Overview: Many transgender people will use self-managed/non-prescribed hormones at some point in their lives (sometimes called "DIY HRT"). The 2019-2020 National HIV Behavioral Surveillance Among Transgender Women survey found that 19.7% of respondents had used nonprescribed hormones within the past year. This session will present a case of a transgender woman choosing to self-manage hormone therapy despite ready access to affirming medical care. We will discuss the range of reasons why patients self-manage hormones, and the clinical, ethical, and medicolegal questions that this raises for healthcare providers. We will also consider varying ideological frameworks to explore possible approaches to working with patients who self-manage hormones. The ultimate goal is not to present a single set of best practices, but to reflect critically on our own perspectives and assumptions about power, autonomy, and medicalization in gender-affirming care.