By Beverly Cosgrove, Version 12, 1/25/2018

Here are a collection of common misconceptions about estrogen injections for MTF Trans people.  I’m often surprised how many of these are accepted as true… in some cases, even by health professionals.

Myth 1: “Injections are too expensive! Since my insurance won’t cover them, I’m forced to use something else.” Not true. If you can afford about $19 a month out-of-pocket, you can afford injections. Want details? See this article.

Myth 2: “I know a girl who tried injections and had mood swings.” This is rare and is usually caused by injecting incorrectly (such as into the thigh instead of the buttocks), or it simply fades away in a few days. It can also be minimized by using estradiol cypionate instead of estradiol valerate, or by injecting smaller doses more often. In particular, it is caused when prescribers write the injection interval as 14 days instead of 7 or less – don’t let your doctor force you onto a 14 day schedule unless you already know it works for you.

Myth 3: “Injections hurt!” Not really. You may be used to the injections you got in a doctor’s office. Those were usually in the deltoid (shoulder) which is fairly sensitive, and using a 20 or 22 gauge needle which is fairly large. Today, there is a 27 gauge needle you can buy which is painless and bloodless. Injections into deep muscle, especially the buttocks, encounter fewer sensitive nerves than you might expect. For the ultimate in painless injections you can do subcutaneous injections, shallow injections into the fat layer, with a 30 gauge needle which can be COMPLETELY painless.

Myth 4: “Don’t I have to visit the doctor for those shots? I don’t have time for that.” Actually, most transsexuals give themselves the injections. With practice it is very easy. In fact, they tend to become more adept than most nurses.

Myth 5: “My doctor says injections cause your estrogen levels to spike dangerously high.” Not true. IM injections in the gluteus cause a slow rise in your estrogen levels over two days, unlike some methods like sublingual pills which cause your levels to spike at extremely high levels every day. Injections can give highly accurate control over your exact estrogen level, if that’s important to your doctor. [Note: injections in the thigh do cause some high spikes. Using the thigh for IM injections of oily hormones is usually NOT a particularly good choice.]

Myth 6: “I’ll break the needle off in myself and have to go to the hospital”. Modern needles such as the BD or Nipro 27g-1.25in do not break at all, they bend. You can twist the needle into a circle and it will not break. The chance of it breaking in you is zero because of the improved metals that needles are made with. Millions of diabetics inject themselves on a daily basis without incident. Hormones have been injected (and self-injected) since the 1940’s by hundreds of thousands of patients.

Myth 7: “I’ve used other methods of HRT for many years and have nice breasts. There’s nothing to be gained by switching to injections.” Not true. Nearly everyone who switches reports new feminization, breast growth, and improved skin, even if they have been on another method for years. The change is especially dramatic if the patient has been on pills.

Myth 8: “My doctor is concerned with thrombosis with injections and wants me to stay on patches.” The latest data shows that this is probably an unfounded worry – the data showing thrombosis risk with estrogens was based on synthetics such as Ethinyl Estradiol which were very dangerous in that regard. Even though parenteral estrogens affect clotting time and fibrinogen time, modern bioidentical estradiol is being shown to have little or no association with added thrombosis risk. The famous “Women’s Health Initiative” study based on Horse-derived estrogens and synthetics resulted in risk data which has not been shown to be applicable to bioidentical estradiols such as injectable estradiol valerate.  This resulted in a tragic misassessment of risks and benefits of estradiol injection.  See this article for more information.

Myth 9: “I have high blood pressure so my doctor says I have to stay on a low estrogen dose using pills.” This runs against actual clinical experience and anecdotal evidence, in which estrogen injection seems to gradually encourage lowered blood pressure when used long term. It is common to see one’s blood pressure drop after switching to injections, and some of us have been able to stop taking blood pressure medications. Estradiol is a vasodilator, and lifetime use of estradiol may confer some of the long life “female advantage”, especially when delivered by a method like injection which has one of the highest ratios of estradiol to total estrogens.

Myth 10: “My doctor worries that I will hit my sciatic nerve when I inject myself.” This is very unlikely. This nerve runs very very deep along the bone in your pelvis and is 3-4 inches away from where you inject. This kind of accident happens more with novice nurses injecting others than with transsexuals injecting themselves (if ever). If your doctor says this, he probably means, “I’m worried you will get so drunk one night you will damage yourself with the syringe and then sue me.” So, do not drink and inject. Alternatively, you can suggest to your doctor that you do your injections subcutaneously, which uses a very thin, short needle, far away from any sensitive nerves. And don’t let your doctor tell you that subcutaneous injections of hormones don’t work. They do, almost as well as gluteal IM.

Myth 11: “My doctor says that long term estrogen levels produced by injections are too high, so he is keeping me on pills.” Estrogen levels can be adjusted to any level your doctor favors with injections – far easier than with pills or some other methods. Chances are, your doctor is simply not experienced with hormones by injection. Furthermore, low estrogen levels arrived at by injection tend to produce more feminization, faster, than low estrogen levels arrived at by most other methods such as oral estrogen, (due to negative effects of pill-derived estradiol antagonists) so if you must keep your levels low, injections are the best way to do it and still get optimum results. Physician fear of injected estradiol can be traced to some Endocrine Society source studies which created the myth of “estradiol overdose” despite knowledge that pregnancy levels are up to 100 times higher.

Myth 12: “My health care is from the Veterans Administration and they won’t approve injections.” Injections are on their official HRT guidance and we can give you a copy if you need it. We know many getting their injectable supplies from the VA. If you are running into blocks from the VA, it is due to individual doctors or administrators. Please consider getting pushy.