What I've Been Told About HRT Self-Injection
Standard disclaimer from my health pages: I am not a doctor, nor am I your doctor. This is civillian-to-civillian communication.
My doctor said that it's best to draw up the medication into the syringe using a larger gauge of needle. It's not impossible to do so with a smaller gauge, but it is slower. So don't be scared by the big needles if they give you one--it's likely you'll get another that's a much smaller gauge.
I didn't, though. My pharmacy gave me a bunch of VanishPoints. VanishPoint syringes don't have exchangeable needles! >:( They also automatically retract when you push the plunger all the way down, so I had to try a couple times with a new syringe. They apologized profusely and agreed to send me the correct syringes/needles (but didn't), so I would watch out for that. I was able to draw up with a 25-gauge needle, but I had to draw up the medication very slowly.
A pharmacy tech at my hospital said that if doing an intramuscular injection, aim for big muscles. This includes the gluteus medius, gluteus maximus, the deltoid, and the muscles of the thigh. He preferred that I do the gluteus medius, as there's slightly more risk of hitting arteries/nerves the closer you get to the gluteus maximus. The needle needs to be at 90 degrees for intramuscular injection. The vial--if you have a 10-dose vial--can keep for 28 days after puncture. If it's a single-dose vial, throw out after puncture. Or share with a friend at the same time, and then throw out!
I would add that aspiration (step 22) is controversial. The pharmacy tech and my PCP both recommended it, but the exchange worker didn't mention it and the nurse said they weren't taught it for IM injections. I do it for my own peace of mind--especially because I've hit a vein before--but it doesn't seem to be necessary.
Click the arrow see the one time I hit a vein!
I then got formal injection training from a pharmacy tech, needle exchange worker, and nurse. I've welded together their processes into a very in-depth guide below.
Start with: Two alcohol wipes, the vial of HRT, a draw needle, an injection needle, a syringe, and a band-aid.
- Wash hands.
- Take off the vial top.
- Rub the top of the vial with an alcohol wipe for 10 seconds. Allow to dry, setting it and the wipe on a flat surface while prepping the skin.
- Take the other alcohol wipe and briskly rub the area you plan to inject. Set the wipe down.
- Tightly screw the drawing needle onto the syringe. Do your best not to touch the area where they connect, but not the end of the world if it happens.
- Uncap the drawing needle.
- Hold the vial with one hand, then puncture the vial with the other. Keep the vial on the table.
- Flip the vial upside down, up to the light. This will allow you to keep the needletip inside the juice.
- Once certain you won't draw up air, pull the plunger out to draw the medication.
- Draw until you reach the recommended dosage. I overshoot it a little, but you don't have to. If you were to undershoot, this is where you would do it.
- Check for bubbles. If found, flick the syringe with your fingertip or re-draw. Some syringes will have a bubble no matter what--a large one just under the needle. This is fine to leave.
- If clear, pull the needle out of the vial.
- If your needle has a tap-closure, tap it against the table instead of closing with your hand. If it's a standard screw cap, screw the cap back on.
- Unscrew the capped drawing needle.
- Screw on the injection needle.
- Push out a small amount of the medication, until you can see it bead at the needle tip. If you can't see it with the cap on, you can unscrew the cap at this stage. This is called priming the needle.
- Once primed, uncap the needle.
- Ensure the bevel will be facing upward when injecting. The "O" of the needle tip should be facing upward. This prevents a little extra pain.
- Relax the muscles of the area you plan to inject.
- Position needle at appropriate angle to injection site.
- Using one hand if you can, push the needle in all the way to the base. Speed is up to you.
- Pull up on the plunger. If blood enters the syringe, start the process again from step 6. This pulling-up is called aspiration.
- If only air comes into the syringe, you are clear to inject. Push down on the plunger at your desired speed.
- Pull out the needle.
- Cap the needle before setting down.
- Apply a bandaid to the injection site and monitor. You did it!
Injections > Gel
Going from patches to gel to injections was a trip. I want to be clear that some people do fine with patches and gel. However, in my experience and anecdotes from others, injections prove to be the superior form of administration.
My levels hung out around 150 ng/dL, which is about 70 ng/dL too high for a cis woman. They stayed there for two years. I experienced decent androgenization from this. My voice dropped, I got body hair, bottom growth, and my hairline changed. I felt angrier and hornier and higher energy.
It was only when I switched to injections that my levels got within target range. Within 9 months of injections, I went up to 926 ng/dL. I actually overshot it! Target for cis men is anywhere between 300-800 ng/dL. I finally experienced the body fat changed and ruggedization/thickening of the skin. I even got facial hair. My energy levels, while still lower than average, are explosive compared to before. When I look in the mirror, I see a teenage boy, as opposed to the cis woman I saw before. For those who are dissatisfied with the speed or extent of their androgenization I highly recommend injections.
Gender Song
Black Room Boy by Above & Beyond isn't my favorite song, but it is the song that best describes me and my relationship to gender and other people. I first heard this as a baby 11-year-old who'd been on the Internet for as long as I could work a mouse. It spoke to my escapism habit. On the Internet, you can be yourself or someone else. The level of possibility is only matched by the level of fragility. You can just log off and never be seen again, with no one calling or coming to your house for answers. Before the Internet, you'd have to move to another continent. This appealed to baby me, trapped in place. It still appeals to me, who wants to keep every part of my gender and orientation a secret. If it's all secrets, you can control how each person sees you, and lose nothing if that aspect of yourself changes. No knocks on your door, no missed calls. I--and many other trans people--often wish I could go be alone for a few years while this transition works itself out, then emerge fully-formed.
