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Conclusion A high proportion of nonprescribed sex hormone use was observed in our sample. Our findings suggest barriers to health care and the need for trans women to resort to medically unsupervised transition procedures. Among sex workers, this may also be due to higher economic and access needs than other groups. Ensuring social rights and providing adequate health care services may lessen nonprescribed sex hormone use, preventing subsequent risks and resulting in better health outcomes for trans women.Monitoring acute distress in tra