HRT Injections
Wiki Index
I've summarized some information here, but make sure you research properly elsewhere as I don't know much about this and have no practical experience. Writing this is my way of learning, and I may as well share.
This is mainly related to injecting HRT, although injecting lidocaine is kind of interesting due to its use in electrolysis and implants/pellets.
Summmary Resources
Injection Techniques
There are two injection techniques for HRT and there appears to be no difference in how effective they are for HRT.
- Subcutaneous uses very fine relatively short needles and is apparently painless, or nearly so. It is more prone to allergic reactions at the injection side than intramuscular.
- Intramuscular uses a much longer and larger needle to inject deep into the muscle. I've not looked into it too much as I don't think I could do this.
YouTube
Subcutaneous Injections
Beverly Cosgrove (admin of a major trans HRT group on Facebook) has some very good information on how to do subcutaneous injections, including YouTube videos.
reddit
Using the wrong length needles
YouTube
Fenway Health
SubQ for Testosterone
Other
Papers
Intramuscular Injections
I've seen Nipro 27g 1.25" needles recommended as very sharp and low pain. The length of the needle may vary a bit depending on how much fat you have as you need to go through the fat and into the muscle below.
reddit
YouTube
Fenway Health
Brighton Health and Wellbeing Centre
Z-track method
Other
Injecting Nebido/Reandron
Used by FTM's, it appears that this is typically injected by a nurse/doctor, but some do it themselves.
YouTube
Papers
Other
Sterile Procedures
After wiping the area to be injected with a alcohol swab let it dry before injecting. Alcohol can sting.
There's reccomendations that wiping the skin with a swab is not necessary
The empty syring package is sterile and can be used to temporarily store the prepared syring before use rather than placing it on a potentially non-sterile surface.
Injecting cold liquid may be more painful than room temperature. However oils are also more viscous at cold temperatures, so you might want to warm it up anway. There's also a risk of estradiol crystalising out of solution in the cold (crashing).
- 2021 - Multidose Vial Technique by aphapharmacists - shows sterile procedures for Covid multidose vaccine vials where its especially important as they do not have preservatives, including swabbing vial top (10:27) and coring (17:10)
- 2019 - Swabbing Vial Tops by Jaymin Patel, Clark Smith
Complications
reddit
YouTube
Fainting
https://en.wikipedia.org/wiki/Syncope_(medicine) - "Syncope, commonly known as fainting, is a loss of consciousness and muscle strength characterized by a fast onset, short duration, and spontaneous recovery. It is caused by a decrease in blood flow to the brain, typically from low blood pressure. There are sometimes symptoms before the loss of consciousness such as lightheadedness, sweating, pale skin, blurred vision, nausea, vomiting, or feeling warm. Syncope may also be associated with a short episode of muscle twitching. Psychiatric causes can also be determined when a patient experiences fear, anxiety, or panic; particularly before a stressful event usually medical in nature. When consciousness and muscle strength are not completely lost, it is called presyncope. It is recommended that presyncope be treated the same as syncope."
reddit
Other
Syringes and Needles
Ideally you want to draw and inject quickly, accuratly, and with minimal pain. The choice of syringe and needle depends on a number of trade-offs.
- It's slower/not possible to inject a thick oil though a very fine needle.
- You can inject anything through a large enough needle, but they hurt more.
- Injectable estrogen is available in various viscosity (thickness) oils, although it may be difficult to choose what you get
- Injectable lidocaine for local anaesthetic is mostly water and cab be injected though very fine needles.
- Subcutaneous injections require short needles; intramuscular injections require long needles.
- Using a needle to draw the liquid from a vial blunts it, increasing pain. Changing to a new needle for the injection reduces pain.
- The volume of liquid (hence dose) cannot be measured accurately when only a small proportion of the syringe is filled.
- Some syringes & needles have reduced dead space, which is the amount of wastage for each injection.
- Syring and needle costs vary greatly. Needles cost around AUD $5 per box of 100 in Australia; syringes cost more.
- There's only two types of syringes in common use
- Insulin syringes are available from 0.3ml to 1.0ml, are low dead space, and have very fine and short fixed needles.
- Luer-Lok syringes are cheap, available in sizes 1ml and up, have a wide range of needles, allow the needle to be changed after drawing, and can be used with a wide range of needle sizes. There appear to be only one 0.5ml Luer-Lok syringe, the low dead space MinimLL; its expensive and not available everywhere.
In practice this means that if you want to inject 0.1ml you'll need to use an insulin syringe. As these have short needles you'll need to perform a subcutaneous injection, and the oil must be thin enough to draw through the fine gauge needle. Conversely, if you want to an intramuscular injection you can't use the short needle on an insulin syringe, so you must use at least a 1ml+ Luer-Lok (or Slip) syringe and can't accurately inject a very small amount. If you want to inject a very thick oil you'll need to use a larger gauge needle, again the 1ml+ Luer-Lok syringe. Given these constraints there are some types of injections that are not practical.
Don't use too large a drawing needle as it can damage the cap of the estrogen vial (if you're using one rather than a glass ampule), leading to rubber fragments in the vial and/or leakage. This is referred to as coring, see below.
Wipe the septum (stopper) of a vial clean with a 70% alcohol pad to stealize it before use, both on the first and subsequent uses (or not as there's reccomendations that its not neccessary).
Luer-Lok syringes have a locking twist mechanism that prevents the needle popping off the syringe under pressure (ie when injecting a thick oil through a fine needle). Luer-Slip syringes use friction fitting to hold the needle on the syringe. The needle used for these types of syringes fits both Luer-Lok and Luer-Slip syringes. For thick oil based injections (ie estradiol) use Luer-Lok as self-injecting is bad enough without the syringe falling apart, and worse, not knowing how much you've already injected.
Finer, smaller diameter needles cause less pain.
Needle diameters are specified using the Birmingham gauge. A smaller number indicates a larger diameter needle, so a 23G (gauge) needle that might be used for drawing (from the vial) is larger than a 30G used to inject. The needles are color coded, and I've noticed the few times I've asked a doctor what gauge they are using they didn't know (and don't seem to care all that much). They go by color.
The maximum length of needles tends to reduce as the diameter of the needle decreases. The maximum length of a 30G needle is around 0.5", while 22G needles are easily available up to 1.5". Longer 1" 30G needles do exist (BD 305128, Terumo NN-3025R), but are difficult to find, expensive, and are not available in Australia at all. However, it seems unlikely these would be useful for injecting estrogen as they are too long for subcutaneous and probably too short for intramuscular injections (and assuming you can push the oil through them). 30G 1" needles are also available on Aliexpress, however buying medical supplies from these kinds of sites seems rather risky.
Its difficult to find needles smaller than 30G, although they are available up to around 33G, where the cost starts increasing rapidly. The smallest one's I've found are the low dead space TSK Invisible Needle which they say are 14% thinner than their 33G needles. I don't think it would be possible to uses these to inject estrogen as the oils are too thick to push through such a fine needle. Due to the varying viscosity of oils you may need to experiment with the minimum size of the needle and time taken to do the injection - or just use a large diameter needle and not worry about it. I would guess these fine needles are usable for injecting local anaesthetics for electrolysis, but doctors probably won't have them as they are very expensive, harder to source, and as the needle is short it would require more injections and time. The TSK needle Invisible Needle is only 9mm, and the slightly larger TSK 33G needle is half the price (around US$50 vs US$100 per box of 100) and a slightly better 13mm (I believe doctors use much larger diameter and longer needles for local anaesthetics - best not think about it).
Some doctors suggest/prescibe 18G needles. Try to avoid them, they are very large diameter, tend to hurt, core vial stoppers, and are unnecessary for HRT. Larger than 18G, eg 16G start to go up in price and no one uses them for HRT, I hope.
Ideally the smallest (volume) syringe possible should be used. Smaller syringes are more accurate and generate higher injection pressure, making it easier to perform the injection (drawing pressure is about the same). Luer slip/lok syringes range from 1ml upwards, while insulin syringes are from 0.3ml to 1.0ml. See Dose Accuracy and Syringe Pressure below.
Do you blood tests immediately before your next injection
For injections in Australia, see wiki page Estrogen Injections.
reddit
Papers
Other
Coring
Don't use too large a drawing needle as it can damage the cap of the estrogen vial (if you're using one rather than a glass ampule), leading to rubber fragments in the vial and/or leakage. This is referred to as coring. There are many reports in trans forums of 18G needles damaging the septum (stopper) of the vial and 23G (or 25G) is normally recommended for the draw needle and it appears to completely stop coring. Medical references suggesting angling the needle as its inserted, but its rare to hear anyone in trans spaces suggest this. The difference may be in the way its used - doctors are busy, but we don't mind taking longer to draw from the vial with a finer needle, and we also do it multiple times with the same vial. Don't insert the needle though the same place in the stopper each time.
reddit
Other
YouTube
Other
Papers
- 2022 - The impact of needle size and angle on rubber coring after multiple puncturing of multi-dose propofol vial rubber stoppers by Thanyarat Chotikawanich, Thipaporn Kammee, and Sirikarn Khanteea - "Large-bore needle was the factor that impacted rubber coring after puncturing through the rubber stopper of the multi-dose vial, regardless of the angle of puncture."
- 2022 - Coring Revisited: A Case Report and Literature Review by Justin L Hruska, Wael Saasouh, Muhammad S Alhamda1 - "Coring is a potential cause of morbidity and mortality, especially in emergent situations, and is likely underreported. The currently proposed techniques to avoid coring include modifying the angle of injection, changing to small gauge needles, and anecdotally visualizing the syringe... To better assist in this process, more research is needed to document the true incidence of coring among the traditional medication drawing practices and test which strategies of medication aspiration or infusion are most effective at decreasing coring rates."
- 2021 - Avoiding unconscious injection of vial-derived rubber particles during intra-articular drug administration by Andreas Hecker, Agostino Di Maro, Emanuel F.Liechti, Frank M.Klenke -
- 2019 - PDF Vial Coring by the Spine Intervention Society - "The prior puncture site should be avoided if a rubber stopper is penetrated more than once in the case of a multi-dose vial."
- 2016 - Rubber Coring of Injectable Medication Vial Stoppers: An Evaluation of Causal Factors by Philip Chennell , Daniel Bourdeaux , Quentin Citerne , Catherine Arnaud , Sylvie Cosserant , Véra Boiko-Alaux and Valerie Sautou
- 2015 - The Incidence of Propofol Vial Coring with Blunt Needle Use Is Reduced with Angled Puncture Compared with Perpendicular Puncture by Gragasin, Ferrante S., van den Heever, Z. A. Neethling MB
- 2014 - The incidence of coring with blunt versus sharp needles by Tariq Wani, Anupama Wadhwa, Joseph D Tobias - "The rubber caps were then pierced with either an 18-gauge sharp hypodermic needle or a blunt plastic (safety) needle. Coring occurred in 102 of 250 (40.8%) vials when a blunt needle was used versus 9 of 215 (4.2%) vials with a sharp needle (P < 0.0001)."
- 2013 - Self-sealing capacity of vial stoppers after multiple needle punctures by James A Ponto - "Vial stoppers in two radiopharmaceutical products demonstrated robust self-sealing capacity, substantially exceeding the USP standard of 10 punctures with a 21-gauge needle. Coring particles were frequently observed after many punctures when using larger-bore needles but rarely when using smaller-bore needles. Under conditions commonly used, failure of self-sealing capacity and generation of coring particles are not anticipated to be problems encountered when puncturing vial stoppers of these two products substantially more than 10 times."
- 2013 - Coring and Fragmentation May Occur With Rubber Cap and Blunt Needles - "Exposure to the macro and microscopic rubber fragments has been linked to latex allergy as well as embolization into small vessels causing ischemia."
- 2008 - Near-Embolization of a Rubber Core from a Propofol Vial by Riess, Matthias L.; Strong, Tatyana MD
- 2008 - A Recommended Solution for Avoiding Coring of a Rubber Stopper by Adachi, Yushi U.; Suzuki, Katsumi; Itagaki, Taiga; Obata, Yukako; Doi, Matsuyuki; Sato, Shigehito - "Recently, we began using the InterLink™ Vial Access Cannula ... for withdrawing liquid materials through a rubber cap. This device integrates a thin solid needle through a blunt plastic cannula. "
- 2007 - How to Enter a Medication Vial Without Coring by Jonathan V Roth and Lawrence Saidman in Letters to the Editor, Anesthesia & Analgesia - "There is a longstanding recommended technique of needle insertion into a medication vial that reduces the risk of coring. The needle should be inserted at a 45–60° angle with the opening of the needle tip facing up (i.e., away from the stopper). A small amount of pressure is applied and the angle is gradually increased as the needle enters the vial. The needle should be at a 90° angle just as the needle bevel passes through the stopper."
- 2001 - Occurrence of Coring in Insulin Vials and Possibility of Rubber Piece Contamination by Self-Injection by Toshinari Asakura, Hiroaki Seino, Seishiro Nozaki, Ryuzo Abe - "The coring is considered to occur because needles are repeatedly inserted and rotated at the same spot."
Dead Space
Low dead space syringes and needles are designed to minimize the amount of drug remaining in the syringe and needle after injecting. These are useful when the drugs used are expensive.
The paper 2018 Options for reducing HIV transmission related to the dead space in needles and syringes has an image with 4 syringes and their average deadspace. The low deadspace syringe with attached needle should be an insulin syringe. Note that 0.1ml corresponds to 100 µL, so if you were injecting that anmount you'd be wasting the same amount (99 µL) in the deadspace and your vial would last half as long.
| Syringe |
Deadspace |
| Standard syringe with standard needle |
99 µL |
| Low deadspace syringe with attached needle |
3 µL |
| Standard syringe with low deadspace needle |
12 µL |
| Low deadspace syringe with standard needle |
45 µL |
reddit
YouTube
Papers
2022 - The Effectiveness of Low Dead Space Syringes for Reducing the Risk of Hepatitis C Virus Acquisition Among People Who Inject Drugs: Findings From a National Survey in England, Wales, and Northern Ireland by Adam Trickey, Sara Croxford, Eva Emanuel, Samreen Ijaz, Matthew Hickman, Joanna Kesten, Clare Thomas, Claire Edmundson, Monica Desai, Peter Vickerman - related to recreational drug use
- 2021 - To Analyze the dead space syringe for intra-vitreous injections by Anderson Teixeira; Isadora Silva; Amelia Pereira; Camila Salaroli - " We described a novel method to quantify the waste volume left into the plastic syringe after anti-VEGF injection and elected the best plastic syringe to use during intra-vitreous injections."
- 2021 - Variation in syringes and needles dead space compared to the International Organization for Standardization standard 7886-1:2018 by Martina Cambruzzi, Paul Macfarlane
- 2021 - Dead volume air flush: How to save 1.3 million vaccine doses in Canada by Murray Allen in 2021 - describes how to avoid wastage due to dead space
2018 - Options for reducing HIV transmission related to the dead space in needles and syringes by William A. Zule, Poonam G. Pande, David Otiashvili, Georgiy V. Bobashev, Samuel R. Friedman, V. Anna Gyarmathy & Don C. Des Jarlais
- Vial usage, device dead space, vaccine wastage, and dose accuracy of intradermal delivery devices for inactivated poliovirus vaccine (IPV) by Courtney Jarrahian, Annie Rein-Weston, Gene Saxon, Ben Creelman, Greg Kachmarik, Abhijeet Anand, Darin Zehrunga
Other
Reading a Syringe
https://www.registerednursern.com/how-to-read-a-syringe
YouTube
Dose Accuracy
Smaller syringes allow more accurate dosing (assuming its not too small).
The specification for a 1ml BD Luer-Lok syringe gives an accuracy of ±5%, but below 0.2ml its 0.07ml. Hence below 0.2ml the accuracy is ±35% at best.
Papers
- 2021 - Development of Guidelines for Accurate Measurement of Small Volume Parenteral Products Using Syringes by Melanie A. Jordan, Dimpa Choksi, Kelsey Lombard, and Lynn R. Patton - "... we recommend that users measure no less than 20% of the indicated volume of the syringe while choosing syringes as close as possible to the desired measurement"
- 2019 - the illusion of accuracy by Dennis Tribble - "The most accurate syringe in common use has an accuracy of ±4% when its nominal volume is 5 mL or greater when delivering at 50% or more of its nominal volume. ... Syringes below 5 mL are accurate if they can deliver within ±5% when measuring 50% or more of their nominal volume. ... Below 50% of its nominal volume, the accuracy of the syringe declines with the volume measured until, at 10% of its nominal volume, it delivers ±16% accuracy."
Syringe Pressure
Smaller syringes generate more pressure when injecting. eg 361 psi for 1ml vs. 177 psi for 3ml, see Hayward 2011. The syringe size and needle diameter makes little difference to maximum vacumn, measured around 10 psi by Haseler 2010 (10 psi is the 517 Torr of the paper). The maxiumum pressure generated by a vacumn is the atmospheric pressure, around 14.696 psi at sea level (on Earth).
We can see then that the injection pressure is far greater than the draw pressure, and we can therefore inject far thicker liquids than we can draw. Hence we use larger needles to draw than to inject.
In principle we could inject/draw thick liquids through fine needles, but at some point the time taken to do so makes it impractical.
In practice the needle size for thick oils may need to be determined experimentally. ie try it and see how it goes.
reddit
Papers
- 2011 - Pressure Generated by Syringes; implications for hydrodissection and injection of dense connective tissue lesions by W A P Hayward, L J Haseler, L G Kettwich, A A Michael, W l Sibbitt Jr, A D Bankhurst - "Smaller syringes generated significantly more injection pressure than did larger syringes: 1 mL (363 ± 197 psi), 3 mL (177 ± 96 psi), 5 mL (73 ± 40 psi), 10 mL (53 ± 29 psi), 20 mL (32 ± 18 psi), and 60 mL (19 ± 12 psi)."
- 2010 - Syringe and Needle Size, Syringe Type, Vacuum Generation, and Needle Control in Aspiration Procedures by
Luke J Haseler, Randy R Sibbitt, Wilmer L Sibbitt Jr, Adrian A Michael, Charles M Gasparovic, Arthur D Bankhurst - "The maximum vacuum possible with each the syringe and RPD was dependent on syringe size: the 20 ml syringe and RPD (−517±12 Torr maximum vacuum), the 10 ml (− 441±11 Torr maximum vacuum), the 5 ml (−334±8 Torr maximum vacuum), the 3 ml (−250±7 Torr maximum vacuum), and the 1 ml (−120±6 Torr maximum vacuum). Thus, syringe and RPD size had a significant effect on the strength of vacuum generated, with the 20 ml syringe and RPD each generating a maximum vacuum of approximately −517 Torr."
Backfilling Syringes
Backfilling refers to filling a syringe from the back instead of the usual way though the needle.
The syringe plunger is removed and another syringe is used to fill it. When the needle is fixed and cannot be replaced (e insulin syringes) this avoids blunting it, reducing pain. Where the injected liquid is very thick it may also be faster. However, the cost is higher as a second syringe is used and its more difficult to maintain sterility.
YouTube
The 2019 FACES video says that backfilling is not safe, against WHO rules, and should be done using a luer lok syringe adaptor instead. The Baxter H93813901 shown costs around US$140 for 50 (in 2021). This method would not work with syringes that have fixed needles (eg insulin syringes).
Papers
Insulin Syringe
Insulin syringes have integrated 29-31g needles, are low dead space, and range from 0.3ml, 0.5ml and 1.0m. As a separate draw needle cannot be used the needle will be slightly blunted when piercing the septum (stopper) of a vial. To avoid this problem some people backfill the syringe by removing the plunger from the syringe and filling it from another syringe. Care must be taken to keep everything sterile.
Tuberculin Syringe
I'm not too sure about this type of syringe, but they appear to be special syringes intended for tuberculosis testing. They are low dead space, usually 1ml with a built-in 27 gauge 13mm needle. They are of interest primarily because they are cheaper than insulin syringes, and far cheaper than 1ml Luer-Lok syringes.
Dental Syringes
Dental syringes and needles are not compatible with the normal Luer slip/lok syringes we would use. They are designed to take premade drug carpules (cartridges) of local anaesthetics (eg Septodont Lignospan), in several sizes around 2ml.
I've never heard of anyone making their own carpules, although it appears you can buy the necessary materials on Alibaba or at bottlecn.com (these are 1.5ml and 3ml, which doesn't appear to be a standard size for dental injections). It seems like a waste of time even trying.
Autoinjectors
https://en.wikipedia.org/wiki/Autoinjector - "An autoinjector (or auto-injector) is a medical device designed to deliver a dose of a particular drug. The injectors were initially designed to overcome the hesitation associated with self-administration of the needle-based drug delivery device."
Suppliers
reddit
YouTube
Air Bubbles
reddit
YouTube
Papers
- 2022 - Venous Gas Embolism by Matthew J. Kerrigan; Jeffrey S. Cooper - "In most cases, small amounts of air are broken down in the capillary bed and absorbed into the systemic circulation without any sequelae. To produce symptoms, it is estimated that more than 5 ml/kg of air has to be introduced into the venous system. However, complications can occur with even 20 ml of air. Sometimes even injection of 1 to 2 ml of air into the CNS can be fatal. Further, as little as 0.5 ml of air introduced into the coronary arteries can initiate ventricular fibrillation. The closer the air is injected to the right heart, the higher the risk of complications."
- 2019 - Air embolism following peripheral intravenous access by Myrian Noella Vinan-Vega, M. Rubayat Rahman, Jeremy Thompson,Misty D. Ruppert, Raj J. Patel, Amr Ismail, Sara Mousa, and J. Drew Payne
- 2016 - Air Embolism: Practical Tips for Prevention and Treatment by Colin J. McCarthy, Sasan Behravesh, Sailendra G. Naidu, and Rahmi Oklu2
- 2016 - The effect of air-lock technique on pain at the site of intramuscular injection by Dilek K. Yilmaz, Yurdanur Dikmen,Furuzan Kokturk, and Yasemin Dedeoglu
- 2010 - Significant air embolism: A possibility even with collapsible intravenous fluid containers when used with rapid infuser system by Deepanjali Pant, Krishan Kumar Narani, and Jayashree Sood
- 1897 - IS THE INJECTION OF AIR IN HYPODERMIC MEDICATION A SOURCE OF DANGER? by Chas. T. McClintock, doi:10.1001/jama.1897.02440090002002
Smaller Volume Syringes
TSK
TSK make a 0.7ml low dead space luer lock syringe, product code TSY-0071P. Its expensive.
SJJ Solutions
Microliter Syringes
The smallest medical syringes available appear to be 0.3ml insulin syringes with fixed needles, or 1ml Luer slip/lok syringes. These are not ideal if you're using high concentration low volume estradiol injections.
There are smaller syringes available, but they appear to be intended for very specialised and are very expensive.
Hamilton
For example, the Hamilton 100 µL Gastight Syringe Model 1710 TLL, PTFE Luer Lock is a 0.1ml syringe for "Precision Measurement" and costs around US$100 each. Its part of a range of syringes measuring from 0.5 µL upwards. Since its made of glass and PTFE it can presumably be sterilised and reused, and given that its Luer Lok it should be able to take normal needles.
NanoFil
Used in animal research.
These are no Luer-Lok.
YouTube
Needle Depth Stop
Like a drill stop, this device can control the depth to which a syringe needle penetrates. It seems like it could be useful if you're doing Kenalog injections into scar tissue (which need to go into the scar, not anywhere else).
YouTube
It might be feasible (cheap) to make a home made version just by cutting the end off a needle cap.
3ml Insulin Pen
DIY supplier oelabs sell an insulin injector and 3ml estradiol Enanthate multidose 'vials', described as "Cartridge of estradiol Enanthate 3 mL. Suitable with insulin (compatible ref. Humapen Savvio Lilly)." I've not seen these 3ml vials for estradiol anywhere else.
The HumaPen Savvio is manufactured by Lilly, a subsidiary of Eli Lilly, as an insulin injection device. The photos of this device look different to the one on eolabs site.
reddit
YouTube
FUDiabetes
Other
Aliexpress
QCVIALZ
Made-in-China
Needle Free Injections
I don't know if any of these are suited to injecting viscous oil based liquids (ie hormones), but anaesthetics are more like water so would presumably work.
For anesthetic use it might be best to use these to get the first location numb, then use a normal needle to work out from that area (which should be painless if done properly).
They tend to be very expensive, have consumables, and more suited to professional use.
Review site
FDA
- 8 October 2021 - Do Not Use Needle-Free Devices for Injection of Dermal Fillers – FDA Safety Communication - "The FDA has not evaluated the safety and effectiveness of needle-free devices for injection of any dermal filler. The FDA also has not approved the marketing of needle-free devices for injection of these products." - note, this only applies to dermal fillers, they do not say anything about using needle-free devices for injecting other materials
Papers
Other
Comfort-in
Sites
Competitor comparison
Other
Dermojet
These are over €500.
https://dermojet.com - "The DERMOJET works without a cartridge, bottle or carpule and therefore does not use any single-use plastic. It is not delivered with medicinal substances; it is the practitioner who chooses the solution to be injected during the filling of the reservoir."
Hyaluron Pens
These devices don't appear to be medically regulated, hence there is no assurance that the device or consumables are safe (and in particular sterile).
Lots of these from online suppliers like e-bay, Aliexpress, etc. Cheap.
reddit
YouTube
Vice
Other
Inojex
Other
Insujet
This device looks like it might require special cartridges prefilled with drugs.
Sites
https://www.needlefreereviews.com/insujet-needle-free-injector/ in 2018, costs $190.
J-Tip
YouTube
PharmaJet
Sites
This competitors page states "However, all their needle-free devices are currently only available in limited forms by prescriptions for vaccinations or other pre-loaded medicines... Pharmajet used to sell a needleless injection device that was available to the general public, however, that was discontinued, and no further news regarding whether or not they will bring it back to the market has been available."
Other
- CNN - Get your shots without any needles in 2010 - "Currently, PharmaJet injectors -- which can be reused thousands of times -- cost about $100 a pop. The single-use, needle-free syringes that feed into the injector cost from 30 cents to $1. (PharmaJet won't specific the exact cost.)"
Expiry Date
Needles have a 5 year shelf-life, and it's not clear if anyone knows how long they actually last. See Healthline, Ask D'Mine: Do Needles Expire?
Anyway, there you have it. Straight from the source of the Nile. The Needle Makers have chosen a date—perhaps by doing research, perhaps by letting the marketing department pick a date, or perhaps by putting it to the lawyers—and then have proved to themselves that their products will last that long.
Filter Needles
Some drugs are stored in glass ampules rather than vials, and opening them introduces glass particles into the drug. Apparently there's no evidence of harm so the medical profession has decided its not worth the cost of using filter needles. Personally, I'd rather use a filter needle.
Filter needles are quite large so probably should not be used with reusable vials as they could cause coring.
A filter needle has the filter built into the needle and looks much like a normal needle. There's another type of syringe filter, the wheel filter. I'm not sure which is most appropriate, but I found many references to wheel filters among recreational drug users (I think they crush non-injectable drugs, dissolve the drug part, and filter out all the non-dissolvable part, or something like that). Filters might be used when compounding injectable estradiol.
Filter needles are more expensive than normal needles. An example is US$10 for ten 5 μm (micron) filters at Westend Medical Supplies. Wheel filters should also be suitable. Filters must be sterile.
reddit
- Glass Found in Syringe and Symptoms of PE APPEARS by Chay___ in 2024 - "I had injected my weekly dose of Estrogen as part of my HRT regime as a trans girl. To be honest, I wasn't really aware about the use of filter needle not until I saw glass shards inside the syringe I've used, like 2 or 3 particles? ... from an ampoule"
YouTube
Other
Research
- 2021 - Safety concerns with glass particle contamination: improving the standard guidelines for preparing medication injections by Natthacha Chiannilkulchai, Siranee Kejkornkaew - "Glass ampoules are widely used to contain injection medications because of their properties. However, the existing literature reports that glass particle contamination is found in opening glass ampoules. ... The method (wrapping technique and breaking direction) that nurses use to break ampoules affects the number of glass particles."
- 2020 - Reducing harm through the development of good preparation practices for the injection of slow release morphine sulphate capsules by Lenneke Keijzer - "It is not always easy to advise people who inject drugs (PWID) on how to prepare their drugs in a way that is associated with reduced harm. This is particularly true for pharmaceutical drugs that are not meant to be injected. Our objective was to find “good preparation practices” for slow release morphine sulphate capsules, namely preparation methods that reduce harm, that are evidence-based and acceptable to PWID."
- 2018 - Particulate contamination associated with the manipulation of drugs in glass ampules: A literature review - L Painchart, P Odou, and J-F Bussières - article in French " Eighteen articles have been included. Most of study shows the presence of particles in glass ampules. Important discrepancies reported regarding the number of particles per ampule. Analysis of data from seven studies: decrease of 83% of the total number of particles (>10μm) identified when drugs are removed with filter needle. All studies but two confirm the efficacy of filter needles."
- 2015 - Glass micro-particulate contamination of intravenous drugs – should we be using filter needles? by Lewis Fry (4th year medical student) - "Conclusion: A recommendation for the universal introduction of filter needles for aspiration of drugs from glass ampoules for intravenous administration cannot be justified on the basis of the paucity of available evidence showing harm and in light of the significant cost of this recommendation. Concerns regarding the lack of studies demonstrating that particle contamination poses no threat remain valid from a perspective of total patient safety."
- 2015 - Filtration of crushed tablet suspensions has potential to reduce infection incidence in people who inject drugs by Huei Ng, Rahul P Patel, Raimondo Bruno, Roger Latham, Troy Wanandy, Stuart McLean - "The medical complications of injecting preparations from crushed tablets can be severe, and most can be attributed to the injection of insoluble particles and micro-organisms. Previously we have shown that most of the particles can be removed by filtration, but it was not known whether bacteria could also be filtered in the presence of a high particle load. This study aims to determine the feasibility of filtration to remove bacteria from injections prepared from tablets."
- 2008 - Glass particle contamination: is it here to stay? by S. T. Lye, N. C. Hwang
- 2006 - Glass ampules and filter needles: an example of implementing the sixth 'r' in medication administration by Heidi Stein
- 2005 - Maximizing patient safety: filter needle use with glass ampules by Gina M Heiss-Harris, M Terese Verklan
- 2004 - Glass contamination in parenterally administered medication by Stan T Preston, Kathleen Hegadoren - " At least one glass particle was found in 22% of the 1-mL ampoules, and 56% and 39% of the 2-mL ampoules, using 18G and 21G needles, respectively, had glass contaminants. Many of the 2-mL ampoules produced multiple glass particles on opening. Use of 19G filtered needles resulted in no glass particles."
- 1986 - Glass particle contamination in single-dose ampules by K B Carbone-Traber, C A Shanks
Retractable Syringe
These are for safety. Personally, I don't think these are particulary benificial for self injecting (i.e. no blood borne diseases from others).
reddit
- retractable needle experience by RicoSenju in 2025
- "Syringe needle came off inside me - intramuscular" by lou_weed1997 in 2024 - "If you came on Reddit because you're worried that your IM injection has gone horribly wrong, FIRST check if your needle packaging says "retractable." I just used one for the first time and it FREAKED me out. There's a popping sound and the needle appears to have disappeared under your skin. I had a full blown panic attack and had to go to the ER. I just got out. Luckily, I took a picture of the syringe/packaging and they didn't need to do anything. Thanks (pharmacy) for not telling me anything about how the syringe works and also selling me draw needles that don't fit! I hope someone can read this and breathe a sigh of relief that they don't have surgical steel implanted in them. I HATE RETRACTABLE SYRINGES."
- TIFU When the Needle Disappeared. around 2021 - "... I give the shot- needle goes in and I hear a little suction noise and no needle comes out! Holy fck! In shock, i tell him his body (right butt area) sucked the needle into it! He went white as a sheet- We are both freaking as I’m frantically throwing clothes on telling him he’s going to have to stand upright through the sunroof on the way to the ER (since there is a 2 inch needle in his arse that would surely prevent any bending) my mind was racing with worrying that the needle would get sucked into his heart- after the crying and screaming subsides- standing over the sink, poised to yack he’s looking down at the packs of needles and reads on one of the packets that the needle is retractable and the noise was the needle going into the handle."
YouTube
Side Hole Needles
Huber (or Tuohy) needles have a hole in the side of the syringe rather than the top, and is said to reduce/prevent coring (in applications other than drawing from a vial). I'm not confident this is the correct name as some photos show the hole entirely on the side, others do not.
When searching for side hole needles add irrigation into the search. e.g.
side hole needle irrigation
reddit
Papers
- 1988 - [The Huber needle as a special cannula for the puncture of implanted ports and pumps--a mistake in multiple variations] - "Huber-point needles, which are thought to be noncoring, are usually recommended for puncture of implanted drug-delivery devices, such as ports and pumps. Nevertheless, we found occlusion by silicone chips deriving from the silicone inlet septum to be a major technical complication. Electron microscopic investigations demonstrated substantial loss of material from the port membrane after repeated puncture with this type of needle. During an in vitro test, multiple puncture with Huber-type cannulas led to a pressure-dependent leakage of a port after only 150 to 750 insertions of a needle. In addition, the forces necessary for puncture or for withdrawal of the needle were increased with Huber-point needles, possibly due to a coring effect. Another disadvantage of the available port needles is the formation of a hook at the tip, which may lead to additional lesion of the port or pump membrane. In our opinion, resterilization of Huber needles, recommended by the manufactures, is not advisable, because it is well known that safe sterilization of small lumina, e.g., the lumen of the needle, is impossible."
Suppliers
YouTube
Other
Syringe Manufacturers
- BD - A comment on Facebook says that BD syringes often stick with oil solutions so are not the best choice.
Needle Manufacturers
As far as I can work out
- BD (Becton, Dickinson and Company) - high quality
- Terumo - high quality
- Nipro - high quality, the favorite on the Facebook TransHRT group
- Exel - poor reviews
Links
Needle Safety
There's a number of safety oriented syringes, desiged to prevent needle stick injuries. Doctors are very very careful with needles as they can catch serious diseases this way, but personally I'm not interested as it doesn't really matter if stick yourself if you're the only person using it.
reddit
YouTube
Reusing Syringes and Needles
reddit
- reply to reusing needle by Andrea_Stars in 2023 - note the part where she says "... in my 20 years in emergency healthcare ...", some key points "The main reason we have disposable needles is to stop you getting an infection FROM SOMEONE ELSE. If the needle has only been in you, and you handle it aseptically (i.e don't touch it) then its extremely unlikely to get contaminated other than by things that are already in you." and "Until about 1960 it was fairly common to sterilise and re-use needles and syringes in healthcare. In some places in the developing world it still is common."
Papers
- 1983 - Safety of reusing disposable plastic insulin syringes by B J Collins, S G Richardson, B K Spence, J Hunter, J K Nelson - "53 diabetic patients took part in a study to assess the safety of reusing plastic disposable syringes for insulin injection. Each patient used the same plastic syringe for 7 days. The syringe needles were changed when blunt. No patient developed signs of infection at the injection site... The presence of these additives renders safe the practice of a diabetic patient reusing a plastic disposable syringe over a 7-day period."
Sharpness
reddit
- reply to Is it okay to use a 2 ml syringe for a two-needle SubQ injection? by plaintortilla11 in 2024 - "As far as blunting during use goes... I've found that the brand/quality of insulin syringe matters FAR more than whether they've been used to draw before injecting. Under a microscope, I see no difference between a fresh needle and one that I've used to pierce a stopper, draw, pierce skin and inject... Now, I have a box of brand name Easy Touch insulin syringes that are less pleasant to use. They take more pressure to pierce the skin and they tend to drag on the way back out. The bag of no-name insulin syringes that the pharmacist handed me at the grocery store pharmacy don't do any of that and are great. There can be differences in manufacturing quality, such as whether they bevel the point in one slope, two, or sometimes even three... whether they coat the needle with a lubricant and whether they polish the bevels. I've used two needles, a single needle, and fixed needle insulin syringes. I don't notice any difference between a fresh single needle, and a good insulin syringe that has been used to draw the dose, but I DO notice lower quality needles that have never been used even once. Quality of the needle matters more than drawing with the same needle or swapping them. The bottom line is that I prefer the insulin syringes, I use 1/2 inch long needles, 27 gauge draws and injects more easily than 29 gauge, but 29 gauge is fine, just slower."
History
https://medicine.uq.edu.au/blog/2018/12/history-syringes-and-needles
Buying Syringes and Needles
International Suppliers
Info sources
Australia
You don't need a prescription to buy needles and syringes in Australia, and they can easily be ordered from online stores. Pharmacies may not have what you want in stock, but at least in some cases can order them in for pickup.
You can quite easily find sellers by using google to search for a particular brand of needles on Australian sites. For example, type this into google
nipro needle site:au
Some examples are
reddit
Canada
Suppliers
reddit
Denmark
Suppliers
Info sources
Finland
Suppliers
reddit
Info sources
France
Suppliers
Info sources
reddit
Germany
Suppliers
reddit
Info sources
Ireland
Suppliers
reddit
Mexico
Suppliers
Info sources
Netherlands
Suppliers
Info sources
New Zealand
Suppliers
Info sources
Russia
You'll need to edit the Russian links to make them work - reddit has been automatically removing pages with Russian links.
Suppliers
reddit
Info sources
Spain
Suppliers
Info sources
UK
Suppliers
reddit
Info sources
Ukraine
Suppliers
Info sources
USA
Charity
- https://transneedles.org - "We are a non-profit mail-based service providing free HRT needle supplies for trans folk who cannot access or afford their own."
From the r/transDIY wiki entry Buying needles and syringes online (so prescription should not be required)
Allegro Medical
Sites
reddit
ADW Diabetes
Sites
reddit
GPZ Med Lab
Sites
reddit
Health Care Supply Pros
Sites
reddit
Healthykin
Sites
reddit
Mainland Medical Supply
Sites
Med-Vet International
Sites
Westend Medical Supplies
Sites
Ampules
YouTube
Storing Drugs in Syringes
If you get your HRT in a glass ampule its intended for single use only and the remainder will go to waste. It is possible to injectable estrogen in a syringe, but its not an FDA approved way to do it.
- FDA notifies health care professionals that Becton-Dickinson replaced problematic rubber stoppers in its syringes in 2018 - "Becton-Dickinson (BD) informed FDA that it is no longer using the rubber stopper material associated with loss of drug potency in its general use syringes, and BD has instead returned to a rubber stopper it used previously in the syringes. In 2015, FDA initially alerted health care professionals not to administer compounded and repackaged drugs stored in certain sizes of general use BD syringes, based on reports of an interaction with the rubber stopper that caused some drugs stored in these syringes to lose potency when not used immediately. As we stated previously, the general use BD syringes are cleared for immediate use in fluid aspiration and injection, but not for use as a closed container storage system for drug products, and we have not established the suitability of these syringes (with either rubber stopper) for that purpose."
reddit
SJJ Solutions
YouTube
Papers
- 2015 - No syringe is approved as a standalone storage container, FDA says by Cheryl A. Thompson - "The seemingly common practice at pharmacies and outsourcing facilities of storing sterile compounded preparations or repackaging sterile pharmaceuticals in drug-administration syringes is actually an unapproved use of these medical devices, according to FDA. “FDA has not cleared or approved any syringes for stand-alone use as ‘closed container systems,’” the agency informed ASHP via e-mail in September. The matter came to light in late July after BD informed customers that..."
- 2010 - Hyaluronic acid filler injections with a 31-gauge insulin syringe by Adrian C Lim - "Decanting HA fillers breaks the sterility chain and introduces potential microbial contamination that can in turn
affect filler shelf life. To what extent filler shelf life is affected by the decanting process is unknown. The author has not experienced any contamination problems with this method, over a 12-month period, where the decanted product is stored no longer than 6–8 weeks and refrigerated when not in use."
Disposal
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UK
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USA
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