Susan's Place Transgender Resources

Yay me! :D After a multi-year break I'm starting HRT again and have a few questions. I'm 40 years post op and my estrogen levels have been within normal menopausal range during my break so I haven't worried it too much but I'm feelin' the need.

(Note: dosages are not discussed in this post)

1) What syringes are you using?

The new script I got is for BD precision glide syringes with 27 gauge x 1½" needles #50, qty 10. Are these the right ones? Does the #50 mean they are 5cc? That seems pretty fat? I've also used 3cc syringes with 21 gauge 1½" needles.

I still have a dozen from before that are 23 gauge with 1" needles (3cc) but I think I recall I still have them because they were too short and I got the longer ones?

2) I was prescribed the standard 40mg/ml estradiol valerate...

Any suggestions where to buy it at a good price and how much do you pay? Are the coupons from places like GoodRX legit and do they work? With the coupon at Walgreens, it is supposed to cost $85.60. How does that compare to what you spend?

I've looked a bit online and see as much as $240.00 for a 5ml bottle of this stuff and that's absolutely ridiculous. Would a compounding pharmacy be cheaper? I used to use 100mg/ml that I did have compounded that costs $100 for 5ml but that was 10+ years ago.

3) Thigh or backside?

I've only ever done it in my butt which is hard to do and want to switch to my leg. Which do you use?

Thanks for any info you can share.

27 ga sounds like an insulin syringe and that would be an unusually long needle for one that long. Needle length is related to body fat, as it needs to be long enough to reach the muscle.

Anything smaller than 23 ga is suitable for intramuscular, 27 would more often be used for subcutaneous. I use 25 ga and they work well for me.

Syringe size is related to dosage, if you need to take 1/4 ml or more then a 3 ml syringe is probably accurate enough, my dosage volume is less than that and so I use ml syringes.

My instructions were to use a larger gauge needle, a 19 to extract the oil from the vial and then exchange for a 1" 25 ga because it's hard to extract the viscous oil through the smaller gauge. When I switched to 1ml syringes, however they came with 25ga 1/2" and while I was able to get the drug out, it takes a while and being too short to reach muscle, I still needed to swap for 25gx1" and eject air / correct volume. Now I'm back to extracting with 19ga because I found it less expensive to buy in bulk than to pay 2 copays for 10 @ a time.

I do it in the thigh, easier to reach, but the method is different for there than for the glutes,be sure to learn the right way and to relax your muscles during the process, I find seated easiest but I usually inject during my Sat am dilation since I'm already occupied and the position is amenable.

Phew!

On price, yep that's in the ballpark for me, until my new insurance sends them the pre authorization CVS wants something north of $220 for Perrigo generic 5 ml vials. I've seen prices more like the $85 you mentioned at Walmart -- check goodrx?

As a starting point, look at Good RX (http://www.goodrx.com) for the cheapest place to buy medication. I am on pills and $20 gives me a 6 months supply of medication. The cost is so low that I don't bother with my medicare drug coverage and pay out of pocket.

My injections are subcutaneous. I inject in the fat area about 2 inches from my belly button with a 25ga x 5/8" needle and a 1ml syringe with a 20ga x 1" needle for extraction from the vial.

I was prescribed the 20mg/ml. My insurance covers this with a $10 co-pay. If I remember correctly I was quoted $70 for the 5ml vial of generic Estradiol Valerate with out insurance.

I really like the subcutaneous method. I can see what I'm doing and it's painless!

Quote from: Lisa_K on October 11, 2017, 02:07:34 AM
Yay me! :D After a multi-year break I'm starting HRT again and have a few questions. I'm 40 years post op and my estrogen levels have been within normal menopausal range during my break so I haven't worried it too much but I'm feelin' the need.

(Note: dosages are not discussed in this post)

1) What syringes are you using?

The new script I got is for BD precision glide syringes with 27 gauge x 1½" needles #50, qty 10. Are these the right ones? Does the #50 mean they are 5cc? That seems pretty fat? I've also used 3cc syringes with 21 gauge 1½" needles.

I still have a dozen from before that are 23 gauge with 1" needles (3cc) but I think I recall I still have them because they were too short and I got the longer ones?

2) I was prescribed the standard 40mg/ml estradiol valerate...

Any suggestions where to buy it at a good price and how much do you pay? Are the coupons from places like GoodRX legit and do they work? With the coupon at Walgreens, it is supposed to cost $85.60. How does that compare to what you spend?

I've looked a bit online and see as much as $240.00 for a 5ml bottle of this stuff and that's absolutely ridiculous. Would a compounding pharmacy be cheaper? I used to use 100mg/ml that I did have compounded that costs $100 for 5ml but that was 10+ years ago.

3) Thigh or backside?

I've only ever done it in my butt which is hard to do and want to switch to my leg. Which do you use?

Thanks for any info you can share.

SYringes  I typically use the biggest syringe I can get my hand on, the oil is pretty thick and I don't like working at the syringe to squeeze it into the leg.   

I don't think we're supposed to discuss doses, but I'm a much reduced dosage of depo-estradiol.  Even the minimal amount I have, it still spikes at times.  (post op-ish here too).  I get mine compounded from our local pharmacy, but I'm hoping to get it soon from the VAMC (I have champva via my spouse who is retired military)

I stick my thigh because frankly the backside I tried once, and winded getting it in there at a painful angle...not doing that again.   I switch legs every week too and avoid the same spot.

Thanks for the replies and advice!

Silly me forgot a higher number gauge means smaller diameter needle, just like wire. I'll never get that stuff sucked out of the bottle with a 27ga needle so I'm going to have to hassle calling to get the right ones.

A 1" needle will be too short. My fat redistributed many years ago and I have plenty of it between my knees and belly button! :icon_blink:

I've got GoodRX coupons for Walgreens so it looks like $85.60 for the valerate and $28.65 for the Prometrium which works out to $62.89 a month.

Thanks again. It will be kind of interesting starting HRT again. It's been so long I'll feel like a newbie but you know, when you started taking hormones 45 years ago at 17, it does get a little old and boring and one of the reasons I stopped in the first place.

I only did intramuscular (IM). I found doing SC (subcutaneous), some of the solution would come back out. :(

I injected in my butt, upper outer quadrant, alternating left and right with every injection. Intramuscular, the needle absolutely needs to be at a minimum 1.5 inches so as not to be injected in fat/subcutaneously and even then, studies have shown that it still ends up being injected in fat as many women have a lot of subcutaneous fat. Since the estradiol is in thick oil, a thicker diameter needle is needed, preferably 25 inches or less. I wouldn't draw with less than 21 inch as this will puncture a big hole in the rubber and this can cause leakage over time. So 21 inch to draw is what I did and 22 inch to inject. The thinner needles, it will take more time to inject...if you're patient enough but it's less likely to be painful as well.

BEST of luck. ;)

OH HOLY CRAP!

Got all my scripts filled and gave myself my first injection this evening. Coupons from GoodRX saved me $185.82 for my two prescriptions. It was quick, easy and simple and injecting into the thigh muscle is a lot easier than trying to twist around, look in a mirror and doing it in my gluteal muscle. Definitely got the 1.5" needle all the way in through my fat and all the way into the muscle. I was quite pleased with my aim and placement. It was painless.

I went to pull the needle out and it detached from the syringe! I now have an inch and a half needle lodged in my thigh!! I tried sqeezing around hoping to push it out enough to grab the end of it but was unsuccessful. I can't even feel it. WTF???

I have previously injected myself for at least five years and never had anything like this happen so I'm not at a novice at giving myself shots. I didn't do anything wrong. I'm not a happy camper about this.

I'm half thinking about leaving it there and see if it causes problems but that doesn't seem right. I'm also thinking I should maybe seek medical attention?. They're going to have to dig to find it and probably make me get an X-ray to locate it? Damn.

Not off to the best start.  :( I'm going to sleep on this before deciding what to do. This is the last thing I need right now.

You absolutely need to get it removed. If there is no way to reach it at all,  then you must seek medical help. X

Sent from my MI 5s using Tapatalk

Quote from: meganjames2 on October 14, 2017, 02:54:04 AM
You absolutely need to get it removed. If there is no way to reach it at all,  then you must seek medical help. X

Yeah, I know. >:(

I have an advanced, high dollar metal detector. I threw some batteries in it and scanned my leg. There's definitely a needle in there. Poop!  :icon_blah:

I'd also contact the syringe/needle manufacturer and inform them what happened.

Sent from my MI 5s using Tapatalk

I'm curious about injections and trying to do a cost comparison against oral estradiol. I'm just not familiar with injections at all, other than having some done at the doctor's office. Think antibiotics or flu shot, etc. :)

What is the waste factor for injections? For example, if I get a prescription for injecting 1 mL and get a 5 mL vial from the pharmacy, do I get five injections from that vial? Or one, or 4½? Assuming you can store the estradiol, does it need to be refrigerated?

Maybe they're stupid questions, but I just haven't heard anyone say.

Thanks,
--AshleyP

Ashley, the vials I've seen are [censored]. I have no idea how much more than the nominal 5 ml is in a vial. My pharmacy could only get the relatively high concentration of 40 mg/ml, I've also heard of people using 20mg/ml and 10 exists but I've never heard of anyone using it. Also my dose is much less than 'normal' and I've talked with women who need double 'normal' to get correct levels. This is why you need to be monitored by an MD.

Shelf life is at least a year, if you were to refrigerate the estradiol might crystalize but will go back into solution at room temp.

The main reason to prefer injections is that taken orally, most of what you take is converted to estrone in the liver. You can get similar bypass of liver metabolization by taking sublingual or transdermal patches.

Here's from my last order...

Purchased from https://www.medical-and-lab-supplies.com/ (https://www.medical-and-lab-supplies.com/)


super reasonable pricing, ridiculously expensive shipping...but still equals super good deal!!



Care Touch Luer Lock Syringe & Needle, 3cc x 23g x 1.5", BOX OF 100 (This is what I use to inject the E)
   SYRNCA3231.5-BX    $7.99
   
Care Touch Hypodermic Needle 18g x 1", BOX OF 100                          (This is what I use to draw the E)
   NEEDCA18G1-BX    $3.98
   

Subtotal                    $11.97
Shipping & Handling    $20.90

Grand Total    $32.87   

That's 33 cents per injection....much, much cheaper than you can get at the pharmacy. For me, roughly a third the price.

Using my best Gilda Radner as Emily Litella voice, let me sheepishly  say... NEVERMIND. :icon_redface:

Let me also add that I am an idiot. I DO NOT have a needle floating around in my leg somewhere. I was just deceived by some evil sorcery and was temporarily out of my mind or something like that? Maybe it was the beer?

I withdrew the needle from the injection site expecting to put the cap back on it, unscrew it from the syringe and put it my can of dead sharp things - but it wasn't there! After going through the above documented freak out and even holding the empty syringe up to a bright light to see if maybe the needle ended up inside of it somehow, I was convinced the needle was still in my thigh.

I tried pulling the plunger out of the syringe but the end of it was surrounded by a plastic ring and I couldn't just grab it and pull it out. I had to use a tool to lift it out of this ring enough get a hold of it and take it out of the syringe. It was then that I noticed that the black rubber stopper part had a hole in the center of it rather than being solid.

I still couldn't see anything but I shook the plunger as you would an old mercury thermometer and out popped the needle. What dark magic is this?

Apparently, after puzzling over this and reading the packaging again, it does say BD Integra Syringe with Retracting BD PrecisionGlide Needle. I had read that before but didn't grasp what it meant. Now I do.

In the picture, you can see the top syringe has the plunger all the way down. When you push just a little harder, it goes further down into the protective ring and magically pulls the needle up inside of it somehow? Who woulda thunk? Not me because I'm obviously not that bright.

(https://www.susans.org/proxy.php?request=http%3A%2F%2Fwww.dooberville.com%2FPhotos%2Fplung.png&hash=c3196f34ccaba4c3fdd45eb9ee2f4fcba281b6d1)

I am relieved to know I don't have an inch and half long needle inside my body but I feel pretty stupid. :P

Other observations:

The Perrigo branded estradiol valerate is much less thick than that I used to have compounded. I could probably switch from 21ga needles to 23ga to make less of a hole and get some of the 18ga needles to draw with. Thank you Jessica Lynne for the link. Even with shipping, the unit price is WAY cheaper than the $7.50 I paid for ten from Walgreens.

Thanks everyone for all the concern and advice. All is well now and I'm breathing easy. Whew!

Quote from: AshleyP on October 14, 2017, 01:18:37 PM
I'm curious about injections and trying to do a cost comparison against oral estradiol. I'm just not familiar with injections at all, other than having some done at the doctor's office. Think antibiotics or flu shot, etc. :)

What is the waste factor for injections? For example, if I get a prescription for injecting 1 mL and get a 5 mL vial from the pharmacy, do I get five injections from that vial? Or one, or 4½? Assuming you can store the estradiol, does it need to be refrigerated?

Maybe they're stupid questions, but I just haven't heard anyone say.

Ashley, there really isn't any cost comparison. Using your hypothetical example of a 5 mL vial with 1 mL injections, let's say you inject 1 mL every two weeks or twice a month. I paid $85.60 for 5 mL of 40mg/ml. That works out to $17.12 per injection or $34.24 per month. It would be nice to think one vial would result in 5 injections but I'm anticipating some loss and really am only expecting to get 4½ as you suggested. Estradiol valerate does not need to be refrigerated but it does need to be kept in the dark.

There is also estradiol cypionate for injection but I know nothing about it or how it compares to valerate in terms of potency and costs. My doctor did give me a price list from a compounding pharmacy that has 10 ml of 5mg/ml cypionate for $60.

All I know is this is WAY more expensive than it used to be. I used to pay $100 for 10 ml of 100mg/ml and now it costs $85.60 for half as much that isn't even half as strong.

Certainly cost advantages would be no reason to switch from pills. What might be though is how your body reacts. I started taking pills in 1972 and over time, have taken probably everything ever made. Nothing has ever worked for me as well as injections plus there's the whole first pass through the liver thing with orals. Even if there isn't a lot of evidence to support it, I think it might be safer for us older folks to be on injections or patches.

Just a share for you Lisa that may or may not make your life easier. When I first started I would struggle with extracting the E from the vial. It finally occurred to me it was vapor locking. So now I always inject the exact amount of air into the vial to match the fluid I intend on extracting. Problem solved. When I get to the end of a vial I will inject a couple of ml. of air and the fluid basically flies out. This stuff is pricey so I want all I paid for  ;D  All the best, Jess

I order my supplies from East Coast Medical.  They are reliable and affordable.  I buy in bulk.

I use 1 mL syringes with luer tip (so the needle won't pop off under pressure), 23 gauge 1 inch needles.  The shorter needles make it easier to draw up and inject the estrogen, although it's still syrupy and slow.  The smaller syringe is marked in finer scale for more accurate dosing than on a 3 mL syringe.  If you like, you can order a set of larger needles to draw it up quickly.  I used to draw up through an 18 gauge and inject with the 23, but over time this does a great deal of violence to the stopper on the multi dose vial.  The stopper starts to get pretty gnarly.  When I draw up with the same 23, I have to be a little more patient, but the vial lasts longer.

I agree with those who recommend a narrower needle (higher number) for subcutaneous.  I tried SQ with the 23 and most of the dose leaked out.  SQ works though, if you prefer it and don't mind the slower injection.  I just don't mind the IM that much.  I inject in the thigh because I can see it and I've got two of them, so I can mix it up.

Order some alcohol wipes while you're at it...cheap and makes the process cleaner/faster.  For those who like to geek out on what difference needle sizes make, the relevant physical equation is Poiseuille's law, which states:

Flow = πR4∆P/8µL

In less mathematical terms, the radius of the needle makes a TON of difference (smaller resists more), and the length of it makes some (shorter resists less).