Questions about injections.

[Ltl89]

Hey all,

Sorry that these questions are going to sound very newbish, but I know very little about injections and am wondering a few things.  I have an endo appointment later this week to discuss switching them and am hoping she will agree to it as I'm not happy with my hormone levels or results so far.  I figure injections have to do much more than than pills. Anyway,  there are a few things that I'm curious about.

1)  Are injections more costly than pills and are they any more difficult to get insurance to cover?  Any direct experience would be great.

2) How many times should one inject?  I keep hearing about them being done biweekly, but I'm not sure if that is the standard or the best. 

3) Does anyone have their injections done by their doctor?  Just curious if there are ways around self injecting as this terrifies me. 

4)  What is the best area of administering?  And do the injection sites ever start to scar?  I don't want to look like a seasoned heroin addict with track marks all over my body.

5)  Did anyone regret going on injections rather than pills?

Thanks for any input.  I realize my doctor is the most important person to discuss this with, and will in 2 days, but I want to hear the direct experience from those that have been using injections.  Thanks a lot!

[Jessica Merriman]

Hey all,

Sorry that these questions are going to sound very newbish, but I know very little about injections and am wondering a few things.  I have an endo appointment later this week to discuss switching them and am hoping she will agree to it as I'm not happy with my hormone levels or results so far.  I figure injections have to do much more than than pills. Anyway,  there are a few things that I'm curious about.

1)  Are injections more costly than pills and are they any more difficult to get insurance to cover? 

I have Medicare and Spiro, injectable "E" and "P", needles and syringes are only $30.00 for a three month supply. Thank you lifting the trans exclusions Medicare!

2) How many times should one inject? 

My Endo has me injecting "E" every week and "P" once a month. It is working a little too well for me! 

3) Does anyone have their injections done by their doctor? 

Being a Paramedic I do my own, but they can do them in the office if you do not want to. It is not that hard or even painful really.

4)  What is the best area of administering?

It depends on how many Mls you inject. Certain muscle groups can only hold so much. I do "P" in the Gluts and "E" in the thighs. Scarring is not a huge issue. Insulin dependent diabetics do have that issue though.

5)  Did anyone regret going on injections rather than pills?

I wish I would have started with injections, They to me are so much better and affective. You don't have to worry about them every 8 hours and if you have patches they can fall off and are not the best administration method.

Thanks for any input.  I realize my doctor is the most important person to discuss this with, and will in 2 days, but I want to hear the direct experience from those that have been using injections.  Thanks a lot!

[antonia]

I'm a Type 1 diabetic, so far I'm on pills but I plan to change to injections as soon as I'm stable and my doctor agrees, I might be able to answer some questions.

3) Most girls I've talked to that do injections do it themselves, you get over the whole needle thing really quick.

4) The HRT injections are designed to be intra muscular since this causes the slowest absorption rate, so large muscles with few nerve cells work best as Jessica said butt or thighs. Since you are not injecting into veins you won't get the bruising and scarring, generally you don't have to worry at all since it it's just a few injections a month.

[Sydney_NYC]

Hey all,

Sorry that these questions are going to sound very newbish, but I know very little about injections and am wondering a few things.  I have an endo appointment later this week to discuss switching them and am hoping she will agree to it as I'm not happy with my hormone levels or results so far.  I figure injections have to do much more than than pills. Anyway,  there are a few things that I'm curious about.

.......

Thanks for any input.  I realize my doctor is the most important person to discuss this with, and will in 2 days, but I want to hear the direct experience from those that have been using injections.  Thanks a lot!

To Answer your questions:

1)  Are injections more costly than pills and are they any more difficult to get insurance to cover?  Any direct experience would be great.

My insurance will not cover anything HRT related. For me injections cost more up front, ( $108 for a 5 month supple ), but cheaper in the long run.

Pills $36/month
Injections $21/month

2) How many times should one inject?  I keep hearing about them being done biweekly, but I'm not sure if that is the standard or the best.

I inject every 2 weeks. The dosage per mL varies per doctors prescription. There are 3 common doses .


3) Does anyone have their injections done by their doctor?  Just curious if there are ways around self injecting as this terrifies me.

I do mine myself now. I've done 2 in front of a nurse and now I've been authorized to self inject. The nurse did tell me there are patients that just come every two weeks for their injections and they are fine with that.


4)  What is the best area of administering?  And do the injection sites ever start to scar?  I don't want to look like a seasoned heroin addict with track marks all over my body.

In the thigh since it's easier to access. Your injecting into a muscle. The fluid you injection is oil based and is meant to slowly distribute in your body through your muscle. The needle is only 21 gauge. You also alternate thighs between each dosage. It doesn't leave a bruise and only leaves a small dot that you could easily mistaken for a hair follicle, so it's not going to look like track marks since it's small, and you injecting  1 1/2 inched into the thigh muscle at a 90 degree angle.


5)  Did anyone regret going on injections rather than pills?

I only regretted not switching to injections earlier!!! Since switching to injections, things seem to be progressing faster.


Edit out injected amounts and dosages available.

[Ltl89]

Thanks everyone.  I'm just nervous about tomorrow I guess.  I'm not the best with change, lol.  Anyway, I hope that she will allow me to switch or at least increase my dose as there is a higher one that some people take.  WE'll see.   Just got to get the ball moving faster than it's been going.

[KayXo]

How many times should one inject?  I keep hearing about them being done biweekly, but I'm not sure if that is the standard or the best.

Weekly to biweekly but some find biweekly is too long and causes too much fluctuation so switch to 7-10 days. Depends on the person although one study showed that levels significantly declined after 7 days in the case of estradiol valerate. I take mine every 5 days.

Does anyone have their injections done by their doctor?  Just curious if there are ways around self injecting as this terrifies me. 

I have them done by nurses. I'm also a little scared, still but slowly, my fear is dissipating.

What is the best area of administering?  And do the injection sites ever start to scar?  I don't want to look like a seasoned heroin addict with track marks all over my body.

In the buttocks area seems to be the best, especially just over the butt crease (upper outer quadrant of the butt cheek) in the gluteus medius because of the lack of nerves and some fat. The muscle there is also quite thick. I find that lower in the area, parallel to or just under the crease but in the outer quadrant hurts a little more. Interestingly, I had some pain the first few times but since then, absolutely nothing. Maybe my muscles got used to it! Who knows?? Best to always loosen up your leg on the side where you having your injection as pain will be less, in the short and long term.

Absolutely no scars to speak of!

Did anyone regret going on injections rather than pills?

Totally the opposite. Best decision EVER! I'm really glad I did. Feel and look way better than before on pills. Night and day! But, to each their own...

[Ltl89]

Thanks everyone for all the input so far.  I'm going to try once a week, if she allows it.  It seems everyone that goes to my practice for transcare (at least mtf) leave with pills from what I heard, so I'm a bit afraid she will be reluctant to switch.  We'll see what tomorrow brings.

One additional question, who does the injections when you go to your doctor?  Is it the Medical Assistants?  If so, are you billed the same as a regular office visit or less?  I doubt my endo would make me see her if she offers that service, so I would imagine it's the MA's rather than not.  I have great insurance at the moment, but once I turn 26 next year I will have to think about copays.  Thinking to much probably, like usual. 

[Sydney_NYC]

When I was being taught and when they did it, it was a nurse that did it. Since I use a LGBT Health clinic (Callen-Lorde), they don't charge anything for those sessions.

[Ltl89]

Turns out my doctor is dead set against injections.  She said that it's much riskier and that she personally had a patient with a stroke as a result of it.  I don't know what to think anymore.  She said she is going to research the issue further, took blood while I was there and said get back to me later after looking at things more deeply.  I know she is doing what she thinks is best and trying to make sure I recieve the best care that is also the safest route.  I respect that as it's what a physcian should be doing and hold no grudge over that as she is the expert.  It just sucks being trans and having no results.  Looking like a giant ugly man and constantly suffering from extreme dysphoria, anxiety and depression because of it.  I don't know what else to do.  Guess I have to accept that I will be unpassable forever and have to deal with it.   I hate being trans, and all the crap that comes with it.   

[alabamagirl]

Turns out my doctor is dead set against injections.  She said that it's much riskier and that she personally had a patient with a stroke as a result of it.  I don't know what to think anymore.  She said she is going to research the issue further, took blood while I was there and said get back to me later after looking at things more deeply.  I know she is doing what she thinks is best and trying to make sure I recieve the best care that is also the safest route.  I respect that as it's what a physcian should be doing and hold no grudge over that as she is the expert.  It just sucks being trans and having no results.  Looking like a giant ugly man and constantly suffering from extreme dysphoria, anxiety and depression because of it.  I don't know what else to do.  Guess I have to accept that I will be unpassable forever and have to deal with it.   I hate being trans, and all the crap that comes with it.

You're being way too hard on yourself, dear. I think you're really pretty, and I'm sure you've feminized even more since the pictures I saw. I don't believe for a second that HRT hasn't produced any results for you. There's just no way. Not unless you started out looking that good. I suppose that's possible. I haven't seen your before pictures. But I want you to know that I'm being 100% honest when I say that I think you're beautiful and that I would absolutely love to look like you do. If I look as feminine as you do now at the very end of my transition, I will consider it a great success.

*hugs*

We're always so critical of ourselves, but I promise you are feminine, sweetie. You don't look like a man, and you are most certainly not ugly.

[Ltl89]

You're being way too hard on yourself, dear. I think you're really pretty, and I'm sure you've feminized even more since the pictures I saw. I don't believe for a second that HRT hasn't produced any results for you. There's just no way. Not unless you started out looking that good. I suppose that's possible. I haven't seen your before pictures. But I want you to know that I'm being 100% honest when I say that I think you're beautiful and that I would absolutely love to look like you do. If I look as feminine as you do now at the very end of my transition, I will consider it a great success.

*hugs*

We're always so critical of ourselves, but I promise you are feminine, sweetie. You don't look like a man, and you are most certainly not ugly.

Thanks pikachu.  I'm just so uncertain of where I am in my transition and where I am going.  I just want things to be easier than they've been.  I'm sure hrt has done a lot.  In fact my endo herself, joked saying that I have b cup breasts and I'm still not happy.  All of this is likely just the result of my poor self esteem, hopeful expecations and fear.  But still, my levels were lower the last two times around.  That's why she took the blood work today to check.  I really hope there has been some improvement, cause I keep hearing the high 100s is where I should be but I haven't come close to that.  Injections vs pills don't matter to me as much as my levels do.  We'll see on what she decides and I'll respect it as she is doing what she feels best as a physician and that's obviously taking my overall health into account which does matter.  It's just such a long wait with hormones and takes so much work for even the smallest changes, at least that's what i feel.   

Sorry for the overly emo posts today.  I'm whining toomuch.  I had to expose parts of my ugly body to two different people at the office, so I'm feeling extra dysphoric today and letting it out.

[Jessica Merriman]

Turns out my doctor is dead set against injections.  She said that it's much riskier and that she personally had a patient with a stroke as a result of it.  I

This is nuts! She needs to subscribe to an Endocrinology scientific periodical. Injections and patches are THE safest ways of administering "E". the only strokes I have personally responded to as a Paramedic were patients on Ethinyl Estradiol. The New England Journal of Medicine also endorses Injections/patches over oral "E". 

[Ltl89]

This is nuts! She needs to subscribe to an Endocrinology scientific periodical. Injections and patches are THE safest ways of administering "E". the only strokes I have personally responded to as a Paramedic were patients on Ethinyl Estradiol. The New England Journal of Medicine also endorses Injections/patches over oral "E". 

Well, it happened to her.  I can't imagine the impact of having a patient taking injections and then suffering from a stroke.  It probably leaves a bad mark in her mind as they became paralyzed. She is very cautious with her approach, which is good, and I'm the only one she has given the current dose that I am on.  My dose is pretty much average from what I see, but she said all the other trans patient's take less than me.  Her method is to be as safe as possible while trying to get the best results under that condition.  I respect that approach, but my levels haven't been the best, so I would like to consider something different.  She did say, however, that levels differ from person to person and my level of 110 Estradiol in January was good even though it may be lower than others (sadly it was 70 in may).  She's the doctor with the education and experience to know more than I do, so I don't doubt her approach.  I'm just hoping she will consider the injections after looking at my latest labs from today and researching/discussing with her collegues about this switch.  I trust her and feel comfortable with her overall, but I do hope my levels will improve and I bet injectinos will do that.  And it's because of her willingness to work with me and help me at this time that I got this far and have been able to do so without any major impact on my health.  Therefore, my complaint isn't with her at all as she is a good doctor and nice person, just really want to try the injections.  Maybe it's because I'm an office assistant/receptionist for a medical group, but I feel like doctors often get unfairly criticized by their patient's at times, and I don't want to sound like I'm doing that in any way.

[Ltl89]

I figured I would update this post.  I went a new endo and discussed injections.  This practice is more open to them, so they gave me a script for them and want me to come in for my first injection.  I'm a little nervous about changing my regimine, but if an estrogen level of 130-140 is the heightest spike I've had on pills, then I got to imagine the injections have more impact on me.

By the way, the script I got was for depo-estrogen.  Anyone have good experiences with that?  I've been reading that more people prefer the valerate, so I'd llike to hear positive stories with  the estradial cypionate.