To An has spent the last decade reliant on feminizing hormones smuggled to Vietnam after her gender reassignment surgery (GRS). 

"I consulted several hospitals in Saigon, but was rejected due to a lack of professionalism. I was stuck and considered suicide," To An recalled.

In 2009, a gay man from Thailand told her about a medicine that could give users smoother skin, develop their breasts, and stop facial hair from growing. After receiving her order, To An asked a friend to help her with the injection, not considering the side effects.

According to the Center for Supporting Community Development Initiatives (SCDI), there are around 300,000 to 500,000 transgender Vietnamese, with 70 percent using hormones purchased from acquaintances, the Internet, or, like To An, the black market.

To An after GRS. Photo courtesy of Nguyen Huynh To An.

There is no pharmacy or medical facility providing hormone therapy to transgender Vietnamese, who have to rely on unprescribed hormones that often cause a host of side-effects.

Most "miracle effect" testosterone and estrogen hormones are imported illegally from Thailand, Germany, and India, their origins completely unknown. 

In the past three months, the Covid-19 pandemic has seen international flights to Vietnam halted, leaving transgender Vietnamese in the lurch.

According to To An, many of her friends, who seldom stockpile hormones, are currently reliant on birth control pills.

The lack of supply is only one dilemma.

For many years, To An’s friends have helped her inject hormones, mostly on a trial-and-error basis.

Once, following an injection in her buttock that caught infection, she had to be rushed to hospital for life-saving surgery, leaving her body permanently scarred.

After a near bleed-out, Truc Quan, 21, has been self-injecting estrogen bought online for eight months, extremely conscious of the many risks involved.

Fortune, however, is not on everyone’s side, with two of To An's friends having succumbed to period hormone injection.

According to Doctor Nguyen Van Phung, plastic surgery lecturer at the University of Medicine and Pharmacy in Ho Chi Minh City, Vietnam has no laws governing hormone therapy or GRS for its transgender populace. 

Common side-effects of hormone injection include embolism, osteoporosis, hypertension, and allergy. Using unprescribed medication can be even more dangerous.

Phung maintained civil law is steadily recognizing the rights of transgender Vietnamese and several hospitals have opened treatment clinics aimed toward the LGBTQ community. 

"If facing complications related to hormone treatment or GRS, transgender citizens should immediately attend hospital," the doctor stressed.

Quan, having learnt her lesson, now periodically visits a clinic to receive a hormone injection. 

"I hope my friends learn about the side-effects of hormone treatment, find a doctor, or someone with a medical background to assist them," she said.