By Beverly Cosgrove, Revision 3, Jan 25, 2018

For AMAB Trans women, the best combination of safety, convenience and effectiveness is to use self injection of estrogen, particularly in the form of estradiol valerate, and this is what I suggest patients request from their doctors. But too often I hear, “My insurance doesn’t cover injectables.” or “I can’t afford it.” The good news is that it is possible to do an excellent HRT using injected estradiol for about $19 a month.

First a caution: I realize that injectable estradiol can be obtained without prescription through various means, and many are doing so. Self medication is not for everyone. In particular those who have heart disease, history or risk of cancer, diabetes, taking other medications, and other conditions which can only be judged by a medical professional. This fact will not sway the minds of all those who are desperate, however, and who face an unyielding environment in which suitable care is impossible to find. Self medication has to be addressed, because it exists, despite being the fourth best way to do an HRT. The one point I’d like to make is that injection (self injection or otherwise) is in most cases the choice for combining best safety and effectiveness, whether you are “DIY” or have a legitimate medical prescriber. So, don’t let cost make you feel you must fall back on swallowing the more-dangerous estradiol pills. A safer injection regimen is still generally possible, and you can save money even if you have a legitimate prescription and some insurance coverage.

Some forms of estradiol injection are currently in short supply.  The article you are reading assumes you can obtain the generic 40mg/ml form of injectable estradiol. If not, your costs may be somewhat higher… or not.  See this article for alternatives.

How inexpensive can it be? Can you afford $19 a month? That’s about $19 a month average in the US, using cash only, no insurance needed. Surprised? Here’s a summary. Let’s assume you are on a nearly-ideal regimen of injected Estradiol Valerate, 5mg twice a week, subcutaneously. (Once a week regimens are a little less effective.) Have your physician write a prescription for “Estradiol Valerate IM, 5ml vial of 40mg/ml”. If he tells you that the vial will cost almost $500 cash, just smile and say you can afford it. Then, obtain a cash discount coupon for it at GoodRx.com. Looking at that coupon today, it shows there is a pharmacy nearby which offers the vial for $68. At 5mg per injection, that means it is nominally enough for 40 injections. In reality, let’s assume that due to waste you only get 36 injections, so then each injection costs 68/36 = $1.88.

Remember that dose equals volume times strength. Or, volume equals dose divided by strength. In this case, dose is 5mg, and strength is 40mg/ml. So volume is 0.125ml. That’s a very low volume, so results will be best using the lowest volume syringe. The most suitable choice is the BD 0.3ml insulin syringe — a ml volume this small is easy to measure on its calibrated scale. So, follow the directions in the “Buying Injection Supplies” article (to be written next) to buy a box of 90 0.3ml BD insulin syringes for about $25 including shipping. (Here’s one source.) That means, your average price of the needles and syringes are $0.28 per injection. Adding, the total cost per injection is then $1.88 plus 0.28 equals $2.16. A month has 4.25 weeks on average, so your twice a week schedule means you will do an average of 8.5 injections per month. Multiply 8.5 times $2.16 and you get $18.36 total average monthly costs. NOT expensive at all! See our article on subcutaneous injection for details on how to do it. Don’t assume injections are too expensive for you just because your insurance does not cover it. All you need is $19 and the prescription.