Safer Hormone Injection

What does it mean if someone tells me they’re trans?

“Trans” (short for “transgender”) people are people whose gender identity doesn’t match the sex they were assigned at birth. Trans is an umbrella term that includes trans women, trans men, nonbinary people (who do not identify as being women or men), and agender people (who don’t identify with any gender).

What does ‘cis’ mean?

Cis (cisgender) people are people who identify with the sex they were assigned at birth.

Why do trans people inject hormones?

Many – but not all – trans people use hormones like estrogen or testosterone as part of their transition, or the process of presenting themselves as the gender they identify as. For trans women and other trans people who use estrogen, it reduces body hair and helps fat grow near body parts like the hips and the breasts. For trans men and other trans people who use testosterone, it helps to lower their voice, encourage facial hair and muscle growth, redistribute fat away from the hips/breasts, and stops menstrual cycles/periods.

For people who use hormones, they can be an important part of reducing gender dysphoria, or the feelings of stress, anxiety, and/or

dissatisfaction with the inconsistencies between trans people’s bodies and gender identities.

Someone I’m distributing came out to me as trans -- what should I do?

• Ask what pronouns you should use for them (she/her/hers; he/him/his; they/them/theirs are some commonly used ones), and use those pronouns. If you accidentally use the wrong pronouns, apologize!

• If this person asks you to call them a new name, call them that name. And, again, if you accidentally use their deadname (the name they used to use), apologize.

• Don’t tell anyone else their gender identity -let this person come out to their community on their own terms.

• Let them know that if they’re going to be using hormones, you can help them get syringes and safer injection supplies for intramuscular hormone injections from NEXT Distro.

Okay, so what if someone I’m distributing to asks me for advice on injection hormones?

There are two ways to inject hormones: intramuscularly and subcutaneously (skinpopping). Here’s what the process looks like for each of these methods:

Intramuscular Injection

• Use a new and sterile syringe. In terms of size, anywhere from 23G to 21G with a 1 to 1.5 inch long needle (long enough to reach the muscle

under the skin) is best. Advise people to start smaller – 23G – and size up to 22G or 21G if they find their hormones are too thick for the smaller syringe.

• It’s best if they can use a syringe with a removable needle, and use a different needle to draw up from their hormone bottle than to inject in their skin.

• Just like with intravenous injection, the person should clean their injection site with alcohol or antiseptic wipes.

• It’s important to clean the top of the hormone bottle, too!

• Quickly insert the syringe into a muscle –often the butt or thigh – at a 90 degree (completely straight) angle.

• Inject the hormone

• Dispose of the syringe in a sharps container.

Subcutaneous Injection

• Use a new and sterile syringe every time. In terms of size, anywhere from 23G to 25G with a ⅝ inch needle is best for the actual injection. Again, if they can use a syringe with removable needle and use a longer – 1.5 inch

syringe to draw the hormone up from the vial, that’s ideal.

• As usual, the person should clean their injection site, and the top of their hormone vial.

• Grab and pinch a 1-inch fold of skin – many people use their thighs or their bellies.

• Insert the syringe at either a 90or 45-degree angle (whichever is easier), and inject the hormone.

• Dispose of all needles and syringes in a sharps container.

Why is it best practice to use one needle to

draw up the hormone and another to inject it into the body?

• Hormone vials have a barrier at the top, so the needle is passing through something, which dulls it slightly. The sharper the needle, the less painful the injection will be.

• Some people may prefer to use even larger needles – like 18G ones – to pull up hormones, since hormones are often a thick, gel-like liquid and can be hard to draw up.

• People who aren’t able to access genderaffirming medical care may be buying hormones underground and sharing them among friends. Using a different, sterile syringe to draw up every time means that people who are sharing hormone bottles won’t transmit bloodborne pathogens to each other.

Someone said something to me about “pumping,” what does that mean?

Some trans people “pump” or inject silicone into their butt or breasts. Pumping can be really risky – silicone can get into the bloodstream and do harm to the body, and it’s hard to know whether the silicone is medical grade silicone or something else. If someone asks you for advice about pumping, you can share these risks -- but don’t tell them what to do with their bodies.

The most important piece of advice that you can give someone who is going to pump silicone is to make sure they’re using their own, sterile syringe and to make sure nobody has inserted a used syringe into the supply of silicone that they’re using.

Resources

• https://www.plannedparenthood.org/uploads/filer_public/ fc/b0/fcb07ab8-4f33-4e1b-8b15-3754c34e3aae/pplm_ gender_affirming_hormone_therapy_injection_guide_2.pdf

• https://www.aac.org/wp-content/uploads/TransCend-Stepby-Step-Hormone-Self-injection-Guide.pdf