There are lots of different ways that people can take hormones like estrogen and testosterone. For people taking these hormones as part of gender-affirming care, also called HRT, one common way is by injecting them with a syringe. Injecting HRT can be intimidating, but lots of people do it safely every day!
What’s the difference between injecting HRT and other ways of taking it?
There are many different ways of taking HRT! These include:
- Pills that someone takes every day
- Patches that release hormones into the body
- Gel or spray that absorbs through the skin
- Injections
Each method has different advantages and disadvantages. So, there are lots of different reasons why someone might choose one type or another! People who take HRT can work with their doctor to find the type and combination of medications that work for them.
Are there different ways of injecting HRT?
There are two different ways of injecting HRT: intramuscular injection, and subcutaneous injection.
An intramuscular (IM) injection is a way of administering medication where the drug is injected into a muscle. Usually, that means injecting into the thigh or butt.
A subcutaneous (Sub Q) injection is a way of administering medication where the drug is injected into the fatty layer of tissue, between the skin and muscle. Sub Q injections can be done in the stomach, upper arms, or the outer side of your upper thigh.
Both of these methods can be done safely with the right equipment and information!
What do you need to start injecting HRT?
You will need the following to safely inject:
- Hand soap
- A new, sterile syringe (1-3ml)
- Withdrawal needle (18g x 1″)
- Injection needle (22-23g x 1″ or 1.5″ for IM injections; 25-27g x ⅝” or ½” for Sub Q injections)
- 2 alcohol swabs
- Cotton swab or tissue
- Band-aid (optional)
- Sharps container
- Your medication vial
You can buy injection supplies at most pharmacies, or get them for free from harm reduction programs like ACCM’s Kontak!
Preparing the syringe
To prepare the syringe:
- Wash your hands well with soap and warm water.
- Take off the plastic cap and use an alcohol swab to sterilize the top metal cap of your medication vial.
- Open the package of a sterile withdrawal needle and a syringe, making sure not to touch the base where they connect.
- Twist the top opening of the syringe into the base of the needle. Then, pull back the plunger of the syringe to your dosage.
- Remove the protective cap of the needle. Place vial on a flat surface and pierce its rubber stopper with your needle.
- Push plunger of the syringe all the way down, keeping the needle inside the vial.
Withdrawing the medication
To withdraw the medication into the syringe, hold the vial with one hand, and the syringe with the other, turn the vial upside down. Make sure the needle tip stays inside the vial. Next, make sure to hold and secure both the vial and and the body of the syringe with one hand, and use your other hand to pull the plunger to your correct dose. This may take a moment to fill.
Check for any air bubbles while your needle is still inside of the vial. If you see some, gently flick the syringe with your fingers. You may need to push the air bubbles out with the plunger and reset your indicator back to your correct dose. If air bubbles do remain, it is still safe to inject but you will be missing some of your medication.
Take the syringe and needle out from the vial and remove the 18G needle. Place the used needle in your sharps container. Place an injection needle of your choice onto the syringe. Keep the protective cap on the needle until you are ready to inject.
Injecting the medication
If you are injecting into your stomach, make sure to stay at least 2 inches away from your belly button. For upper arm, you must stay at least 3 inches below your shoulder and 3 inches above your elbow. If you are injecting into your thigh, try to target halfway between your knee and hip on the outer part of the thigh. If you have another person to help, they can inject into a butt cheek right where pant packets would be. Do not inject lower.
It is important to pick a place on your body that has no scarring, bruising, or other skin damage. Avoid injecting into tattoos, especially more recent ones. It is also recommended to change the place you inject from one to the next to keep your skin healthy.
When doing the injection:
- Make sure your hands are clean. Use an alcohol swab on the area of your body you will be injecting into. Let it air dry for a few seconds.
- Use one hand to gently pinch about 1″ of your skin, and hold your needle with your other hand. If you’re doing an IM injection, hold the needle at 90 degrees, or a close to it as you can. If you’re doing a SubQ injection, hold it at a 45 to 90 degree angle.
- Try to relax and insert the needle under your skin in a fast downward motion. Unpinch your skin and gently push the plunger of the syringe all the way down. This may take a few moments.
- Wait a few seconds and pull out the needle in a quick motion. If needed, use a cotton swab or tissue to stop any bleeding. Apply a band-aid if needed.
- Throw out the used syringe and needles into a sharps container. Do not reapply the protective caps beforehand.
It’s common to feel nervous, or be a little clumsy when you first start injecting HRT. It can take a few times to get used to it. If it’s difficult, you can ask a friend or someone you trust for help!
