Estradiol valerate IM (intramuscular) injections: site

[KayXo]

So, as I mentioned earlier on another post, I recently switched to Estradiol Valerate IM intramuscular injections. The results have been quite positive, actually surprised me how good I've been doing since BUT I am somewhat concerned about where it's injected. And should I really be if it seems to be working well? In any case, I'd still be interested in getting feedback from others on this.

The area of injection is actually supposed to be the upper outer quadrant of the buttocks, alternating between left and right every week. The reason I prefer this area to others (deltoid muscle, thigh) is because it tends to hurts less there and I concur. Barely any pain both times. Where I am concerned is that the nurses, especially last time, injected outside the area, quite high up, just under the waistline. I questioned the nurse about this but she said she's always done it this way and that really injections are not ever done in the butt area but above it. I didn't insist. What do you think? One transwoman said it was fine, that the muscle there is the gluteus minimum but from my own review of human anatomy, the muscle there seems to be more the gluteus medius. In either case, as long as there is muscle there, I'm fine but I'm still concerned as someone else told me that injecting it so high up could end up being a subcutaneous injection, where hormone would be dissolved much faster and not last as long, giving higher peaks and lower troughs.

This is all new to me so if you do have an opinion on this, please explain it to me in detail so I can understand. This way, I can be at least sure that it is done the proper way.

The other problem is that if nurse is not doing it right, how to bring this up to her in a way that she won't take it bad. That's where it gets tricky cause I wouldn't want to get on her bad side, she is the one with the needle!!! 

Thanks.

[Randi]

Injections into the gluteus maximus should be done about two inches from the top and 2-3 inches toward the outside of the centerline.    It would be good to locate the sciatic nerve and stay way from that for obvious reasons.

If the nurse is using a 1 1/2" needle you don't need to worry about it being Sub-Q.

When you do the injections yourself it's probably easier to use the vastus lateralis.  This is your outer thigh, midway between hip and knee.

Of course it's good practice to alternate left and right sides.

[KayXo]

Thanks Randi. Today, I had my 3rd injection (done by nurse) and I was a little worried when I came back home as I noticed it was injected pretty close to the center line, about an inch away towards the outside but definetly on top like the first 2 times. If it had touched the sciatic nerve, I would have felt it, right? There would be pain and numbness in my leg and foot, right? Since she is a nurse, I want to trust her but i just found it was closer to the center than the first 2 times and was a little worried.

Thanks.

[KayXo]

I took a pic of where she injected. I could show u but I don't know how to attach pics.

[Randi]

If she had disturbed the sciatic nerve you probably wouldn't be able to walk for a while.  The glutes provide a pretty large area that is safe to inject in.   It's pretty random whether you will get any bleeding or not.  It's usual to keep a bandaid and even a paper towel handy.

[Cindy]

I took a pic of where she injected. I could show u but I don't know how to attach pics.

You need to put your pics in an online system such as photobucket, there are several, from there us the first tag above the smileys <insert image> copy your pic and place the source as in [img]source[img]

As Randi said if she had hit the sciatic you would know it pretty straight away. Tends to be temporary but unpleasant.

If you can, and if they are available to you, try to get implants. They are very effective and last about 6 months at a time and maintain a steady state of E in your body. They are great!

[judithlynn]

Hi
When I was transitioning the first time I visited Australia on a business trip. I was then working for a very big IT Company and whilst in Australia for  6 months on secondment working on a project I ran out of my prescription drugs (I was then on Premarin twice a day), anyway I went to see a Doctor in Melbourne and they were quite surprised that  despite being on Oestroigen for over 12 months I had so little feminization.

She then said that I would be far better having weekly injections and immediately put me onto weekly intra muscular injections of Primogyn Depot in the maximus gluteus. Because I was worried about injecting it myself (and she really recommended that I saw her) she suggested coming to the surgery for the injections. She also put me on a dosage of Progestrone, Although I don't quite remember the drug name. Anyway after about 2 months of weekly injections, she reckoned that my body was accepting the injections very well and she moved me to a double dose fortnightly.  I must admit injections then were definitely the way to go because about 9 weeks later, I was trying to catch someone leaving my office in South Melbourne and ended taking the steps a couple of time running down and then all of a sudden realised I had real breasts and they were noticeably moving up and down independently as i ran down stairs - Wow!! Unfortunately by the time I emigrated back to Australia a few years later, Primogyn Depot injections had been removed from the list of supported solutions.

Unfortunately now I would rather have injections or pellet implants, but my GP will not countenance this for me, which is disappointing as I have to consciouly remember to take my "girly pills" when I wake up and when I go to bed even day!

[KayXo]

Thanks girls for your feedback. Much appreciated. I feel so much more reassured now.

As to using pellets, three things. First, I worry that too steady levels might desensitize cells to estrogen over time. Second, I don't heal that well so I am worried that insertion will leave scars. I already have scars, though tiny, on my abdomen from my gallbladder surgery even if it is was laparoscopic.  Thirdly, I have a problem with anything that anaesthetizes me, locally or systemically. I've been through two major surgeries already, have had local anesthesia at the dentist several times, I hate it!!! LOL. I much prefer injections in the butt. The only thing I really like about pellets is that they are inserted once and you don't have to think about it for at least 3 months versus going to the nurse every week for an injection.

So far, anyways, I'm doing quite well on the injections. So much better than on orals, where I think I may have had an allergy to something in the pills. I feel normal again, my mood is so much better, I have more energy, I look better. Truly miraculous!

Re: sciatic nerve, I was just worried that hitting the nerve might paralyze me forever in the leg and foot. I had read something about it on the Net. Thanks again for your reassuring words.

[KayXo]

First injection

"Photo removed" (for confidentiality purposes)

Third injection

"Photo removed" (for confidentiality purposes)

What do you think? Too high up? Could this be problematic?

Thanks.

[Tori]

If it is working, it should be no worries. Not as muscular up there, but it makes sitting easier. I tend to react to my shot for a few days with redness and pain, so that site looks good to me.

Do you notice mood swings before the next shot? About how soon before if you do?

[KayXo]

I've actually not felt as good the last week and I think it's due to the injection being too high.

Today I went for my fourth injection and I'm already starting to feel better, the way I felt after the first injection. The injection was done way lower, as it should be, in the UPPER OUTER QUADRANT of the butt. Not higher than. The nurse told me that it should ALWAYS be done that way and I should (I have the right to) refuse any injection that is not done this way. I showed her the photos of my previous injections and she said, apart from the first injection which was JUST ok, at the limit, the third one (injected at the same height as the second) was much too high. I asked her if it made a difference in terms of absorption and she said she honestly didn't know, just that muscle there would be smaller (?) and someone else told me that possibly, injected that high, it could end be subcutaneous where hormone would be absorbed faster and be exhausted sooner (not good!).

In any case, I'm happy where it was done this time, exactly as I had learned where it should be injected when injected intramuscularly in the butt. I will keep a picture of it on my phone and ask nurses to always inject me this way in the future or if they refuse, to ask for another nurse. Simple as that! My hormones are important to me, to my well-being especially. Not something to play around with and I'd rather it be done exactly the same way every week to keep things constant.

Here is a picture of the 4th injection today

"Photo removed" (for confidentiality purposes)

[ath]

Injections into the gluteus maximus should be done about two inches from the top and 2-3 inches toward the outside of the centerline.    It would be good to locate the sciatic nerve and stay way from that for obvious reasons.

If the nurse is using a 1 1/2" needle you don't need to worry about it being Sub-Q.

When you do the injections yourself it's probably easier to use the vastus lateralis.  This is your outer thigh, midway between hip and knee.

Of course it's good practice to alternate left and right sides.

I inject myself in the vastus lateralis - mainly because I want to definitely easily see if I draw any blood into the syringe when I pull the plunger up. Plus it's just easier for me and I can do it sitting down so I don't keel over from nervousness lol.

It's not very painful - I use 1 1/2" 23g needles, not sure if it's actually too long or not but I have pretty thick thigh muscles, with some fat on top. I just get a little pinch feeling when the needle is almost all the way in. It's way more disturbing to me how it feels for the hand driving the needle in, as it sort of pops through my flesh and also the texture I feel as it slides all the way in.

[KayXo]

About the needle length, nurse uses the same for me, 22 gauge and 1.5 inches. It needs to be at least 1.25 inches long to go into muscle, preferably 1.5 inches.

I prefer butt to thigh because there tends to be less pain there and less of a chance of hitting a vein. It can be done on your own, many do it. But to each their own. If it works for you, then great.

[KayXo]

Just a quick update to say that things are slowly getting better, nurses were gathered all together in one room to see how to do it properly. Since then, there have no problems.

Blood tests were taken. Estradiol levels are still on the rise but given accumulation over time, recent increased frequency of injections (5 days versus 7 days) and last blood test taken 3 days (versus 4 days) after injection, this was to be expected.

First blood test: 1,920 pg/ml (7,049 pmol/L)
Second blood test: 2,212 pg/ml (8,120 pmol/L)
Latest blood test: 3,844 pg/ml (14,111 pmol/L)

Just like a pregnant woman LOL....levels slowly rising and typical of first trimester levels.

Other health functions were tested about a month ago and everything came back normal (liver, thyroid, blood cells, electrolytes, etc.). Except Vitamin D levels which should not be that surprising given I live in a cold country like Canada and there is not much sun exposure, especially in winter. I take supplements now, 1,000 IU daily. I've also been spending more time in the sun now that it's warm. I'm somewhat tanned and I love it! 

I feel good, better than on oral. Have also seen some improvements physically, most notably, softer skin and hair. Body seems more curvaceous, more feminine as does face.

[Sarah S]

I use a 1 1/2 inch 22 gauge needle and never had a problem with a injection every 2 weeks now for a year  I inject in my hip , The results are fantastic.

[KayXo]

In your hip? It's supposed to be in the upper outer quadrant of the buttocks or the thighs cause the muscles there are dense and very much infused with blood circulation. Weird!...but if it's working and you are observing good results, good absorption, then be it!

I had a guy do it today! omg...first time, it's usually a girl. It went very well, he seemed much more proficient at it than any of the other girls before him. He definitely knew what he was doing.

[princessKisses]

You got a pretty high estradiol levels kayxo. Can you pm me what are the dose your taking every 5 days. I will ask my doctor if i can safely achieve that level too so i could feel much better on myself.