TRANSGENDER HEALTH

Injection Guide
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,

in other words, the needle is going straight
through the skin into the muscle.

Needles for IM injections can be 22-23 Gauge, 1-1.5

inches in length, adjusted for thickness of site.
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
 1
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:

➝ Medication in a vial
➝ Disposable syringe and two
needles—one 18 G needle
(to draw up medication)
and one injection needle
(22 -23 G; 1-1.5 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 is expired.

• W
 ash your hands. Hand washing is one of
the most important things you can do
to prevent infection.
 2
STEP
Preparing the Injection Dose

• T
 ake the cap off the vial. Clean the rubber
stopper with one alcohol swab, and then
allow it to air dry.

• C
 heck the package containing the syringe. If the
package has been opened or damaged, do not
use the syringe.

• P
 ull the 18 G needle cover straight off the
syringe. 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.
• K
 eep the vial on your flat working surface and
insert the needle straight down through the
center of the rubber stopper into the bottle.
(figure 1)

(figure 1)

• P
 ush the plunger of the syringe down and push
the air from the syringe into the vial.

• K
 eeping the needle in the vial, turn the vial
upside down.

• P
 osition the needle so the liquid is covering
the tip of the needle.
• K
 eeping the vial upside down, slowly pull back
on the plunger to fill the syringe with the med-
ication to the number (mL or cc) that matches
the dose your doctor ordered. (figure 2)

(figure 2) (figure 3)

• K
 eeping 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. (figure 3)

• A
 fter air bubbles are gone, pull the plunger
back to the number (mL or cc) marking on
the syringe that matches your dose.
 (figure 4)

• P
 ull the syringe with needle out of the bottle,
remove the 18 G needle (discarding it into the
sharps container, without recapping it), and
place a new IM injection needle securely on
the syringe. Remove the protective cap from
the injecting needle.

• C
 heck to make sure that you have the correct
dose in the syringe. It is VERY important that
you use the exact dose prescribed by your
doctor. (figure 4)
 3
STEP
Selecting and Preparing
the Injection Site

Vastus lateralis muscle in the thigh

The upper thigh is a good site if you
are injecting yourself.

To find the appropriate location:

• L
 ook 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
To find the correct location for injecting
into the Gluteus maximus muscle:

To find the appropriate location:

• E
 xpose the buttocks and imagine dividing
each buttock into four parts.

• A
 im 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.)
 4
STEP
Give the Injection

• C
 lean the injection site skin with a new alcohol
swab; let the skin air dry.

• H
 old the skin around the injection site by pinch-
ing up a section of tissue about an inch wide.
(The portion of skin between your fingers will
be the injection site.)

• Insert the IM needle into the muscle at a 90

degree angle with one quick and firm motion.

• A
 fter inserting the needle into the muscle, lift
your hand away from where it is holding the skin.
• G
 ently pull back on the plunger of the
syringe to check for blood.
➝ If you see blood in the syringe, do not
inject the medicine, and remove the
needle immediately. Replace the IM
needle and try again at a different site.
➝ If you do not see any blood in the
syringe, you can complete the injection
by pushing the medicine slowly into the
muscle.

• Y
 ou may feel some burning or pressure as
the medication enters the muscle.

• A
 fter the medication has been injected, pull
back on the syringe to remove the needle
from your skin. Dispose of the syringe and
needle properly, using a sharps container.

• G
 ently press an alcohol swab on the injection
site. Hold pressure on the site until there is no
bleeding. You can use a band aid if needed.
T 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 Massa-
chusetts, it is illegal to dispose of sharps in
standard household waste.

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.

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:

http://www.mass.gov/eohhs/docs/dph/aids/needles-syringes-disposal.pdf

These instructions were adapted from the University of Michigan

Guidelines available here: http://www.med.umich.edu/1libr/spinal-
CordInjuryProgram/IMselfInjectionTesto.pdf
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 25-26

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
 1
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:

➝ Medication in a vial
➝ Disposable syringe and two
needles—one 18 G needle
(to draw up medication)
and one subcutaneous injection needle
(25 -26 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 is expired.

• W
 ash your hands. Hand washing is one of
the most important things you can do
to prevent infection.
 2
STEP
Preparing the Injection Dose

• T
 ake the cap off the vial. Clean the rubber
stopper with one alcohol swab, and then
allow it to air dry.

• C
 heck the package containing the syringe. If the
package has been opened or damaged, do not
use the syringe.

• P
 ull the 18 G needle cover straight off the
syringe. 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.
• K
 eep the vial on your flat working surface and
insert the needle straight down through the
center of the rubber stopper into the bottle.
(figure 1)

(figure 1)

• P
 ush the plunger of the syringe down and push
the air from the syringe into the vial.

• K
 eeping the needle in the vial, turn the vial
upside down.

• P
 osition the needle so the liquid is covering
the tip of the needle.
• K
 eeping the vial upside down, slowly pull back
on the plunger to fill the syringe with the med-
ication to the number (mL or cc) that matches
the dose your doctor ordered. (figure 2)

(figure 2) (figure 3)

• K
 eeping 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. (figure 3)

• A
 fter air bubbles are gone, pull the plunger
back to the number (mL or cc) marking on
the syringe that matches your dose.
 (figure 4)

• P
 ull the syringe with needle out of the bottle,
remove the 18 G needle (discarding it into
the sharps container, without recapping it),
and place the smaller subcutaneous injection
needle securely on the syringe. Remove the
protective cap from the injecting needle.

• C
 heck to make sure that you have the correct
dose in the syringe. It is VERY important that
you use the exact dose prescribed by your
doctor. (figure 4)
 3
STEP
Selecting and Preparing
the Injection Site

There are several places you can give

yourself a subcutaneous injection,
including the sides or backs of your
arms, the fronts of your thighs, or your
abdomen. You may also use the but-
tocks as described above.
If you choose to inject yourself in the
abdomen, avoid the belly button or
any bony areas.

Wherever you choose to inject, you

should be able to firmly grasp the skin
and pinch it up into approximately a
1-inch fold.
 4
STEP
Give the Injection

• Make certain your hands are clean.

• C
 lean the injection site skin with an alcohol
swab; let the skin air dry.

• H
 old the prepared syringe with the hand you
will use to give the injection

• W
 ith the other hand, pinch a fold of skin. (You
will inject into the skin between your fingers).

• W
 ith 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.
• A
 fter inserting the needle under the skin, lift
your hand away that is holding the skin.

• G
 ently pull back on the plunger of the
syringe to check for blood.
➝ If you see blood in the syringe, do not
inject the medicine, and remove the
needle immediately. Replace the SubQ
needle and try again at a different site.
➝ If you do not see any blood in the
syringe, you can complete the injection
by pushing the medicine slowly under
your skin.

• W
 ait 5 seconds, and then pull back on the
syringe to remove the needle from your skin.
Dispose of the syringe and needle properly,
using a sharps container.

• G
 ently press an alcohol swab on the injection
site. Hold pressure on the site until there is no
bleeding. You can use a band aid if needed.
T 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 Massa-
chusetts, it is illegal to dispose of sharps in
standard household waste.

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.

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:

http://www.mass.gov/eohhs/docs/dph/aids/needles-syringes-disposal.pdf

These instructions were adapted from the University of Michigan

Guidelines available here: http://www.med.umich.edu/1libr/spinal-
CordInjuryProgram/IMselfInjectionTesto.pdf