It took Aicha Sylla three attempts to get a prescription for hormones in Burkina Faso so she could start to transition gender. In the end, one doctor agreed – if she had sex with him first. “I didn’t have any choice … The other doctors didn’t even listen to me; they refused,” Sylla, 22, told the Thomson Reuters Foundation, visibly upset, as she sat in a restaurant in the capital, Ouagadougou. Despite the health risks, she has been self-medicating ever since using the same prescription, a practice that trans rights advocates say is widespread among transgender people in the conservative West African country. A shortage of qualified doctors who are willing to work with trans patients, and fear of seeking medical help due to social stigma, lead many trans people to take hormones without proper supervision, campaigners and community members said. Another trans woman in Ouagadougou said many transgender people feared being “outed” by doctors to family and friends, or on social media. “(People don’t go to doctors) because you risk your image on social networks … because this doctor will talk. Maybe you won’t be well received (or) you’ll be discriminated against,” said Naomi Campbell, 27. Taking hormones improperly can lead to complications such as hypertension and cardiac arrest and can be fatal, medical experts said. “It takes a knowledgeable healthcare professional and a well-educated patient to make informed decisions,” said Jean-Baptiste Guiard-Schmid, an internal medicine and infectious diseases specialist who has worked with Burkinabe trans people.