Estradiol Injections are NOT Expensive!

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.

25 thoughts on “Estradiol Injections are NOT Expensive!”

  2. I tried to get this and couldn’t. I was fortunate to get 5ml at 20mg/ml for almost $200. 1 injection of 1ml every 2 weeks makes $40 per injection or $80 / month. Good RX or similar wouldn’t apply.
    I’m in the Denver area, Just started so I took what I could get and am ok with that. Maybe on the refill I can get a better deal.

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    1. If you are a trans woman, it’s VERY important not to do a 2 week schedule of injection. Splitting your dose in half and doing it once a week is usually sufficient. Yes, I know your doctor probably wrote it that way. Their mistake. The two week schedule causes you to backslide in the second week, so that suppression in the first week is reduced. This is one of the most common mistakes made by prescribing doctors.

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      1. Hi Bev, what a wonderful article. I would like to comment on your 2 week warning. If a trans woman is self injecting into the thighs you are right as the medication will be released much quicker. However if you inject using a longer 1.5″ needle into the Gluteal 2 weeks is fine as the release is much more gradual. There are obvious a little more caution dues to the sciatic nerve, however once a site is established you can reduce the # of injections and it gives a month to rest the injection site on the other side,

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      2. I am not sure if what I’m experiencing is real or imagined, but it seems on the second week my body hair grows a little faster. As I am in my first month or so I’m not real sure what is real, hoped for or imagined.
        What is real is skin texture ant breast pain. The rest…..I am going to try the weekly, though.

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      4. I’m sorry to dig up a dead post but I’ve been prescribed .35ml of 20mg/ml once a week. I think I’ve worked this out to be a dose of 7mg per week. Is this enough to suppress testosterone?

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  4. Please explain suppression in the first week and backsliding in the second week and how weekly injections will make that different. My tits hurt plenty in the second week, too,

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  5. I would love to transition but it is too late for me. I am and have always been a woman inside. It was not very widespread when I was young in the 50’s or 60’s. So I remain as is. I have been able to realize some sufficient breast development through various Phytoestrogens and a waining supply of testosterone through the aging process. Hurray for me. Lately the urge is has increased greatly. But still not possible. I can’t lose my loved ones over it. There is also side effects of herbs if taken too many per day which I tried 10 years ago and ended up at emergency with a seizure. Anyway i console myself with crossdressing and that helps some but it is hidden. Boohoo. That’s all for now because I think my wife is getting up and this upsets her. Me too. Thank you for listening.

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    1. Joyce (and others in the same position)
      me too. Full transition is also not an option, but low-dose estrogen keeps my ‘girls’ at a B cup. The calming effects of estrogen / less T is equally welcome.
      It helps me if I focus on my (femme) state of mind, rather than the overt physical.

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      1. It is not too late for you. I just turned 67 and am a little over a year on HRT. Best thing I ever did for my body. I feel as though full transition is the only option for me.

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      2. Salut moi c Mima une fille normale de 22ans pas assez développer s ke je prendre l estradiol valerate en injection pour féminiser un peut

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  6. Unfortunately, I live in Brazil, and the only options available are pills, gels and patches. As for progesterone, we have utrogestan. I use 8 estrogel puffs a day, 4 a day and 4 a night. utrogestan 200mg sublingual.Is a good hormone therapy?

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  7. Maybe it’s my pet peeve, but why we we write “AMAB trans women?” I know that when I transitioned in the late 70s, no one went thru this process to be labeled a transsexual women, which then became a transgender women, which then became a trans woman, and now a “AMAB trans women.” Jennifer Finley Boylan famously stated on the Caitlyn program that she didn’t go all this to be referred to as trans or a tranny.

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  8. I am 67 years old and was experiencing Estrogen dominance; insomnia, depression, vertigo. I was using 0.5mL of 100mg/5mL Estradiol Valerate Injection, USP every 14 days; a change from pills because of my age. As a result of these complications, and almost a year of testing, my endo finally took me completely off injectable depoestrogen and back on pills (2 mg per day) which, along with 200mg of bio-identical progesterone (Prometrium) has done wonders for my disposition, sleep, and dizziness. Trouble is I now have 6 sealed vials of 100mg/5mL Estradiol Valerate Injection, USP from Perrigo (expiration is between 5/20 and 9/20). Does anyone know a venue by which these could be re-sold to someone in need? They originally cost over $50 with a Good Rx coupon.

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  13. I wanted to get your feedback on this post. The assumption that you have is that you can get approx 36 draws from a single vial. Dividing that into the cost of a vial + the cost of the needles/syringes and you have your cost. The issue that I’ve heard is that each time you draw, you push an equal amount of air back into the vial. Over time, the vial can build up bacteria (regardless of how well you sanitize before pushing a draw needle into the vial). The feedback that I have received is that the oil will become cloudy/milky or will start to form crystals around 10-12 draws (2-1/2 – 3 months). Once the estradiol has turned, it is not recommended to use as it can cause infections. As such the cost is approximately 3 times what your calculation is for the EV.

    Are you familiar with the issue of the estradiol spoiling and if so, how quickly has that happened for you?

    For me, I am figuring 12 injections which works out to $26/month:
    1 – 40mg/ml x 5ml vial – $71 (GoodRX/CVS)
    12 – 1ml TB syringe with 25g needle ($4/Walmart)
    12 – 21G draw needle ($4/Walmart)

    CVS seems to have a difficult time filling my prescription. I’ve been waiting 2 weeks now. I don’t understand why…

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    1. I’ve used EV by injection for 30 years, stretching each vial to the last drop, and have never seen any evidence of spoilage. There’s a lot of misinformation floating about, and what you heard might be some of it. However, it’s true that using a giant needle, such as 18 gauge, to do your draws with will damage the seal excessively and cause bits of rubber to float about in the vial. That’s why I suggest a 22 gauge needle for drawing. It only takes a few seconds longer, but it damages the seal much less. Also, use care to store the vial upright, and wipe the seal with an alcohol-moistened cotton swab before use.

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      1. Thanks for the feedback. I just did my 4th injection this morning. I have been doing as you say other than I’m using a 21G vs 22G as that was what was prescribed. It’s good to hear that you are able to use nearly the entire vial. That will more than cut my estimate in half. At what temperature do you store you vial at?

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