Anyway, I bumped into a few people I haven't seen in some time. One of them is someone I'll call Lorna. She participated in two of the support groups I attended early in my transition. Back then, she was still living as male but was exploring her gender identity and sexuality. After a few other life-changing events which I won't reveal, so as not to run the risk of outing her, she recently began her transition.
I was reminded that more than a decade has passed since we attended those support groups. A lot has changed since then, but something--disturbingly--hasn't: Apparently, desperate trans women are still buying "German hormones" on the streets. Someone offered them to Lorna; she refused.
When I started my transition, it was undoubtedly easier to get hormones through legitimate means--and get the other care I needed--than it was for people who made the transition a decade before me, or the ones who transitioned a decade before them. Still, then--as now--some trans people, especially the young, cannot access mainstream healthcare for all sorts of reasons, the most common being a lack of documentation. Very often, young trans people are kicked out of, or run away from , their families or are bullied out of their schools and communities. Or they are fleeing countries where they are likely to be incarcerated or murdered, sometimes by the very people who have the power to imprison them.
As long as such conditions prevail, we're still going to have lots of trans teenagers who won't make it to the third decade of their lives. I don't think any society would stand for such a mortality rate in any other group of people. But, as long as there are barriers to access of the improved health care, young (and sometimes not-so-young) people will continue to buy (or trade sex for) "German" hormones or other black- and gray- market substances and treatments.