E Injections: Crash and Crave

[Shadowsister]

Hello there everyone, I have been ordered by my doctor to take estrogen injections once per week which I inject every Friday. Although I have been on HRT for a year, I am new to injections and have been doing them for less than a month. A problem I am having is toward the end of that week I begin craving my injection really bad and I start feeling a bit more depressed and pessimistic as well. I crave my injection day and as soon as I get the injection in me I start feeling better and looking forward to the next one. This is weird for me. I have never been addicted to any drugs and estrogen is my first experience with injecting myself with anything. Should I be worried? Has anyone ever dealt with these injection cravings and mood crashes? If so, how did you deal with it?

[kelly_aus]

This is something you'd be best to talk to your prescribing doctor about, as what you describe suggests that your weekly dose is possibly a little low. They will have some suggestions on how to alleviate the issue.

[Shadowsister]

This is something you'd be best to talk to your prescribing doctor about, as what you describe suggests that your weekly dose is possibly a little low. They will have some suggestions on how to alleviate the issue.

Alright, I'll talk to her and see what she says. Thank You.

[SadieBlake]

I'll suggest it's probably in your head, most women on im injected estrogen are on either a weekly or every 2 weeks schedule and on weekly, based on my measurements you ought not to be so low as to cause any physical symptoms.

That said, everyone is different, it's certainly possible your body processes estrogen faster than most people do so you could talk to your doc now or you could wait for your next blood work to be scheduled and address it then.

Sorry your experiencing anxiety, I can also relate to that in a less strong way -- I saw results so soon after starting in E that my anxiety was short lived but it was certainly there

[Shadowsister]

I'll suggest it's probably in your head, most women on im injected estrogen are on either a weekly or every 2 weeks schedule and on weekly, based on my measurements you ought not to be so low as to cause any physical symptoms.

That said, everyone is different, it's certainly possible your body processes estrogen faster than most people do so you could talk to your doc now or you could wait for your next blood work to be scheduled and address it then.

Sorry your experiencing anxiety, I can also relate to that in a less strong way -- I saw results so soon after starting in E that my anxiety was short lived but it was certainly there

My doc has me on subcu. Google searching, I found out that was not typical and most women are on IM, asked Doctor about it and she said subcu was fine.

I am somewhat worried because the reason I am on injections is because after a year of estrogen pills and spiro my testosterone was not dropping to the proper levels, so after some research I was taken off estrogen pills and put on subcu injections and finasteride along with the spiro I was already taking.

Thus far, about 13.5 mos total on HRT my transition feels like such a failure on the inside and out. I woulda thought that at a year in I would have been settled at cruising altitude, but guess not So frustrating! I cannot wait to get GCS, girl, I swear. Hopefully that destroys testosterone once and for all. So much to go through with insurance company gatekeepers though.

I asked about my issues here because I was wondering if it was typical before I went ahead and contacted my doctor.

[SadieBlake]

Oh that's good to clarify, subcutaneous is actually slower to get into the body, however it's becoming the preferred way to administer injected estradiol.

That also makes me think your anxiety isn't in physical causes ... well the whole mind body thing is intertwined ... anyway because the subcutaneous route is slower, you may not yet be up to target levels but when you are, your systemic levels should be more even than with injected, which are in turn more even than orally administered.

However here's the good news, injected by whatever route toes a better job of suppressing T (for me that alone sufficed, I never needed spiro). And yes this stuff takes a long time, trust me there is no failure possible here, your body is going to do what it does and your doc will help find the right way for you.

Also you're definitely not alone in having really persistent T. I look forward to hearing your levels whenever you know them, hopefully as you say, injected will help eliminate the T.

[Shadowsister]

Awesome Sadie, that's good news. Most of what I read about IM being better must have been older news or internet folklore. Not that I at all doubt what you said about subcu being slower uptake, but do you have some science stuff I can read about it? If not it's absolutely a-okay. It feels good knowing that subcu may actually be better. Sometimes I feel like I am rushed because a year in I still don't "pass" and I am in my 30s which feels like so much lost time. The sad part about passing is I do not look all ultra masculine, but my height 6' gets me, so does my nose lol. I am taller than most everyone, male or female. Thanks for helping me out with your posts.

Oh, here are my most recent T numbers from late November of 2017. I copied them from my record for you.


TESTOSTERONE, TOTAL   3.24 ng/mL   ng/mL

Weird because 2 months earlier it was 2.19. I never missed a single dose or modified my doses without doctor's instructions. I really want the T down. I have never been tested since starting injections. My first was Mid December.

[kelly_aus]

TESTOSTERONE, TOTAL   3.24 ng/mL   ng/mL

Weird because 2 months earlier it was 2.19. I never missed a single dose or modified my doses without doctor's instructions. I really want the T down. I have never been tested since starting injections. My first was Mid December.

Levels will fluctuate, regardless of meds taken or not. And it will take some time to balance out the levels, especially after a change in meds.

[Shadowsister]

Levels will fluctuate, regardless of meds taken or not. And it will take some time to balance out the levels, especially after a change in meds.

This thread helped me to feel a little better. My next appt is all the way in March, but what I am going to do is see if my body adjusts to this new HRT regimen, if for a week or two I still get the lulls in my mood I'll send my doc an e-mail and see if adjustments are in order. I really appreciate your help. 

[jill610]

Your T level is within female range. My spiro was reduced because I was "<2.00", so I wouldn't worry too much about a reading that low.

[Mariah]

Exactly this

This is something you'd be best to talk to your prescribing doctor about, as what you describe suggests that your weekly dose is possibly a little low. They will have some suggestions on how to alleviate the issue.

[Dena]

Your T level is within female range. My spiro was reduced because I was "<2.00", so I wouldn't worry too much about a reading that low.

The units are ng/ml which means the levels are in the lower male range. The female range would be .1 to 1.2 ng/ml and male 2.4 to 12 ng/ml.

[KayXo]

On Spironolactone, T levels may not be sufficiently suppressed BUT what is often overlooked is that spironolactone also BLOCKS T so that part of that reading is actually blocked...and free or bio-available T is more accurate and could actually end up being within female range due to higher levels of SHBG.

Subcutaneous or intramuscular E would suppress T more strongly due to higher, sustained E levels. This was shown in men with advanced prostate cancer where T levels in the castrate range were achieved on only injected E.

[Shadowsister]

Thanks a lot everyone. I will be talking to my doc about this. One thing I like doing though is having more knowledge on things before I go ahead and talk to my docs. I trust her, but I still like to know as much as possible about what's going on. It's like if I needed to go to a mechanic, even if I trusted them I'd still ask folks about stuff so I can go into the shop with a better working knowledge so that I can ask better questions.

Just wondering is anyone else out there on subcu estrogen injections? Does anyone know of science literature that talks about it being better than IM? If anyone out there has tried both IM and subcu have you noticed any differences between the two?

My doc works with more trans men than she does women and as far as I know many transmen who use injections do so subcu, it's supposedly better for the guys, but a lot of stuff I see for women prefer IM. I expressed this to my doc and she told me she understood what I was asking and still prefers subcu for women, but if possible I'd just like to know more. 

[KayXo]

Contraception. 2011 Dec;84(6):565-70.

"The results presented herein demonstrate that the injection (...) of MPA plus (...) E(2)-Cyp has similar efficacy and safety with either the SC or IM route of administration."

J Clin Endocrinol Metab. 2017 Jul 1;102(7):2349-2355.

"Our observations indicate that SC T injections are an effective, safe, and well-accepted alternative to IM T injections."

The Endocrine Society's 95th Annual Meeting and Expo, June 15–18, 2013 - San Francisco

"SC T was well tolerated and produced therapeutic serum concentrations at doses generally lower than required for IM injections."

http://centennial.rucares.org/index.php?page=Intramuscular_Injection

"They carefully followed up on this chance event, and in 1905 they published the first experiments comparing the rates of absorption of substances injected subcutaneously and intramuscularly, concluding that "absorption from intramuscular tissue is incomparably faster than from subcutaneous tissue."

Subcutaneous is said to result in slower absorption because injected in fatty (subcutaneous) tissue where blood flow is slower.

Fertility and Sterility [01 Aug 1991, 56(2):225-229]

"Compared with IM administration of hCG, peak serum drug concentration was significantly delayed (P = 0.01) and serum half-life was prolonged (P = 0.01) after SC injection; however, T, LH, and FSH responses were identical.Subcutaneous application of (...) IU hCG is as effective as IM administration in terms of steroidogenesis."

My conclusion...SC seems slower acting and should give steadier levels vs IM which tends to result in faster, greater absorption but also perhaps quicker peaks and valleys. I'm not a doctor though, this is just my limited understanding of it all.

[Shadowsister]

Kay that is really awesome and I thank you bunches for taking the time to give that info to help me better understand the more intricate details of what's going on. Glad to find out subcu is just as good or even better which is a lucky break because I am no a fan of having to push a needled even deeper into my flesh rofl.

A problem that I often have some trouble dealing with is not finding information because there is tons at my fingertips, but the problem is sifting through that mountain of info to find out what is correct. It's like info overload, much of it almost like folklore, and I want to find out what is right. I really thank all of you here addressing my concerns. I don't have many friends in my corner to help me deal with, understand, and process the many things that are on my mind about transgender issues and I'm happy to get that here. Transition stuff is really tough, something most of you all can appreciate I am sure. Thanks.

[SadieBlake]

I'll just devil's advocate here.

The first few times you do an im injection there will probably be significant muscle soreness in the couple days following. Once I started I found this was lessened if I always went to the same area. You're definitely not supposed to do that with subcutaneous, and should inject in a different place each time.

It's been difficult to find needle / syringe combinations that work, im is best done with a small needle, 23-25 gauge but it also has to be at least an inch long for me, longer if you're heavier to get to the muscle. It's hard to find 3cc syringes with 25ga, equally difficult to find long enough 25ga with 1cc syringes etc. Subcutaneous may be even more difficult, the oil the estradiol is carried in (castor oil) is quite viscous and doesn't easily draw into the syringe with a 25 ga (I have been able to but its slow) so they want you to pull it out if the vial with about 21 ga, change needles, expell the air and then inject.

You'll have to do all that with subcutaneous, the needles are even smaller so you absolutely have to do the needle size swap.

My endo did suggest changing to subcutaneous, having become familiar with im, I'm passing so far mostly because the delay from when the faster im wears out until the slower subcutaneous takes effect seemed like it would be a week or more and I really hate any disruption to my levels. Also, I have about 2 years worth of needles that I bought in bulk that I don't want to waste.

Don't hesitate to go with subcutaneous, it's probably better in the long run, I'll probably switch to it myself when I run out of the im needles and also when I am far enough past GCS that I feel fully settled into my body :-)

[Shadowsister]

Heya Sadie

I hope talking about needles does not get me in trouble for violating the rule against talking about dosages, but I suppose since needles are not dosages I should be fine. Sorry to the moderators if I violate anything here.

The needles the pharmacy gave me are 25g x 5/8, and drawing up the estradiol can be a challenge. I have only been on injections since the 15th of December of 2017 and injecting weekly I have only injected a total of four times, so my experience is limited. However, on my last injection this past Friday I learned something about drawing the medicine into the syringe and I'll share that with you and the forums.

When I went in for lessons on how to inject, the nurse showed me how to get the medicine into the syringe and after going through all the motions to the point where she actually began drawing it she did so by delicately pumping  the syringe's plunger to deal with the viscous nature of the medicine. I did it that way for the first few times, but on my last injection I learned if I just draw the plunger back as far as I can get it without actually pulling it out of the barrel (be careful not to pull it out and waste your meds!) and hold it there, the estrogen flows into the barrel slow, yes still, still but seemingly a bit faster then when I pumped it AND with the awesome added benefit of less air bubbles in the medicine. You know plucking those little bubbles out are a pain because it is indeed so viscous.

Even injecting subcu, (my injection sites are alternating upper thighs each week) I found that for two or three days after injection I was a bit sore in the area surrounding the point where I injected, but with the method of drawing the medicine by just pulling that plunger back as far as possible and holding it there resulted in absolutely no post injection pain and I am not sure why, but guessing it may be because there were less, none in fact, air bubbles using my latest method. Just to note, I never injected myself with a bunch of bubbles lol but there would be just a few.

I thought about getting a larger gauge needle to draw it up, but going forward at this point I am going to pass on it, firstly because the way I just explained how I draw the medicine is easy enough, I can just hold that plunger back while I watch TV or something, and secondly because I've been told that larger gauge needles will chew up the little rubber stopper on your vial faster.

[Gail20]

I guess I'm a bit dense.  Is the difference between IM and Subcutaneous injections really just the depth?  One goes deeper intro the muscle and the other is just below the surface in fat?

[Shadowsister]

I guess I'm a bit dense.  Is the difference between IM and Subcutaneous injections really just the depth?  One goes deeper intro the muscle and the other is just below the surface in fat?

Yup that is pretty much the basics of it.