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Injections

(also: im, intramuscular, parenteral, shots, subcutaneous, subq)

Table of Contents

Introduction

Various medications can be injected.

General Information

The information on this page is supplementary reading material for the estrogen and testosterone pages of this dictionary. This is not medical advice. I am not a doctor. This is just a collection of my own research. Do your own further research prior to injecting hormones. Talk to a doctor before taking any medications.

To reduce pain and injury, keep the following things in mind. Medication should be kept at room temperature. Keep your body warm and relaxed before and during an injection. When doing an injection, be sure to break through the skin quickly with the needle. Do not inject in the same spot over and over again, and change the location of the injections every time. After an injection, pull the needle straight out without wiggling it around. Do not massage the site of the injection. Ice or numbing cream can be applied to the injection site prior to cleaning it as a way to prepare for possible pain with injection.

Never share or reuse syringes or needles. Use new needles and syringes every time you inject. Most pharmacies sell syringes and needles. Free needles can sometimes be found at a needle exchange program. Do NOT dispose of needles in the recycling.

Peak testosterone levels can be measured 24 – 48 hours after injection. Trough levels can be measured immediately before injection.

Autoinjectors can be useful for people who experience anxiety regarding the usage of needles.

Note that if you experience significant redness or swelling at the injection site that you may be allergic to the oil-based solution that the testosterone is suspended in, and may have to discuss alternatives with your provider.

Note that needle sizes are measured in a unit known as gagues. The higher the number, the smaller the gague, and therefore the smaller size the needle is. For example, a needle that is 22 gague is physically much smaller needle than a needle that is 18 gague. Having a bigger gague needle makes it easier to draw up liquid from a vial. Having a smaller gague needle makes it less painful to inject medication into the body.

How to Dispose of Needles

Used needles should be stored in a puncture-proof sharps container. A hard plastic detergent bottle or hard plastic milk jug can also be used to safely store used needles.

Safety

Intramuscular

Intramuscular (i.m.) injections are injected directly into the muscle. Intramuscular injections typically require the help of a doctor, friend, or family member to administer. Intramuscular injections can be more painful than subcutaneous injections. Intramuscular injections can go into the thighs (aim for halfway between your knee and your hip on the outer part of your thigh) or buttocks (aim for where the top of your pants pocket would be to avoid hitting a sciatic nerve). If you choose to inject into the thighs, you will most likely need help from another person. If you feel an extreme amount of pain during an intramuscular injection, immediately remove the needle (pull it straight out), as this indicates that you hit a nerve.

  1. Make sure to gather all of your supplies before injecting. The required supplies consists of an alcohol wipe or pad or rubbing alcohol (two alcohol wipes are ideal), the vial of medication, a syringe, two needles (a single 18 or 20 gauge needle to draw up medication & a single 22 or 23 gauge needle for the injection), cotton ball or gauze, and a puncture-proof sharps container (or a hard plastic detergent bottle or milk jug) to safely dispose of needles. Check the expiration date, dosage, and concentration of your medication (double and triple check this throughout the process to ensure that you are getting the correct dose).

  2. Find a spot that is well lit, clean, and has a lot of space available for your supplies. Wash your hands with either antibacterial soap and water or an alcohol-based gel aka hand sanitizer (if soap and water are not available). Hold up the bottle of medication to the light. If it is cloudy, or there are little bits floating in it, don't use it (it is expired).

  3. Take the cap off the medication vial. Clean the rubber stopper with an alcohol wipe for 15-20 seconds. Let it dry. Clean the injection site (thigh or butt) with another alcohol pad or pour alcohol over the area. Clean the area on your body where you intend to do the injection with a circular motion from the center moving out. Let it dry.

  4. Secure the larger gauge needle for drawing up medication on the syringe. Pull the needle cover straight off the syringe. Pull back the plunger to the number on the syringe that matches your dose. Insert the needle straight down into the bottle (through the rubber stopper), and push the plunger of the syringe all the way down, injecting air into the vial.

  5. Turn the vial upside down (keep holding it and the syringe steadily). Slowly pull back the plunger to fill the syringe with medication, and check to make sure you have the correct dosage. Gently tap the syringe with your fingers until the larger air bubbles rise to the top. Slowly push the plunger up to force the air bubbles out. After the air bubbles are out, slowly pull the plunger down to the number corresponding with the correct dosage of medication.

  6. Dispose of the drawing up needle (put it in the sharps box). Replace the drawing up needle with the smaller gauge injection needle.

  7. Pull the skin taught around the injection site. Quickly and firmly push the needle straight through the skin (at a 90° angle) and into the muscle. If you experience extreme pain while doing this, immediately remove the needle, as this indicates you hit a nerve. Slowly push the plunger to inject the hormones. Wait 5 seconds, then let go of the skin that was being pulled taut. Pull the syringe straight back out to remove from skin.

  8. Safely dispose of injection needle (put it in the sharps box along with the syringe). If bleeding after the injection, use a cotton ball or tissue to clean up. Apply a band-aid as necessary. Wash hands with warm water and soap. Keep sharps container out of reach of children.

Subcutaneous

Subcutaneous injections are injected just under the skin. It is easier to self-inject a subcutaneous injection, as opposed to intramuscular ones. Subcutaneous injections can go in the stomach (below and away from the bellybutton, avoid boney areas), the side or back of the upper arms (aim for below the shoulder and above the elbow), and thighs (aim for halfway between your knee and your hip on the outer part of your thigh). The risk of hitting a nerve is significantly reduced compared to with intramuscular injections, as subcutaneous needles are much smaller.

The best type of syringe to use is one that is 1cc (or 1 milliliter). Larger syringes make it more difficult to do subcutaneous injections with oily substances such as hormonal medication. A 1.5 inch 20 gauge needle is optimal for drawing up the liquid medication. A 0.5 inch 30 gauge needle is optimal for injecting the medication into the body. Some healthcare providers will give patients slightly larger gauge needles, such as 25 gauge, which can be slightly more painful when injecting.

  1. Make sure to gather all of your supplies before injecting. The required supplies consists of an alcohol wipe or pad or rubbing alcohol (two alcohol wipes are ideal), the vial of medication, a syringe, two needles (a single 1.5 inch 20 gauge needle for drawing up medication & a 0.5 inch 30 gauge needle for injecting), and a sharps container (or a hard plastic detergent bottle or milk jug) to safely dispose of needles. Check the expiration date, dosage, and concentration of your medication.

  2. Find a spot that is well lit, clean, and has a lot of space available for your supplies. Wash your hands with either antibacterial soap and water or an alcohol-based gel aka hand sanitizer (if soap and water are not available). Hold up the bottle of medication to the light. If it is cloudy, or there are bits floating in it, don't use it (its expired).

  3. Take the cap off the medication vial. Clean the rubber stopper with an alcohol wipe for 15-20 seconds. Let it dry. Clean the injection site (thigh, butt, or upper arm) with another alcohol pad or pour alcohol over the area. Clean the area on your body where you intend to do the injection with a circular motion from the center moving out. Let it dry.

  4. Secure the larger gauge needle for drawing up medication on the syringe. Pull the needle cover straight off the syringe. Pull back the plunger to the number on the syringe that matches your dose. Insert the needle straight down into the bottle (through the rubber stopper), and push the plunger of the syringe all the way down, injecting air into the vial.

  5. Turn the vial upside down (keep holding it and the syringe steadily). Slowly pull back the plunger to fill the syringe with medication, and check to make sure you have the correct dosage. Gently tap the syringe with your fingers until the larger air bubbles rise to the top. Slowly push the plunger up to force the air bubbles out. After the air bubbles are out, slowly pull the plunger down to the number corresponding with the correct dosage of medication.

  6. Dispose of the drawing up needle (put it in the sharps box). Replace the drawing up needle with the smaller gauge injection needle.

  7. Pinch an inch of skin at the injection site. Quickly and firmly insert needle just under the skin. The needle can be inserted straight up and down, or at a 45⁰ angle. If you experience extreme pain while doing this, immediately remove the needle, as this indicates you hit a nerve. Slowly push the plunger to inject hormones. Wait 5 seconds. Pull the syringe straight back to remove from skin.

  8. Safely dispose of injection needle (put it in the sharps box along with the syringe). If bleeding after the injection, use a cotton ball or tissue to clean up. Apply a band-aid as necessary. Wash hands with warm water and soap. Keep sharps container out of reach of children.

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