Injecting hormones

Fear of needles

Fear or avoidance of needles is common among people of all ages, and may be the result of emotional stress and anxiety or increased sensitivity to pain.

There are many strategies available to make the discomfort of injections more manageable.

• Self-regulating behaviours such as deep breathing, playing with a fidget toy, or offering yourself soothing or grounding touch help your mind and body know that you are safe, even if you’re scared.
• Buzzy is a device designed to reduce the pain and fear by applying high-frequency vibrations and an ice pack near the injection site. These sensations distract the nervous system and make it more difficult to feel the needle.
• A topical numbing cream or patch can be purchased from a pharmacy without a prescription. It’s important to check with your pharmacist or medical provider to make sure it’s safe to use numbing cream alongside other medications. Numbing cream needs to be applied about 30-60 minutes before the injection to be effective. For more information, see the HealthLink BC page Numbing Creams and Patches for Immunizations.

Consider exploring ways to increase your comfort and relaxation during an injection rather than only focusing on decreasing discomfort. For example, if you’re worried about fainting after your injection, it may be a good idea to have the injection while sitting in a comfortable place. See our page When feelings get stuck for more information and resources related to managing stress and regulating the nervous system.

If your fear of needles is intense, exposure therapy may help make injections tolerable. A primary care provider A person’s main health care provider in non-emergency situations such as check-ups and referrals. Family doctors, general practitioners (GPs) and nurse practitioners (NPs) are all primary care providers. or mental health professional can help you find appropriate treatment options. 

Additional resources

• Take control game plan & Creating comfort for teens during needle pokes by Meg Foundation for Pain — Two resources developed to support youth in managing their pain and anxiety related to injections. Contains tips relevant for people of all ages.
• Facing your fears: exposure by Anxiety Canada — A guide for adults who wish to explore gradual exposure on their own.
• Needle fears by BC Children’s Hospital — A resource for children and youth with needle phobia.

Alternatives to self-injection

Injections can be given by another person, such as a friend, family member, nurse, doctor, or in some cases, pharmacist.

If you are taking an injectable form of hormones but cannot self-administer injections due to a disability, your health care provider may suggest an alternative form of medication such as gel. You may be eligible for special authority A BC government system for obtaining coverage for prescription medications not covered by PharmaCare. pharmaceutical coverage to help reduce the cost.

How to inject hormones

It’s no longer recommended to do intramuscular (IM) injections in the buttocks because of the increased risk of negatively affecting the sciatic nerve. Instead, many people self-inject into subcutaneous (fat) tissue on their legs and abdomen because it’s easier, safer and equally effective.

These downloadable pamphlets provide step-by-step instructions on how to inject hormones. Speak to your care provider about how to choose and safely landmark the injection sites that are best suited for you.

• Subcutaneous injections pamphlet — A guide to giving yourself subcutaneous hormone injections prepared by Trans Care BC and BC Centre for Disease Control (BCCDC) Harm Reduction Services.
• Intramuscular injections pamphlet — A guide to giving yourself intramuscular hormone injections prepared by Trans Care BC and BCCDC Harm Reduction Services.
• Transgender Health: Injection Guide by Fenway Health — A step-by-step guide for intramuscular (IM) and subcutaneous (SubQ) injections.

Accessing safe injection supplies for free

Hormone injection supplies can be accessed for free through many harm reduction sites across B.C. To locate the nearest harm reduction site:

1. Use your browser to go to: https://towardtheheart.com/site-finder
2. In the “What supplies are you looking for?” field, choose “Hormone Injection Supplies” to find safer injection equipment near you.
3. Call the site you choose in advance to ensure they have what you need. Ask about the following supplies based on the type of injection you do.

Intramuscular (IM) injections

• Alcohol swabs
• 18 gauge needles (to draw up the medication)
• Syringe (ideally 1cc* or 3cc)
• 22 or 23* gauge needles (to inject), approximately 1 or 1.5 inches long
• Sharps container
• Little bandages* (if needed)

Subcutaneous (Sub-Q) injections

• Alcohol swabs
• 18 gauge needles (to draw up the medication)
• Syringe (ideally 1cc* or 3cc)
• 25, 26 or 27 gauge needles (to inject), approximately 0.5 or 5/8 inches long
• Sharps container
• Little bandages* (if needed)

* Indicates supplies that are not funded and would need to be purchased out-of-pocket

Hormone Injection Supplies Toolkit

If you use a harm reduction site that does not carry the supplies you need, you can let them know that Trans Care BC offers a Hormone Injection Supplies Toolkit—a handout that outlines recommendations and strategies for providing services for trans, Two-Spirit A term used within some Indigenous communities to reflect complex Indigenous understandings of gender and sexuality and the long history of sexual and gender diversity in Indigenous cultures. Two-Spirit encompasses sexual, gender, cultural and spiritual identity. It may refer to cross-gender, multi-gender or non-binary gender roles, non-heterosexual identities, and a range of cultural identities, roles and practices embodied by Two-Spirit peoples. Some people also use "2-Spirit" or "2S." (Source: Battered Women’s Support Services) and non-binary Umbrella term referring to people whose gender does not fall within the binary gender system of woman/girl or man/boy. Some individuals identify as non-binary while others may use terms such as gender non-conforming, genderqueer, or agender. Non-binary people may or may not conform to societal expectations for their gender expression and gender role, and they may or may not seek gender-affirming medical or surgical care. people. This handout was developed by Trans Care BC in collaboration with the BC Centre for Disease Control. 

Download the Hormone Injection Supplies Toolkit — Intended for harm reduction sites and any organization or program interested in offering hormone injection supplies and inclusive harm reduction services.