuse in medical settings may not be comfortable openly discussing their needs with care providers, counting on these resources to keep them safe.
Ultimately, these resources play an important role in a culture where power imbalances in medicine, particularly when trans patients don’t know if they can trust a provider, can put trans patients in danger if they don’t have independent access to information about their health. With trans culture, and standards in trans health, moving faster than medical education, a community with a deep history of bodyhacking and retaking control of their bodies believes that knowledge is power.
Q, a nonbinary trans person living in the UK, told The Verge via Signal that after fighting through NHS red tape and waiting lists, they discovered that providers had a very limited understanding of trans identity and relied on rigid, binaristic guidelines for gender-affirming care. “There’s also the thing of having to perform my transness to the satisfaction of (probably cis) medical professionals just so I can get some tits,” they said wryly, articulating a common problem for trans people who don’t have clearly defined binary outcomes in mind when they start hormones. Their understanding of the risks, benefits, and potential side effects of gender-affirming hormones, as well as awareness of the latest clinical recommendations for trans patients, was critically important for conversations about their care.
Users of these spaces face another risk. Lawmakers and others who influence policy, citing “transgender ideology,” are pushing for a world where talking about transgender people in any context is being treated as “adult material,” equating existing while trans to pornography, something that could put individual hosts and disseminators of information at risk as well as threatening the existence of these resources. Restricting the presence of, and access to, online trans culture through measures such as age verification laws is designed to suppress transness itself.
Being cut off from community, along with access to scientifically accurate and current medical information, certainly won’t stop people from being transgender, but it would make being trans even more dangerous, whether it means taking medical risks without accurate information or feeling hopeless and cut off from community. People fighting for survival deserve access to the tools to make that fight safer, whatever that looks like for them, argues OHSU-PSU School of Public Health professor Alexis Dinno, who is transgender herself and collaborated on a public guide to risk reduction for adults using self-managed hormones.
She told The Verge that “I am always going to try to be as out as possible, professionally and personally.” The ability to “tinker” hormones safely with accurate scientific information to support her was essential for her own gender expression and health. People in positions of relative privilege, particularly with so many trans people living at the margins of multiple identities, need to make sure everyone can access that information.
As the community reckons with the increasing existential threat, nearly a dozen trans people told The Verge that they were nervous to talk about resources that allow people to share information about trans health, even as they felt that such spaces are more important than ever. Most also noted, though, that the trans underground has been a quintessential part of the trans experience for centuries, and while the present moment may force some to step into the shadows, it cannot eliminate the fundamental beauty, glory, and joy of being trans. One person told me being trans was too cool to give up on; besides, as Q put it, “trying to legislate it out of existence just doesn’t work.”
