TRANSGENDER HEALTH
Injection Guide
MG-6
How to Give Yourself
a Hormone Injection
Intramuscular (IM)
What is an Intramuscular Injection?
An intramuscular injection, delivers
medication deep into the muscle tissue.
This allows the medication to be quickly
absorbed into the bloodstream.
90
skin
subcutaneous tissue
muscle
Intramuscular shots are given at a 90
angle. The needle enters the skin vertically
and directly down in a quick, dart-like
movement.
Needles for IM injections can be 21-23
Gauge, 1-1.5 inches in length.
NEVER REUSE OR SHARE
SYRINGES OR NEEDLES.
If you need needles or syringes and
cannot afford to get them from your
doctor or pharmacy, please visit a
local needle exchange.
Massachusetts Needle Exchange Programs:
Boston: 800.383.2437 or 617.534.3967
Cambridge: 617.661.3040 or 617.680.1063
Holyoke: 413.315.3732
Northampton: 413.586.0310 or 800.696.7752
Provincetown: 508.487.8311
Springfield: 413.733.6639
STEP
Setting Up for the Injection
Find a comfortable, well lit working place
and inject at the same time of day each time
you do your injection.
Clean your work area and assemble supplies. (figure 1)
(figure 1)
Medication in a vial
Disposable syringe and two
needlestwo 21-23 G; 1-1.5 inch
needles (one to draw up medication
and one injection needle)
Alcohol swabs, two (one for vial,
one for skin)
Puncture proof needle/sharps
disposal container
Check the expiration date on the medication vial.
Do not use a medication with visible particles,
medication that is discolored, or that is past the
expiration date. (Medication is generally clear
or light yellow when fresh and safe to use.)
Wash your hands. Hand washing is the most
important thing you can do to prevent infection.
STEP
Preparing the Injection Dose
* If you are unsure what your dose is,
STOP and call your doctor's office for help.
Take the cap off the vial. Clean the
rubber stopper with one alcohol
swab. (figure 2)
Check the package containing the
syringe. If the package has been
opened or damaged, do not use the
syringe. Connect a sterile needle to
the syringe.
(figure 2)
Pull the 21-23 G needle cover straight
off the needle. Then, pull back the
plunger and draw air into the syringe.
The amount of air drawn into the
syringe should be the same amount
(mL or cc) as the dose of medication
that your doctor prescribed.
Do not let the needle touch any
surfaces.
Hold the vial on your flat working surface and
insert the needle straight down through the
center of the rubber stopper into the bottle.
(figure 3)
Push the plunger of the syringe down and
push the air from the syringe into the vial.
(figure 4)
(figure 3)
(figure 4)
Keeping the needle in the vial, turn the vial
upside down.
Position the needle so the liquid is covering
the tip of the needle. You may need to pull
the needle out slightly to make sure the tip is
completely covered by the liquid.
Keeping the vial upside down, slowly pull
back on the plunger to fill the syringe with
the medication to the number (mL or cc)
that matches the dose your doctor ordered.
(figure 5)
(figure 5)
Keeping the needle in the vial, check for air
bubbles in the syringe. If there are air bubbles,
gently tap the syringe with your fingers until
the air bubbles rise to the top of the syringe.
Then slowly push the plunger up to force the
air bubbles out of the syringe without removing
the needle from the bottle.
After air bubbles are gone, pull the plunger back
to the number (mL or cc) marking on the syringe
that matches your dose.
(figure 6)
Pull the syringe with needle out of the bottle,
remove the needle (discarding it into the sharps
container), and place a new IM injection needle
securely on the syringe. Remove the protective
cap from the injecting needle. Do not press on
the plunger while you change needles.
C
heck to make sure that you still have the correct
dose in the syringe. It is VERY important that you
use the exact dose prescribed by your doctor.
(figure 6)
STEP
Selecting and Preparing
the Injection Site
Vastus lateralis muscle in the thigh
The upper thigh is a good site if you are
doing self-injection of your medication.
To find the appropriate location: Look at the
top of your thigh, and imagine dividing it into
a three by three grid.
The injection will go into the outer middle third.
Gluteus Maximus muscle in the buttocks*
* This site is used if you have someone
else doing your injection. Do not self-inject at this site.
To find the correct location for injecting
into the Gluteus maximus muscle:
To find the appropriate location:
Expose the buttocks and imagine
dividing each buttock into four parts.
Aim the injection into the upper, outer
quarter of the buttock towards the
hip bone (Approximately at the top
of where a pants pocket would be.)
STEP
Give the Injection
Clean the injection site skin with a new alcohol
swab; let the skin air dry. (Do not pat or blow
on skin to dry it.) (figure 7)
Pull the skin tight around the injection site.
(figure 8)
(figure 7)
(figure 8)
Insert the IM needle into the muscle at a 90
degree angle with one quick and firm motion.
After inserting the needle into the muscle,
keep the skin pulled tight and firmly push the
plunger down slowly and completely to finish
the injection.
You may feel some burning or pressure as
the medication enters the muscle.
After the medication has been injected, pull
the syringe and needle out of your skin at
the exact same angle as you injected. Let go
of your skin once the needle is out. Dispose
of the syringe and needle properly, using a
sharps container.
Gently press with sterile gauze on the
injection site. Hold pressure on the site until
there is no bleeding. You can use a band aid
if needed.
Tips for Reducing
Injection Pain
Never reuse needles
Use separate drawing up and injecting needles
Let the skin dry fully from the alcohol wipe
before beginning the injection
K
eep the muscles in the injection area warm
and relaxed
Inject medicine that is at room temperature
Break through the skin quickly with the needle
Insert the needle straight into the skin, and pull
it straight out again without changing direction
or wiggling the syringe.
Instructions for Disposing of Sharps:
Improper disposal of syringes, needles, and other sharp
objects can pose a health risk and damage the environment.
In Massachusetts, it is illegal to dispose of sharps in standard
household waste.
(figure 9)
To dispose of medical sharps,
first place them in a sealable,
puncture-resistant container.
You can purchase a home sharps
container from most pharmacies.
Alternatively, you can use a
plastic container, such as a
liquid-detergent bottle or milk
jug, sealed with tape, to
transport used sharps. Disposal
sites will not accept loose
needles or sharps in bags or
glass containers. (figure 9)
The Massachusetts Department of Public Health and local
public health departments have established a network of
community drop-off collection stations for used sharps.
To learn more, or find the disposal location nearest you, visit:
[Link]
These instructions were adapted from the University of Michigan Guidelines available here: [Link]
How to Give Yourself
a Hormone Injection
Subcutaneous (SubQ)
What is a Subcutaneous Injection?
A subcutaneous injection, delivers
medication into the subcutaneous layer
of tissue that is directly under the skin.
Medication delivered this way is more
slowly absorbed into the bloodstream
than medication that is directly injected
into the muscle.
45
skin
subcutaneous tissue
muscle
Needle for SubQ injections are usually 23-25
Gauge and 5/8 (inch) in length. Medication
should never be drawn up through these
needles. Use a separate drawing up needle.
NEVER REUSE OR SHARE
SYRINGES OR NEEDLES.
If you need needles or syringes and
cannot afford to get them from your
doctor or pharmacy, please visit a
local needle exchange.
Massachusetts Needle Exchange Programs:
Boston: 800.383.2437 or 617.534.3967
Cambridge: 617.661.3040 or 617.680.1063
Holyoke: 413.315.3732
Northampton: 413.586.0310 or 800.696.7752
Provincetown: 508.487.8311
Springfield: 413.733.6639
STEP
Setting Up for the Injection
Find a comfortable, well lit working place
and inject at the same time of day each time.
Clean your work area and assemble supplies. (figure 1)
(figure 1)
Medication in a vial
Disposable syringe and two
needlesone 21-23 G; 1-1.5 inch
needle (to draw up medication)
and one subcutaneous injection
needle (23-25 G; 5/8 inch)
Alcohol swabs, two (one for vial,
one for skin)
Puncture proof needle/sharps
disposal container
C
heck the expiration date on the medication
vial. Do not use a medication with visible
particles, medication that is discolored, or
medication that is expired.
Wash your hands. Hand washing is the most
important things you can do to prevent infection.
STEP
Preparing the Injection Dose
* If you are unsure what your dose is,
STOP and call your doctor's office for help.
Take the cap off the vial. Clean the
rubber stopper with one alcohol swab,
and then allow it to air dry. (figure 2)
Check the package containing the syringe.
If the package has been opened or
damaged, do not use the syringe. Place
a sterile 21-23 G, 1-1.5 inch needle on
the syringe to draw up with.
(figure 2)
Pull the cover straight off the needle.
Then, pull back the plunger and draw
air into the syringe. The amount of air
drawn into the syringe should be the
same amount (mL or cc) as the dose
of medication that your doctor prescribed.
Do not let the needle touch any
surfaces.
Hold the vial on your flat working surface and
insert the needle straight down through the
center of the rubber stopper into the bottle.
(figure 3)
Push the plunger of the syringe down and
push the air from the syringe into the vial.
(figure 4)
(figure 3)
(figure 4)
Keeping the needle in the vial, turn the vial
upside down.
Position the needle so the liquid is covering
the tip of the needle. You may need to pull
the needle out slightly to make sure the tip is
completely covered by the liquid.
Keeping the vial upside down, slowly pull
back on the plunger to fill the syringe with
the medication to the number (mL or cc)
that matches the dose your doctor ordered.
(figure 5)
(figure 5)
Keeping the needle in the vial, check for air
bubbles in the syringe. If there are air bubbles,
gently tap the syringe with your fingers until
the air bubbles rise to the top of the syringe.
Then slowly push the plunger up to force the
air bubbles out of the syringe without removing
the needle from the bottle.
After air bubbles are gone, pull the plunger back
to the number (mL or cc) marking on the syringe
that matches your dose.
(figure 6)
Pull the syringe with needle out of the bottle,
remove the needle (discarding it into the
sharps container), and place the smaller
subcutaneous injection needle securely on the
syringe. Remove the protective cap from the
injecting needle. Do not press on the plunger
while you change needles.
Check to make sure that you still have the
correct dose in the syringe. It is VERY
important that you use the exact dose
prescribed by your doctor. (figure 6)
STEP
Selecting and Preparing
the Injection Site
There are several places you can give
yourself a subcutaneous injection,
including the fronts of your thighs,
or your abdomen. You may also use
the buttocks as described above, or the
backs of your arms if you have someone
else doing the injection for you.
Injection Site on the abdomen
If you choose to inject yourself in the
abdomen, avoid the belly button or
any bony areas.
Injection Site on the back
of the arms if someone
else is injecting you
Injection Site on the
thighs
Wherever you choose to inject, you
should be able to firmly grasp and pinch
up approximately a 1-inch fold of skin.
STEP
Give the Injection
Thoroughly wash your hands with soap and water
and dry them.
Clean the injection site skin with an alcohol swab;
let the skin air dry. Do not pat or rub the skin to
dry it.
Hold the prepared syringe with the hand you
will use to give the injection.
With the other hand, pinch a fold of skin. (You will
inject into the skin between your fingers).
With one quick and firm motion, insert the needle
either directly into the skin fold at a 90 degree
angle, or angle it slightly (45 degrees), if that is
easier.
After inserting the needle under the skin,
keep the skin pinched up as you complete
the injection by pushing firmly and slowly
down completely on the plunger. (figure 7)
Wait 5 seconds, and then pull back on the
syringe to remove the needle from your
skin. Pull the syringe and needle out at the
exact same angle you used to enter the skin.
Dispose of the syringe and needle properly,
using a sharps container.
Gently press a sterile piece of gauze on the
injection site. Hold pressure on the site until
there is no bleeding. You can use a band aid
if needed. (figure 8)
(figure 7)
(figure 8)
Tips for Reducing
Injection Pain
Never reuse needles
Use separate drawing up and injecting needles
Let the skin dry fully from the alcohol wipe
before beginning the injection
K
eep the muscles in the injection area warm
and relaxed
Inject medicine that is at room temperature
Break through the skin quickly with the needle
Insert the needle straight into the skin, and pull
it straight out again without changing direction.
Instructions for Disposing of Sharps:
Improper disposal of syringes, needles, and other sharp
objects can pose a health risk and damage the environment.
In Massachusetts, it is illegal to dispose of sharps in standard
household waste.
(figure 9)
To dispose of medical sharps,
first place them in a sealable,
puncture-resistant container.
You can purchase a home sharps
container from most pharmacies.
Alternatively, you can use a
plastic container, such as a
liquid-detergent bottle or milk
jug, sealed with tape, to
transport used sharps. Disposal
sites will not accept loose
needles or sharps in bags or
glass containers. (figure 9)
The Massachusetts Department of Public Health and local
public health departments have established a network of
community drop-off collection stations for used sharps.
To learn more, or find the disposal location nearest you, visit:
[Link]
These instructions were adapted from the University of Michigan Guidelines available here: [Link]
