This article was updated on 8/29/23 by the FOLX Editorial Team.
Get comfortable, put on some good music, and follow along with these instructions for an easy, seamless, and stress-free injection.
If you are new to HRT, also called GAHT or gender-affirming hormone therapy, you and your clinician can decide which method and frequency is best for you. Once you decide on routes and dosages, the instructions are pretty much the same for SubQ (subcutaneous) or IM (intramuscular) injections. Only the size of the needle and the injection site will differ.
Want a video tutorial instead? Check out our step-by-step videos for intramuscular (IM) or subcutaneous (SubQ) injections.
Let’s get started.
1. First things first: wash your hands
Be sure to wash your hands. Wash long enough to sing "Happy Birthday." Cleanliness is important—no one wants an infection. And adequete hand washing is the number one way to prevent infections!
2. Next, gather supplies and make a clean, comfortable work area
- Alcohol pads x 2 (one to wipe down your vial top, one to clean your skin).
- Medication vial (either T or E).
- Sterile syringe (1mL).
- Needle (18-22G) for drawing up the medication from the vial.
- Needle for administering medication 22-23G, 1-1.5inch for intramuscular (IM).
- Needle for administering medication 25G, 5/8 inch for subcutaneous (SubQ).
- Sharps container for disposal.
3. Check the medication
- Correct medication name.
- Check the expiration date.
- Make sure the medication isn't discolored.
- Make sure there are no visible particles.
4. Time to prep the injection dose
- With an alcohol swab, rub the rubber stopper at the top of the T or E vial.
- Connect the sterile needle (22G) to the sterile syringe (1mL).
- Draw air into the syringe equal to that of your dose with the cap still on.
- Push the needle into the upright vial and inject the air into the vial.
5. Flip the vial upside down and pull on the plunger
- This draws medication into the syringe equal to that of your dose.
- Make sure the tip of the needle is below the medication line so that you’re drawing up medication and not air!
6. Turn the vial upright
- Remove the needle tip from the vial.
- Pull down on the plunger.
- Make sure any medication that may be left in the draw up needle is drawn into the syringe.
7. Engage the safety device on the draw-up needle (or recap the needle if it’s not a safety needle)
- Twist off the draw-up needle from the syringe.
- Place the draw-up needle in sharps container.
8. Connect a new needle to inject
- New 22G to the syringe for IM injection.
- New 25G for SubQ.
This ensures that your injection needle is new and has not been dulled by inserting into vial top!
9. Check for air bubbles
- Make sure to remove as many air bubbles as possible by flicking the side of the syringe.
- Push the plunger until air bubbles are cleared from syringe.
The key is to draw up the medication slowly when injecting estrogen or testosterone HRT.
10. Choose your injection site
For subcutaneous injections, common SubQ injection sites include the belly and outer thigh for self-injection. You can also inject or have someone else inject SubQ shots into the fatty part of your arm.
For intramuscular injections, the best IM injection site is the outer thigh for self-injection. You can also inject or have someone else inject IM shots into the muscular part of your arm (deltoid muscle).
Always clean the injection site with an alcohol swab beforehand!
The gluteal site (buttocks) is no longer recommended as an injection site. Over time, with repeated injections into the incorrect area, inferior gluteal nerve injury can occur. If gluteal location is truly desired, proper placement of injection is key to prevent nerve damage.
11. Go time: give yourself the injection
- ”Prime” the needle by pushing gently on the plunger of the syringe so that the medication fills up the length of the needle.
- Move your thumb and index finger into place by holding taught the skin at your chosen injection site.
- Quickly enter the skin at a 90-degree angle for IM injections or at a 45-degree angle for SubQ.
- Slowly push the plunger down to empty the syringe and inject the hormones.
12. Remove the needle from the site of injection
- Pull needle directly out of injection site at same angle you entered.
- Use gauze or bandaid to cover and put a little pressure at injection site.
13. Discard needle
- Engage safety device, if using safety needles.
- Push the plunger till air bubbles are cleared from syringe.
- Dispose of needle in sharps container.
That’s it! GAHT injection secured.
Congrats. Take a breath. You did it—and that was all you.
With the different routes and dosages of testosterone and estrogen, there are a lot of ways to find the one that fits your hormone replacement therapy care plan. When it comes to gender-affirming care, FOLX works with you to find the best GAHT route for your body.
Know that we always review informed consent with you before starting hormone replacement therapy. We follow WPATH (World Professional Association of Transgender Health) standards of care so that your gender-affirming care is safe. Whether you’re on a masculizing, feminizing, or nonbinary journey, know we work with gender-diverse folks every day and are committed to helping you find your authentic gender identity. We celebrate transgender men, transgender women, nonbinary folks, and everyone who is seeking LGBT-centered healthcare.
For existing FOLX members with questions about self-injecting, don't hesitate to schedule time with a clinician. And for those who’ve just got some more questions, read up on gender-affirming HRT/GAHT in the Library, and feel free to check out our FAQs in the Help Center.
FOLX Health is the first digital healthcare company designed by and for the LGBTQIA+ community. Our services include virtual primary care, gender-affirming hormone therapy including estrogen and testosterone (HRT), mental health care, sexual and reproductive health care, preventive care, and fertility consultations. FOLX memberships give you access to LGBTQIA+ expert clinicians, peer support, thousands of LGBTQIA+ resources, and more. Whether you’re lesbian, gay, bisexual, transgender, queer, gender non-conforming, or nonbinary, you can find LGBTQIA+-specialized health care that helps you meet your wellness goals. FOLX Health is health care that's queer all year. Get all the benefits of becoming a FOLX member and sign up today!