Adolescent Gender Affirming Care – Injection Information
Injection Information
NOTE: This information is compiled from several sources readily available on the internet. To review the original sources, please see the footnotes. Nothing in this information resource should be construed as medical advice.
DISCLAIMER: The information contained herein is for informational purposes only and is not intended to substitute for medical advice or constitute medical advice. The information contained herein does not create a health care provider-patient relationship between the reader and any of the authors. The information contained herein is not intended to be definitive or exhaustive, and is compiled from sources believed to be accurate, but the authors make no representation that it is accurate. Moreover, the authors and their agents make no warranties or guarantees, express or implied, concerning the accuracy or appropriateness of this information for any particular reader given the frequent changes in the practice of medicine as new information is learned through medical studies. Readers should consult with a knowledgable healthcare provider for medical advice, treatment, and additional information on gender affirming care options based on their specific health care needs and medical history.
Injections for puberty blockers and hormones can be intramuscular or subcutaneous, depending on which medicine is being given. Refer to the dosing section of the site to know which technique to use. [1]
Information provided below has been compiled from Seattle Children’s Gender Clinic “How to Give Yourself Hormone Shots”, The Fenway Institute, and videos created by Dr. Kevin Hatfield.
Injection Information and General Guidance:
Open all supplies onto cleanish surface and wash hands.
Clean rubber top of the vial with one alcohol swab, rubbing at least 3 times, then let it AIR dry.
Attach draw needle (size 18–21-gauge* and 1–1.5 inches long) onto syringe with twisting motion. Then remove plastic protective cap from needle.
Pull back on syringe plunger to allow your injection volume (or dose) of air into syringe.
Gently insert draw needle straight down into top of cleaned vial then flip both over vertically (now the syringe is upright, with the bottle on top and upside down).
Reposition the syringe (slowly pull it out just a bit) so that the needle’s tip is well UNDER the level of liquid in the bottle (near the neck of the bottle usually).
Inject the air into the vial by depressing the syringe plunger.
Pull back on the syringe plunger allowing your current dose of hormone to flow into the syringe. If you fill the syringe past the line marking the mL of your dose, just push the syringe plunger until the liquid is at the correct line.
Depress (or push) syringe plunger to release extra air from syringe cylinder until only your dose of liquid hormone remains in the syringe barrel.
While still connected, flip bottle and syringe once again so that bottle is upright. Slowly withdraw the draw needle from the bottle.
Once again, pull back on syringe plunger allowing all liquid in the draw needle to flow back into the syringe barrel.
Carefully untwist draw needle from syringe and place into a sharps container.
Attach injection needle (23-25 gauge, ⅝ - 1 inch long needle) onto syringe with twisting motion. Double check mL in syringe once more for accuracy.
Cleanse area of skin to be injected with an alcohol swab 3 times in a circular motion moving from inside the circle to outside the circle. Don’t touch the cleaned area again, if you accidentally do, clean it once more with a fresh alcohol swab.
Subcutaneous injections can be given in abdomen, outer portion of upper thigh, and love handle region. You can see examples here.
Intramuscular injections can be given in the upper, outer quadrant of the bum or the front, outer third of the mid to upper portion of the thigh.
Don’t use the same site for each injection, rotate sites.
Remove plastic protective cap from needle. DO NOT SET THE SYRINGE ON ANY SURFACE once you have removed the needle cap. Hold syringe vertically with needle pointing upward, gently tap the syringe to move air bubbles upward, then gently push plunger to release air from syringe barrel until liquid drops barely emerge from needle tip.
At the previously cleaned injection site:
Subcutaneous: pinch skin firmly so that you’re holding about a 1-inch portion and then at a 45-degree angle QUICKLY insert needle into injection site all the way to the needle hub (as deep as it will go) and just a little further to indent the skin.
Intramuscular: pinch skin firmly so that you’re holding about a 1-inch portion and then at a 90-degree angle QUICKLY insert needle into injection site the all the way to the needle hub (as deep as it will go- intramuscular injections may use 1, 1.5, or 2 inch 23-25 gauge needles depending on your size)
Gently depress (or push) the syringe plunger until all of the hormone has been injected.
Count to 5 before removing the needle from yourself.
Place adhesive bandage over injection site. It is okay to remove in 30 minutes to an hour.
Remove injection needle from syringe with an untwisting motion and dispose of it into a ‘sharps container’.
Throw away all other used injection supplies in regular trash.
Store vial in cool, but not refrigerated, place.
Additionally, The Fenway Institute has a downloadable guide that may be helpful.
Dr. Kevin Hatfield has made instructional videos available on YouTube which we recommend watching as well. There is an introductory video and a self-injection video.[2]
*20 or 21 gauge needles will make smaller holes in the rubber stopper helping your vials to last longer