Hazel’s Trans Injection Guide

As many trans individuals in the world do, I take my HRT as a subcutaneous injection. I was disappointed not to find many great resources on how exactly one goes about doing this when I was starting, and now that I’ve been doing this for a while, I want to share both my process and some advice on the topic.

A quick word on what this is not: I will not be giving advice on which kind of HRT you should be taking or what dosage you should be aiming for - while I could give that kind of advice that would be much more individual and very much out of scope for this! I’m just going to show you how I would recommend performing a subcutaneous injection in general. Please see https://diyhrt.wiki for a overall primer and help with all things HRT, https://hrtcafe.net to find trusted vendors (and updates on vendors!) and further information on particular medications, dosing, extra health concerns (e.g. liver function tests for bica), and so on.

I have recorded a demo video of me performing this method, but it is not a replacement to this guide, just a demo of me performing an injection according to it on camera.

Another good guide, and the resource that got me started, was Dr. Jerrica Kirkley’s video for Plume, here: Subcutaneous injection tutorial for trans people and here: Intramuscular injection tutorial for trans people. This method and mine diverge in some places, but it’s a good, well produced guide.

Even if you prefer to follow these videos’ method, because they are clearly far more professional than this blog post, I still would ask you to read my advice section at the end of this page, as there are things I know now that I wish I knew when I was following these!

In addition, while my tutorial does not cover the injection method for an intramuscular injection, I still believe my preparation to be a better method. I defer to the video linked for the IM method as I have never injected intramuscularly.

Three Injection PSAs

Yes, the PSAs are boring / a chore to read, but if I’m going to be telling and showing you how to do an injection, I want you to be doing it safely, and you need yourself to be doing it safely. Please read this carefully and do your best to stay safe out there. It’s worth the time. Also keep a level head, if you get a little more soreness than usual or a bit more blood than usual it’s not the end of the world for a subcutaneous injection, try not to freak out, you’ll be okay, and beating yourself up will hurt your confidence for next time around.

One: you are injecting a substance into your body. As such, preventing infection is very important, and we do this by being sterile.

• Don’t forget to use alcohol swabs on the vial and injection site to sterilise them before use.

• You must use new/fresh needles and syringes each time. This ensures that there are no contaminants inside the syringe left over from last time. If you have to reuse a syringe for some reason, you can find instructions on syringe cleaning here. Never reuse a needle. They are one-use-only.

  • If you are considering cleaning reusing a syringe due to inability to afford injection equipment, I would urge you to first consider using a single-needle injection technique in which you use an injection-suitable needle to draw and then inject without a needle swap. This is a much lesser risk than reusing syringes, and I explain how to adapt this method for a single needle in the advice section at the end.

• You should keep the cap on the needle whenever possible, for general safety (it’s sharp!) and to protect it, but also to prevent it from getting contaminated by contact with anything that isn’t the inside of the cap, the vial, or your injection site.

Two: needles are sharp, so don’t spike yourself, and they must be sharp. A blunt needle is more dangerous than a sharp needle, just like a blunt kitchen knife is more dangerous than a sharp kitchen knife.

• Again, keep a cap on the needle whenever possible, so you don’t spike yourself or something else.

• When you recap the needle after using it, do NOT put the cap onto the needle with your hands, instead, place the cap on a desk, move your hands away from it, and slide the needle into the cap and kind of hook it up onto it, then you can press it onto the needle until it clicks into place. If that description is hard to follow, see the videos linked previously to see someone doing exactly this, or look at the pictures of me doing it. This method prevents the most likely point for you to accidentally stab your hand.

• When a needle is sharp, it has a very clean sharp point that will cleanly pierce the skin, and can do so with the minimal possible damage. When a needle is used, that point experiences a very high pressure (because science!), and so it rolls over a little. It will end up forming a kind of hook shape that will certainly do more damage on both the way in and out as compared to a fresh needle. You cannot see this with the naked eye. You’ll feel this as increased pain as you push into the skin and as increased soreness post injection.

  • In addition, you should rotate (change between many) injection sites to allow them more time to heal and recover from the inevitable tissue damage that occurs due to an injection.

Three: Keep Steady. You do not cause very much pain and damage by just inserting the needle into yourself. You are going to get more pain if you move the needle around while it’s inside, both sideways, and especially in/out. Obviously you can only do so much, especially when you’re nervous for your first injection, and you’re shaky, but as best as you can, try to push in in one motion, hold it as still as possible while you inject, then pull smoothly out.

Miscellaneous Terminology

The needle is the part of the total assembly that is sharp - the metal piece and generally a plastic Luer connection.

The syringe is the part with a plunger and measurements on it, usually either plastic or glass. There is no word that refers to the assembly of the syringe and needle, so unfortunately there is a bit of ambiguity in the language there.

Syringes which have a needle permanently affixed to them are known as fixed-needle syringes or insulin syringes.

Drawing (or drawing up) is the process of pulling the injection from the vial into the syringe. A drawing needle is a needle that is being used purely to draw up.

Needle Gauge describes the diameter of the needle. The higher the gauge number, the thinner the needle - yes, this is confusing! A 30G needle is thinner than a 20G needle.

Dead Space is the volume inside the needle that would retain the medication after the injection or removal of the needle. Needles generally come in either a standard kind which are just a plastic Luer connection bonded to a metal needle, or a low dead space variant in which the metal needle actually pokes through the syringe’s hole back inside it to reduce the dead space.

Luer Lock and Luer Slip refer to standardised connection types for needles to syringes. Any Luer needle should work with any Luer syringe. Needles just push onto Luer Slip syringes and stay in place with friction. Needles on a Luer Lock syringe push in and screw on clockwise as you attach it, then will not come off without being unscrewed anticlockwise.

A subcutaneous or subq injection is one in which you inject into the layer of fat below the skin. These are generally done either on your tummy or thigh (I’ll discuss how to find your site later). This guide covers subcutaneous injections.

An intramuscular or IM injection is one in which you inject into a muscle, generally on your thighs for the case of HRT. This is done with a longer and thicker needle, and you’re more likely to see just a little blood, but it can reduce initial post-injection soreness.

Air-Locking is an injection technique in which you purposefully let a little air follow your HRT down to help prevent it from pushing up back out of your injection site or from being left in the needle. It is not something I do on purpose, and I don’t recommend you do it in this guide, but it is a technique many people perform and is generally safe. If you get a small air bubble in your syringe that can actually be helpful to your injection for exactly this reason. This is safe for subcutaneous and intramuscular injections but very dangerous for intravenous (into the bloodstream) injections!

Coring is when a hole is made in the rubber stopper on a vial, generally by using a needle that is too thick, by drawing from the exact same spot every single time, or wiggling around the needle too much while it is in the vial. This is very bad as it means that the stopper no longer forms an airtight seal to the outside world, and contaminants can find their way into your medication.

Stuff You’ll Need

Obviously you’re going to need your hormones/etc themselves first. For injection, these should come in a glass vial with a rubber stopper on the top. You should not attempt to open this vial in any way, as this would ruin the sterility - you will poke a hole in the top with a needle instead, and the rubber stopper pushes itself closed again hard enough to keep a seal.

Next up, you’ll need isopropyl alcohol swabs. The ones I’m using are 70%. The percentage concentration is not too important as long as it’s quite high. You will need TWO of these per injection! One is for the vial and one is for the injection site.

Some people perform their injections with only needle, and I’ll talk about that after the method, but I recommend using two needles. For your injection needle, you want a length of between 1/2 inch and 5/8 inch for subq, and 1 to 1+1/2 inch for IM injections. You’ll want a gauge of 25-30G for subq and 23-25G for IM.

For a drawing needle (the needle used to pull the hormones up into the syringe) pretty much anything goes, but a wider gauge is useful as it reduces resistance. I personally use 22-gauge needles that are 1+1/4 inch long to draw, because I can get these cheap in bulk. Try not to go too thick, though, as the thicker the needle, the more likely you are to core your vial.

I recommend looking for Luer Lock syringes, and buying those. If you’re worried about minimising wastage of your medication, it may be more economical to get all low dead space needles or even fixed-needle syringes (insulin syringes), depending on availability and the cost difference.

For a syringe, the main requirement is the capacity. You want a syringe that only has capacity of 1ml to help you get much greater accuracy (down to 0.01ml!) for the relatively small quantities at play with HRT injections. 3ml can work but you ideally want 1ml.

You will need a sharps box. You can get these in many places. This is to put your used needles in once you are done with them. Contact your local authority for information on how to dispose of your filled sharps box. I like exchange supplies’ compact locking one. You can also use a lidded hard plastic container, but it’s not ideal.

You cannot just put needles in the trash as-is, they must be stored in a sharps box and specially disposed of, because if the cap comes off, they poke holes in bags and could cause serious harm to waste workers and wildlife, or pierce other items such as batteries. They are also considered a biohazard!

Finally, I recommend having a plaster/band-aid for after your injection. The ones I find the best are the small circular ones that are about 20-25mm diameter. This is because they stay on for much longer and are basically unnoticeable compared to larger more standard plasters. I have been getting them from plaster multipacks so far, but you can also buy them online in bulk. My experience has been that pharmacies likely don’t have boxes of JUST the small ones but naturally your mileage may vary. There are boxes of just the small ones on Amazon, though!

If you are based in the UK as I am, then https://www.exchangesupplies.org/ is an awesome source for all of this stuff. I priced up all the supplies you’d need to get going at £40, but you can get it cheaper if you don’t go standard for low dead space! I have heard good things about https://praxisdienst.de for any readers in Germany.

You can also ask a pharmacist for injection supplies in most places too, and you can also order them online - in the US even on Amazon!

Many needle brands will colour code their needles by gauge, which is helpful to help you remember which is for drawing and which is for injecting (e.g. my drawing needles are grey and my injecting needles are orange).

Injection Method

I suggest you read the entire method once before starting, so you know what’s ahead, but absolutely feel free to follow it step-by-step as you go, it’s intended to be followed step-by-step.

So, you’ve got your medication , your syringe , your two needles , your two alcohol swabs , and your sharps bin out on your desk, a clear work space , and either are alone for privacy or have a trusted friend to help keep you calm (or even deliver the injection for you if you’re too nervous and shaky! That’s totally okay, especially if it’s your first time!). You know what your dose is . Let’s do this.

Prep: Drawing up

The first step I do is sterilising the vial because, to be totally honest, otherwise I might forget. So take one of your two alcohol swabs, and wipe it left to right across the top of the vial once. Do not wipe back and forth repeatedly like you might be accustomed to for cleaning, as then you’d be wiping any contaminants that you just picked up on the swab back over the rubber stopper again! One movement is enough. Place the swab and its packaging to the side (you’ll likely end up with a little trash pile at the end of this, or you can throw stuff straight in the bin, whatever works for you).

Next we’ll prep the drawing needle. Take your drawing needle and syringe out of the blister pack, and lock them together. Make sure you keep the needle’s cap on. If you have a luer lock syringe, you need to twist on the needle until its secure. The cap and needle are designed such that twisting the cap will twist the needle, so you can and should do this with the cap on.