Injection Guide

When it comes to hormone therapy, you have a few options for the type of medication you take. One of these options is injectable medication, which is available for both testosterone and estrogen. For each of these, there are two injection types: intramuscular (which goes directly into your muscle) or subcutaneous (which goes into the tissue just under your skin). 

This guide will explain how to perform both kinds of injections yourself. If you’d prefer, you can also ask someone you trust or a healthcare professional to do the injections for you.

Injections: A step-by-step guide

1. Get ready. Gather all your supplies – medication, needles, syringes, alcohol wipes, bandages, clean tissue or gauze, a sharps container – in a clean area and wash your hands. You can get sharps containers from your local pharmacy or harm reduction centre. If you don’t have a sharps container you can use a hard laundry detergent bottle with a screw cap.

2. Clean the top of your vial with an alcohol wipe and allow it to air dry. 

3. Math time! Calculate your dose volume. For example, testosterone cypionate in Canada has a concentration of 100 mg/ml. To draw up 50 mg, you’ll need 0.5 ml. Another example is estradiol valerate, which is usually 10 mg/ml. To draw up 5mg, you’ll need 0.5 ml. Your clinician or pharmacist can help you figure this out – once you’ve reached your target dose, it’ll be the same each time. If there are supply issues in your area you may have to temporarily switch to a different type or strength of medication, but your pharmacist can advise on how to maintain your dose amount.

4. Attach an 18 gauge needle to your syringe and remove the safety cap.

5. Draw air up into the syringe to the level needed for your injection. 

6. Pierce the rubber cap of the vial with your needle and push it straight into the vial. Turn the vial upside down with the needle still attached. 

7. Inject the air into the vial. Ensure the tip of the needle is below the top of the liquid (i.e. not in contact with any air) and then pull back slowly to bring the medication into the syringe to the correct line. 

8. Check for bubbles. You can do this by letting them rise to the top of the syringe (gently tapping the syringe can help). If there are bubbles in the syringe, inject this air back into the upside down vial and then redraw your medication until it fills the syringe to the right level. 

9. Remove the needle from the vial. Carefully twist the 18 gauge needle off your syringe and dispose of it in your sharps container. 

10. Place a 22 or 23 gauge needle on the syringe for intramuscular injection. This is a longer needle (about 1-1.5 inches). Use a 25 or 26 gauge needle for subcutaneous injection. This is a shorter needle (about 5/8 of an inch). Keep the safety cap on for now!

11. Choose your injection site. For intramuscular injections, go for the outer thigh or your upper outer buttock. For subcutaneous injections, go for your belly or thigh.

12. If you are injecting into your thigh, you should aim for the outer side of your thigh about halfway between your hip and knee. If you are injecting into your buttock, imagine dividing your buttock cheek into quarters (you can also draw this on if it helps). You should inject into the upper and outer quarter of the buttock, if someone was looking at this from behind you.

13. Prep your injection site. Clean it with a fresh alcohol wipe and let it dry. 

14. Remove the safety cap from your needle. 

15. Injection (intramuscular). Moving at a 90 degree angle into the skin, enter the needle into your muscle (most of the needle will be under the skin, in the muscle). Push slowly on the plunger of the syringe to inject.

16. Injection (subcutaneous). Moving at a 45 or 90 degree angle into the skin, enter the needle into the tissue under the skin (most of the needle will be under the skin, in the tissue). Push slowly on the plunger of the syringe to inject.

17. When you’ve injected all the medication, slowly remove the needle from your injection site. Put your syringe and needle into the sharps container (you don’t need to take them apart). Never re-use or share a needle.

18. Place a clean tissue or gauze onto the injection site and apply light pressure to stop any bleeding. After a minute or two, you can apply a small bandage to your injection site if you’d like.

This content has been reviewed by Foria’s Medical Director, Dr. Kate Greenaway and our community advisory team. Medical sources include Fenway Health.

by Foria Clinical Team

Jul 24, 2023・ minute read

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