Step 1: Set Up for the HRT Injection

1. Find a comfortable and well-lit location to administer the HRT injection.

2. Gather your supplies:

•  HRT medication vial

•  Syringe

•  One 18-gauge needle (to draw up medication)

•   One 22-23-gauge needle, 1-1.5 inch (to inject medication) - for intramuscular (IM) injections only

•   One 25-26-gauge needle, 5/8 inch (to inject medication) - for subcutaneous (SC) injections only

•  Two Alcohol pads (one for vial, one for skin)

•  Gauze pads

•  Band-aid, if needed

•  Sharps container

 

3. Look at the HRT medication vial. Do not use the medication if you notice any visible particles, medication discoloration or if the medication has expired.

4. Check the syringe and needle packaging. Do not use if the packaging is damaged or if it came opened.

5. Wash your hands with soap and water.
 

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Step 2: Prepare the HRT Injection Dose

1. Take off the cap of the HRT medication vial. Clean the rubber stopper with one alcohol pad. Allow the vial to air dry before use.

2. Pull the 18-gauge needle cap straight off the attached syringe. Pull back the plunger of the syringe and draw air into the syringe. The amount of air drawn into the syringe should match the amount (ml or cc) of the HRT medication prescribed by your LGBTQIA+ health specialized care provider.

3. Place the HRT medication vial on a flat surface (i.e., table, desk, etc.) and insert the 18-gauge needle straight down through the rubber stopper into the vial.

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4. Push the plunger of the syringe down and push the air from the syringe into the HRT medication vial.

5. Hold the 18-gauge needle while you turn the HRT medication vial upside down.

6. Make sure the 18-gauge needle tip is covered by the liquid HRT medication.

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7. With the vial upside down, slowly pull back the plunger of the syringe to fill the syringe with medication to the amount (ml or cc) that matches the medication dose prescribed.

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8. While the 18-gauge needle is still in the vial, check for air bubbles in the syringe. If there are air bubbles, gently tap the syringe with your fingers until the air bubbles rise to the cop of the syringe. Slowly push the plunger up to force the air bubbles out of the syringe. 

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9. Once the air bubbles are gone, pull the plunger back to the amount (mL or cc) that matches the medication dose prescribed.

10. Pull the 18-gauge needle and syringe out of the vial. Remove the 18-gauge needle and dispose it in the sharps container without recapping it.

11. For intramuscular (IM) injections: Place the 22–23-gauge needle onto the syringe and then remove the needle cap.

    For subcutaneous (SC) injections: Place the 25-26-gauge needle onto the syringe and then remove the needle cap.

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Do NOT let the injection needle touch any surface. 

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Step 3: Identify and Prepare the Injection Site

1. Select the injection site based on the injection type: Intramuscular (IM) or Subcutaneous (SC)

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For intramuscular (IM) injections: The self-injection site is the front of your thighs. 

• Divide your thigh horizontally into three equal parts. Your injection site will be in the outer middle third.

   

For subcutaneous (SC) injections: Injection sites include the front of your thighs or your abdomen. Choose a site where you can grasp 1-inch of your skin.

• If selecting the front or top of your thigh, divide your thigh horizontally into three equal parts. Your injection site will be in the outer middle third.

• If selecting your abdomen, avoid the belly button and any bony areas.

 

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Step 4: Give the HRT Injection

1. Pick up the syringe with the attached injection needle in the hand you will use to give the injection with.

2. With the other hand, pinch a fold of skin.

3. Clean the skin where you will inject the medication with an alcohol swab and let the skin air dry.

4. Insert the injection needle either directly into the skin fold between the two fingers:

• For intramuscular (IM) injections: Insert the 22-23-gauge needle at a 90-degree angle

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• For subcutaneous (SC) injections: Insert the 25-26-gauge needle at a 90-degree angle or 45-degree angle, based on your comfort level.

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5. After inserting the needle under the skin, release the skin pinched between the two fingers.

6. Pull back on the plunger of the syringe to check for blood.

• If you see blood in the syringe, do not inject the medication, and immediately remove the injection needle. Replace the needle with a different injection needle and try again.

• If you do not see any blood in the syringe, you can complete the injection by pushing the medicine slowly under your skin.

 

7. Wait 5 seconds, and then slowly pull back on the syringe to remove the injection needle from the skin.

8. Dispose the syringe and injection needle in the sharps container without recapping the needle.

9. Gently press a gauze pad on the injection site skin. Hold pressure on the site until there is no bleeding. You can use a band-aid, if needed.

 

Important Safety Tips:

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•  Maintain HRT medication in a room temperature environment.

•  Keep injection site skin and muscles warm and relaxed.

•  Allow rubber cap of HRT medication vial and skin to fully air dry once disinfected with an alcohol pad.

•  Only inject HRT medication that is at room temperature.

•  Use two separate needles to draw up and inject medication.

•  Never reuse needles.

•  Break through skin fold quickly with the injection needle.

•  Insert the injection needle directly into skin and pull straight out once injection has been given.

•  Do not move injection needle around in skin fold.

•  Safely and proper dispose of all used needles and syringes in a sharp  container. See https://safeneedledisposal.org/ for proper disposal instructions in your State.

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Resources:

1. Fenway Institute Transgender Health Injection

https://fenwayhealth.org/wp-content/uploads/2015/07/COM-1880-trans-health_injection-guide_small_v2.pdf
2. University of Michigan Health
https://www.med.umich.edu/1libr/SpinalCordInjuryProgram/IMselfInjectionTesto.pdf
3. Planned Parenthood Gender Affirming Hormone Therapy Injection Guide
https://www.plannedparenthood.org/uploads/filer_public/fc/b0/fcb07ab8-4f33-4e1b-
8b15-3754c34e3aae/pplm_gender_affirming_hormone_therapy_injection_guide_2.pdf