Welcome to Planned Parenthood Metropolitan New Jersey!
680 Broadway, Suite 001
Paterson, NJ 07505
973-345-3833
Planned Parenthood League of Metropolitan NJ (PPMNJ) offers quality, compassionate, and
confidential Gender Affirming Hormone Therapy (GAHT) for our transgender and non-binary patients
using a model of informed consent. We are committed to improving the way transgender people
receive health care in our region and we proudly work together with our transgender community to
lead the way in eliminating barriers to care. By providing comprehensive education around hormones
and general health, we can enhance a patient's ability to make informed decisions about all aspects
of their health and transition. We believe true affirming care honors a patient’s autonomy and
self-determination in that process.
For more information, contact us at 973-345-3883 or visit us online at www.ppmnj.org. You
can set up appointments and ask to speak with clinicians by using our main number. If you would like
to speak with Avery Heimann, our Patient Navigator for Gender Affirming Services, you can reach
them using extension 1532. We are located on the lowest level of the Barnert Medical Arts Complex
in the rear of the building with a blue awning and outdoor stairwell leading to the back entrance.
About GAHT:
Gender Affirming Hormone Therapy (GAHT) is when a medical provider prescribes hormones to
someone whose body doesn't generate enough to affirm their gender identity and/or when they
require medication to block the hormones which their body does make. PPMNJ cannot change what
hormones will do to your body, but we can work with you to help you get as close as you can to the
changes you want.
Additional Services Offered:
In addition to offering GAHT, we also aim to provide other services in an inclusive and affirming
environment. Our services include:
● Annual gynecological exams, including Pap tests and breast cancer screenings
● Cervical cancer screenings, including colposcopy and LEEP
● UTI testing and treatment
● Birth control
● Emergency contraception
● Pregnancy testing
● HPV vaccinations
● Abortion services
● Sexually transmitted infection (STI) screening and treatment
● PrEP and PEP
What to Expect When You Arrive:
When you visit our PPMNJ facility you will be greeted at reception by our Clinical Assistant. After you
are checked in, you will meet with a second Clinical Assistant inside the office. Next you will meet
with a Physician Assistant, followed by one or two nurses. Finally, you will meet with Patient
Navigator for Gender Affirming Services, Avery Heimann, MA, MEd, LSW (they/them). Feel free to
ask us any questions at any time; we are here to assist you in any way possible!
Our Process:
● We conduct appointments in-person at our Paterson location, reviewing a patient's medical
history through the informed consent model, performing on-site lab work, discussing lab
results, and finally prescribing hormones with regular check-ups to ensure patient satisfaction
during their transition.
● Patients are also able to transfer their GAHT from other providers to our center by making an
appointment so we may outline our informed consent model with them.
● We see patients ages 18 and older, and for youth we are able to refer to other local providers
who can offer Gender Affirming Care.
● Our Patient Navigator for Gender Affirming Services provides referrals to all our GAHT patients
for trans-competent providers and community resources.
● We extend Gender Affirming Care to every person regardless of financial circumstance.
Initial Visit:
During your first consultation, your provider will:
● Assess for pre-existing medical and mental health conditions.
● Discuss the informed consent model.
● Take your history, asking you about your story, journey, how you relate to your gender identity,
your support networks, your personal goals for GAHT, and whether you have future plans for
Gender Affirming Surgery.
● Review irreversible and reversible changes of GAHT with timeframe estimates.
● Disclose potential risks of GAHT.
● Discuss reproductive life plan and hormone effects on fertility; assess need for contraception.
● Outline schedule of follow-ups with 3 month, 6 month, and 1 year appointments.
● Address tobacco use.
● Take vitals including blood pressure.
● Draw labs on site.
● Provide additional resources through our Patient Navigator for Gender Affirming Services.
● Prescribe hormones.
● Offer injection training if needed.
● Initiate treatment if/when appropriate.
● Remind you when to schedule your next follow-up appointment, typically in one month.
Next Steps:
● Once we have determined it is safe for you to begin GAHT, you will see us for follow-up
appointments at 1, 3, 6, and 12 months during your initial year. Hormone therapy is different for
every patient, so individual doses, adjustments, types of medications, medication
administration, and other factors may vary based on your needs.
● Follow-up appointments for established patients will include taking vitals and blood pressure,
lab work, prescribing renewals of medications, and checking in on your transition experience.
● You can prepare questions for your appointments which can be answered by a clinician or by
the Patient Navigator for Gender Affirming Services. Some questions might include name and
gender marker changes, medication concerns, mental health resources, information about safe
tucking or binding, or options for vocal training.
How much will this cost?:
Payment is due at time of service. We have affordable self-pay options or you may use your
insurance if in network. We accept Aetna Health Plan, Amerihealth, Cigna, Emblem Health, Horizon
BCBSNJ, Empire BCBS, Anthem/First Health, Meritain Health, Oxford Health Plans, Qualcare, Oscar,
UMR, United Healthcare, UHC Student Insurance, 1199 National Benefit Fund, and GreatWest. We
do not take Medicaid plans H, I, D, or E and we do not take Medicare.
Insurance and Prescription Information:
● When initiating a hormone prescription, it may take a little time to get the medication covered
by your insurance through a process called Prior Authorization. Prior Authorizations take
roughly a week to be approved through your insurance.
● Make sure to check with your pharmacist to see if there are any refills left on your medications.
If no refills are left, call our office so we can schedule a follow-up with labs to renew your
prescription.
● If you would like to transfer medications between pharmacies, you can sometimes do this with
a simple phone call to the pharmacist. For controlled substances like testosterone, we may
need to speak with the pharmacy directly.
● Many pharmacies offer free shipping or delivery to your home. There are several pharmacies
we recommend for their familiarity with Gender Affirming Care and ensuring these medications
are in stock. Recommended pharmacies are included in our resource packet, including Middle
Village Pharmacy in Clifton (973-478-0600), Walgreens in Newark (973-849-9386), and
Walgreens at Robert Wood Johnson Somerset Hospital (908-947-2667). These pharmacies
work exceptionally well with prescription discount cards.
● Prescription costs for GAHT vary, but can range from $15 to $60 depending on the medication,
dosage, frequency, and supply when using a GoodRx card. It is important to know that even
when your insurance covers a medication, it still may be cheaper to pay with a discount card
instead.
● For prescription renewals, we ask that you contact us at least 2 weeks in advance of your final
dose to ensure completion of any required labs, follow-ups, or Prior Authorizations.
● For appointments and prescriptions, we will need to use your legal name to make sure your
insurance bills and covers you accurately. We will communicate with you using your affirming
name, but there may be some times when speaking with insurances and pharmacies where
this is not possible. If you have legally changed your name and it is reflected on your
insurance policy, please let us know so we may update it in our system.
Gender Affirming Hormone Therapy (GAHT) Estimated Costs for Self Pay Patients (as of 2022):
Service
Lowest Cost
Highest Cost
New Patient Consultation
$92
$206
Established Patient Follow-Up
$65
$173
Labs BUN
$10
$22
Labs CMP
$10
$22
Labs Estradiol
$22
$34
Labs A1c, Hgb
$10
$22
Labs Lipid Panel
$12
$32
Labs Potassium
$10
$22
Labs Prolactin
$12
$24
Labs Total Testosterone
$20
$32
Pregnancy Test
$12
$24
Total Costs Assigned Female at Birth (AFAB) / Assigned Male at Birth (AMAB) Patients (as of 2022):
Service
Lowest Cost
Highest Cost
AFAB Full Panel Lab Total
$96
$200
AMAB Full Panel Lab Total
$86
$178
AFAB New Patient Consultation
+ Labs Total
$188
$406
AMAB New Patient
Consultation + Labs Total
$178
$384
AFAB Established Patient +
Labs Total
$161
$373
AMAB Established Patient +
Labs Total
$151
$351
*GAHT services can be determined at $0 cost depending on proof of income. Contact Sandra
Mercorelli at 973-902-1920 or [email protected] to inquire about eligibility.*
Informed Consent:
● Informed Consent is a model of care in which patients are able to access hormones during a
visit with their provider, where they will discuss the risks and benefits of care. No visit with a
mental health professional is required. True Informed Consent does not gatekeep a patient’s
access to care and focuses more on a multidisciplinary, well-communicated, harm-reducing,
decision-making process.
● PPMNJ believes that people have a right to make decisions about their gender, gender
identity, and whether they wish to establish or continue Gender Affirming Hormone Therapy.
This means that we provide complete, accurate information about GAHT to help you make an
informed decision. Some doctors modify the World Professional Association for Transgender
Health (WPATH) Standards of Care model, which can require Letters of Support from a mental
health professional. However, we recognize that this can create a barrier for many people. Our
informed consent model does not typically require a referral letter.
● Although we try our best to make GAHT as accessible as possible, there are instances in
which hormone prescription is not 100% guaranteed. Prior to prescribing hormones, we have
to do an intake with each person to make sure there are no major health concerns and that
you are making an informed decision. Our practice believes in self-determination, and it is our
goal to work with you to meet your needs to the extent that we are able. We work hard for each
person to verify that hormones will be safe, and if we do have concerns we will discuss them
with you.
About Feminizing Hormone Therapy:
Each person, regardless of gender or assigned sex at birth, is born with both Estrogen and
Testosterone hormones in their body. The goal of Feminizing Hormone Therapy is to help reduce
Testosterone and increase Estrogen. Feminizing Hormone Therapy uses different medications and
hormones which can assist your gender transition process. There are two main medicines that you
might be given, Estradiol and Spironolactone.
Estrogen is the sex hormone that causes the development of feminine characteristics. It may be given
as a pill that you put under your tongue, as a shot, or as a cream or patch you put on your skin.
You may be given medicines called anti-androgens that can block and lower the amount of
Testosterone made by your body. The most common anti-androgen is called Spironolactone. This
makes estrogen work better and comes as a pill. Spironolactone can cause high amounts of
potassium in the blood, which can cause changes in your heartbeat that may be life-threatening. It is
also a diuretic, which can cause more frequent urination. If you have surgery to remove your testicles,
you can stop taking Spironolactone.
Before starting Feminizing Hormone Therapy, you need to know the most common benefits, risks,
side effects, and other choices you have. PPMNJ is mindful that benefits for one person may not be
benefits for another person, and even some side-effects may be considered benefits. It all depends
on your unique experience, goals, and identity.
Estrogen
Benefits
Risks
Side-Effects
Breast Development
Liver damage
Shrinking of testicles
Slowed growth of body and
facial hair
Increased fat and/or cholesterol
in the blood
Reduced Testosterone levels
Fat redistribution to butt, hips,
and thighs
Increased risk of heart disease
Feeling less sexual
Softer skin
Increased risk of blood clots in
legs, lungs, or brain
Difficulty obtaining or
maintaining erection
Slowed, but not stopped, hair
loss at top of head
Increased risk of stroke
Reduction in semen during
ejaculation
Increase in blood pressure
Less able to cause pregnancy
Increased risk of diabetes
Decreased muscle and strength
of the body
Increased risk of gallbladder
problems
Mood changes
Migraine headaches
Milky liquid coming from nipples
(notify provider if this happens)
Pituitary tumors
Estrogen risks are increased for people who:
● Smoke
● Are overweight
● Are older than 40
● Have a history of blood clots
● Have a history of high blood pressure
● Have a family history of breast cancer
No one can tell you for sure if you’ll be able to cause a pregnancy after beginning Feminizing
Hormone Therapy. You could cause a pregnancy or you may never be able to, even if you stop
GAHT. If you have sex with a person who can get pregnant, you will need to use some kind of birth
control or barrier method to prevent pregnancy, just in case. Stopping Estrogen and Spironolactone
may result in an increase in sperm. If you think you may want a pregnancy in the future, you can talk
to your provider or Patient Navigator about storing your sperm and other fertility services before you
start GAHT.
In addition to GAHT, there are other ways to transition including surgery, cosmetic products, clothing,
wigs, padding, and tucking. If you are interested in other options for transitioning, talk with your
provider or Patient Navigator. You can choose to stop Feminizing Hormone Therapy at any time. If
you decide to do that, talk to your provider. Remember, only you get to define your transition. Even if
you do not use GAHT or have stopped GAHT, this doesn’t have to mean you “stopped transitioning”
unless you want it to mean that.
Effect
Expected Onset
Expected Maximum
Effect
Reversibility
Breast Growth
2-6 months
2-3 years
Permanent
Thinning/Slowed Hair
Growth: Face and
Body
6-12 months
>3 years
Reversible
Softening of Skin and
Decreased Oiliness
3-6 months
Unknown
Reversible
Body Fat
Redistribution
3-6 months
2-5 years
Reversible
Decrease Muscle
Mass and Strength
3-6 months
1-2 years
Reversible
Decreased Sex Drive
1-3 months
1-2 years
Reversible
Decreased
Spontaneous Erections
1-3 months
3-6 months
Reversible
Sexual Dysfunction
(Less Firm Erections)
Variable
Variable
Possibly Permanent
Decreased Sperm
Production Reduced
Fertility
Variable
Variable
Possibly Permanent
Decreased Testicular
Volume (By 25-50%)
3-6 months
2-3 years
Likely Permanent
Cessation of Male
Pattern Balding
No Regrowth, Loss
Stops 1-3 months
1-2 years
Reversible
About Masculinizing Hormone Therapy:
Each person, regardless of gender or assigned sex at birth, is born with both Estrogen and
Testosterone hormones in their body. The goal of Masculinizing Hormone Therapy is to help increase
Testosterone. Masculinizing Hormone Therapy uses different medications and hormones which can
assist your gender transition process.
The main medication is called Testosterone, a hormone that causes the development of masculine
characteristics. Testosterone can be given as an intramuscular or subcutaneous injection or put on
the skin as a gel, a cream, or a patch.
Some providers will additionally prescribe Finasteride, an anti-androgen that only blocks
Dihydrotestosterone (DHT), not Testosterone itself. Some people choose to use Finasteride in
conjunction with Testosterone to prevent male-pattern baldness or slow down bottom growth.
Before starting Masculinizing Hormone Therapy, you need to know the most common benefits, risks,
side effects, and other choices you have. PPMNJ is mindful that benefits for one person may not be
benefits for another person, and even some side-effects may be considered benefits. It all depends
on your unique experience, goals, and identity.
Testosterone
Benefits
Risks
Side-Effects
Deeper voice, thickening of
vocal chords
Increased red blood cell count
Acne
Facial hair thickening, such as
moustache and beard
Increased fat and/or cholesterol
in blood
Thicker, more oily skin
Body hair grows faster and
thicker
Increased risk of diabetes
Hair thinning on head, male
pattern baldness
Clitoral enlargement (bottom
growth)
Liver damage
Mood changes
Increased strength and muscle
mass
Increased sex drive
Cessation of menstruation
Vaginal dryness
Fat redistribution from buttocks,
hips, and thighs to belly
Menstrual spotting
The risks of testosterone may be higher for people who:
● Smoke
● Are overweight
● Have a family history of heart disease
No one can tell you for sure if taking Testosterone will affect your ability to get pregnant. You could
become pregnant or you may never be able to get pregnant in the future, even if you stop
Testosterone. If you have sex with a person who produces sperm, you need to use birth control or
barrier methods to prevent pregnancy, just in case. If you do get pregnant, you must stop
Testosterone. If you think you may want a pregnancy in the future, you can talk to your provider or
Patient Navigator about different fertility services before you start GAHT.
In addition to GAHT, there are other ways to transition including surgery, over-the-counter hair growth
products, clothing, packing, and binding. If you are interested in other options for transitioning, talk
with your provider or Patient Navigator. You can choose to stop Masculinizing Hormone Therapy at
any time. If you decide to do that, talk to your provider. Remember, only you get to define your
transition. Even if you do not use GAHT or have stopped GAHT, this doesn’t have to mean you
“stopped transitioning” unless you want it to mean that.
Effect
Expected Onset
Expected Maximum
Effect
Reversibility
Facial and Body Hair
Growth
1-6 months
1-2 years
Permanent
Increased Muscle
Mass and Strength
6-12 months,
dependent on amount
and type of exercise
2-5 years
Reversible
Deepened Voice
3-12 months
1-2 years
Permanent
Cessation of Menstrual
Periods
2-6 months
N/A
Reversible
Clitoral Enlargement
3-6 months
1-2 years
Permanent
Body Fat
Redistribution
3-6 months
2-5 years
Permanent
Skin Oiliness/Acne
1-6 months
1-2 years
Reversible
Male Pattern Baldness
>12 months
Variable
Permanent
Increased Sex Drive
Variable
Variable
Reversible
Other Medications for GAHT:
Some other medications that may be prescribed in tandem with Estradiol or Testosterone GAHT
include Finasteride, Dutasteride, Minoxidil, Spironolactone, or Progesterone. The function of these
medications varies from reducing unwanted side effects or enhancing desired results. For example,
Minoxidil can be prescribed or purchased over-the-counter as Rogaine to help prevent hair loss, and
Progesterone can help decrease the likelihood of spotting or breakthrough bleeding during a
menstrual cycle.
Legal Documentation Changes:
Several legal advocacy programs, both nationally and within New Jersey, offer How-To Guides on
changing your license, state ID, birth certificate, social security, passport, and much more. We
recommend first visiting Garden State Equality’s page on “Updating Identification Documents,” where
they also provide personal assistance for the process if you would like an advocate to help you along
the way. The website is https://www.gardenstateequality.org/take-action/update-id/
Additional Resources:
If you are seeking additional information, our Patient Navigator for Gender Affirming Services has
created an ever-growing resource document for providers such as endocrinologists, therapists,
psychiatrists, support groups of all kinds, hotlines, STI testing, fertility and reproductive services,
voice and speech clinicians, surgeons, hair removal and electrolysis, salons, employment assistance,
legal assistance, housing assistance, education and advocacy organizations, recommended
pharmacies, and online websites. Please feel free to scan the QR code below to access this
document, as it is frequently updated. Additionally, if you have a resource you would like to
recommend, please email our Patient Navigator at Avery[email protected] and they can put it on
the list!
Frequently Asked Questions:
What if I run out of prescriptions?
● Pharmacists may tell you that 1 ml vials can only be used as single use or you may see
instructions to use the vial as single use. Please note that these vials can be used for multi-use
and it is safe to do so with new syringes/needles each time as instructed by your clinician
during your initial appointment. Often times pharmacists are not trained about GAHT and do
not know this. If you have already thrown away a vial please let us know and we will pass it
along to your clinician.
What if I want to increase my dosage or change the prescription?
● For prescription changes, please call our Patient Navigator and they can connect you with a
practitioner to discuss options. We may need lab work and a follow-up to make sure your
hormone levels are within a safe range to raise or lower your dosage. If you are changing the
method of administration such as an injection to pill or gel, we will need to work with your
pharmacy and insurance to make sure this switch is possible.
How do I learn to inject hormones and what if I get confused?
● In addition to the injection guide provided in this packet with supplemental videos, we also
provide an injection training after your first visit. We know that this can be a lot of information
to take in and you may feel a little overwhelmed during your first few injections. If this
happens, please call our facility and we can schedule a follow-up for you to come in for a
second training. We will also ask you during your regular scheduled follow-up if you need any
additional assistance with injections.
Can someone come to my appointment with me?
● Due to COVID-19 policies during the pandemic, we are not able to allow any visitors at this
time. If you require accompaniment for special needs, please let us know so we are able to
accommodate you.
Can I document memorable moments on my phone during my appointment?
● While we celebrate your experiences at PPMNJ, especially during an initiation or continuation
of GAHT, according to HIPAA privacy policies we ask that you refrain from using your phone,
social media, live streaming, taking pictures, or recording videos during your time in our facility.
Will you ever do pediatrics?
● We are currently not providing GAHT services to anyone under the age of 18, but have a list of
providers who are able to do so. Please contact our Patient Navigator or visit the “Pediatric
Endocrinology” section of our resource packet for further information.
Why would I need a Letter of Support?
● Letters of Support are typically used in modified WPATH versions of “Informed Consent” with
regards to the mental health status of a patient. PPMNJ’s use of the true Informed Consent
model means we do not require these letters unless it is related to extenuating circumstances
such as physical conditions which may adversely interact with GAHT and put you at a higher
risk of medical complications. In these cases, our Patient Navigator will assist you in finding
resources for practitioners who can help with these referrals. If you are seeking Gender
Affirming Surgery, some practices and insurances will require a Letter of Support. Sometimes
this will solely be from your prescribing GAHT clinician and sometimes it will also require a
letter from a mental health professional. Avery can assist you in finding the most cost-effective
and accessible routes to acquire these materials.
How can I get insurance coverage for Gender Affirming Care?
● Many insurances will cover GAHT and some other Gender Affirming procedures, and some
practitioners will offer things like reduced out-of-pocket expenses or sliding scale fees. This
guide from TransEquality.org can assist you with determining insurance coverage:
https://transequality.org/health-coverage-guide
What if I miss a dose or stop taking GAHT?
● In the interest of your physical and mental well-being, please contact us if you miss a dose,
take the wrong dosage, change your dosage schedule, or stop taking your medications.
Can I travel with GAHT medications?
● Legally, you are able to travel with all of your medications and supplies. Keep them in your
hand luggage or carry-ons just in case your checked bags get lost. You should bring them in
their original packaging with some documentation of the prescription. This can be a doctor’s
note, a hard copy of your prescription history, a printout of your appointment information from
the NextGen Patient Portal, a receipt from your pharmacy, or even one of our brochures.
Some people choose to travel with injection kits from Transguy Supply, Stealth Bros., or from
Amazon when searching for an “Insulin Travel Case,” but you might want to swap your
medications from a kit to a clear plastic ziploc bag before running them through security. Make
sure you have enough medications to cover the duration of your trip, as pharmacies out of
state and internationally may not have the supplies you need or honor a prescription for a
controlled substance from our clinic.
Do I need to take GAHT medications with food?
● It isn’t necessary, but it can’t hurt. Some people find pills easier to swallow if they have a little
food in their stomach. Some people prefer to eat before injections to help raise their blood
sugar and reduce their chances of fainting. There are no formulary guidelines that mandate
taking your medications with food, so it’s all personal preference.
Can hormone patches fall off and do I have to shave for them?
● Patches can fall off, and if you have a lot of hair in the location you intend to apply them,
shaving can help them stay put. Also make sure your skin is clean and free of all lotions
before applying a patch. If a patch falls off but is still tacky, you may be able to reapply it back
to the original site. If the adhesive has worn off completely, you will need to apply a fresh
patch, but call our clinicians first to make sure it doesn’t alter your dosage levels. Applying a
new patch when one falls off also means your prescription will be short a patch, so calling the
clinic to notify us will help with future refills and communications with your insurance and
pharmacy.
Will hormone gel rub off?
● Yes, gel can rub off, so we recommend you wait at least 15 minutes after applying the gel to
your skin before putting on clothing or any other covers like bedding. Gel can also rub off onto
anyone you make physical contact with, which in turn can transfer your hormones into their
system. Make sure you have waited a full 15 minutes for the gel to dry before touching anyone
else.
Are there any medication interactions with GAHT?
● Some GAHT medications can interact with other prescription medications, and our clinicians
will discuss this with you prior to prescribing. Contact our practice first before taking any new
medications to make sure there are no negative interactions, and if you are comfortable, you
can also ask your prescribing physician about these interactions as well.
What about substance usage?
● Tobacco, alcohol, and caffeine consumption can negatively affect your body with GAHT.
These substances can either raise or lower your hormone levels and how you metabolize your
medications in potentially harmful ways. It is best to be as honest as possible during your
consultation about the frequency and quantity of usage or let us know once you are an
established patient if you have begun or increased your intakes of these substances. We offer
information on tobacco cessation programs as well as alcohol reduction programs if you are
interested.
Will my Sexual Orientation change during GAHT?
● Some patients on GAHT report changes in their Sexual Orientation over the course of their
transition. Although Sexual Orientation, Gender Identity, and Gender Expression are all
different, it is not uncommon for you to experience a shift in Sexual Orientation, meaning who
you love or are attracted to. Some transmen, for example, report being mostly attracted to
cisgender women prior to GAHT and then more attracted to cis and other transmen after
beginning GAHT. Some patients may also identify as Asexual and shift to more of a Gray Ace
identity after initiating hormones. The possibilities are endless, and there is no singular right
way to identify. While your Sexual Orientation can change and is something only you get to
define or claim, if you are experiencing distress please contact our Patient Navigator. In
addition to navigation services, Avery is also an advocate and member of transgender and
queer communities. They can refer you to educational, therapeutic, or other supportive
resources to assist you.
Can I donate blood if I am on GAHT?
● Absolutely! Initiation of GAHT may affect your Hemoglobin levels, but you are still eligible for
blood donation. The FDA and Red Cross still have a very gendered MSM (“Men who have sex
with men”) policy, which requires a 3 month deferral period for people assigned male at birth
who have sex with other people who are assigned male at birth. This means you will have to
wait 3 months after your last sexual encounter before donating blood.
How to Give Yourself a Hormone Injection
Video tutorials (English and Spanish):
https://www.plannedparenthood.org/planned-parenthood-greater-texas/self-injection-videos
Supplies:
● One 1-ml syringe
● One 18 or 20 gauge, 1 or 1 ½ inch needle for drawing up the medication
● One 21, 22, or 23 gauge, 1 or 1 ½ inch needle for injecting the medication intramuscularly, or
one 25 or 26 gauge ⅝ inch needle for injecting subcutaneously
● Vial of Testosterone or Estrogen
● Alcohol wipes or cotton balls/pads with a bottle of rubbing alcohol for cleaning your vial and
your injection site
● Cotton or gauze to put apply pressure after injecting
● Bandage
● Sharps container or other appropriate container for disposal of needles and syringe
Preparing the medication:
● Find a comfortable, well-lit location with a clean work area to set out your supplies.
● Wash your hands with soap and warm water.
● Make sure you have the correct medication and dosage according to your prescription; it
should be clearly shown on vial with name and strength.
● Check the expiration date of your medication.
● Hold medication vial up to the light to check for floaters or other contaminants.
Preparing the syringe:
● Pop the top off of your vial. Once the top is off, it never goes back on, and the rubber stopper
in the vial will keep the medication from leaking.
● Before each use, clean the top of your vial off with an alcohol pad in a circular motion starting
from the middle.
● Prepare your syringe for drawing up your medication. Make sure not to touch the tips of your
supplies, and when twisting the needles make sure to twist from the base and not the top so
you do not accidentally poke yourself.
● Draw air into the syringe that is equal to the dose of your medication. When you put this air
from the syringe into your medication vial, it helps keep pressure in the vial and makes it easier
to draw up more medication in the future. For example, if you are drawing up .2mL into the
syringe, you will pull air into it at the .2mL mark before pushing it into the vial.
● Pull off the top of your needle and hold your vial on a flat surface. Poke the needle directly into
the middle of the rubber stopper of the vial at a 90 degree angle. Inject the air into your vial
while holding it. Make sure the needle is positioned so your medication is covering the tip of
the needle.
● Flip the vial upside down, keeping the needle in the medication liquid and pulling back on the
syringe slowly. You may see bubbles of air with the medication in your syringe which can be
pushed back into the vial as you lightly tap the syringe chamber so the bubbles rise to the top.
You may need to repeat this step several times to get rid of all the bubbles. Do not remove
your needle from the vial when tapping the bubbles out.
● Return the vial right side up to your flat surface and pull your needle straight out, capping it,
and twist the needle from the base off of the syringe. Dispose of drawing needle in your
sharps container.
● Attach your injection needle to the syringe by twisting it on at the base. Keep needle capped
and once attached, place the syringe down on a clean, flat surface while you prepare your
injection site.
Selecting your injection site:
● Intramuscular injections can be performed on your vastus lateralis muscle on the side of your
upper thigh.
● To find this muscle, place the outside edge of your nondominant hand at the top of your
kneecap sideways, then your dominant hand sideways right above that one, then your
nondominant hand again sideways above the dominant hand to determine the distance from
your kneecap to your muscle.
● Rotate your hand out to the upper side of the thigh, pinch the muscle, and that 2 inch area is
where you will inject.
● Subcutaneous injections can be performed in your abdomen, the fatty part at the front of your
thigh, or the fatty part of the back of your arm. For your abdomen, be sure to inject at least an
inch away from your belly button and never above your belly button.
Injecting your medication:
● Open your alcohol prep pad and clean your injection site in a circular motion away from the
center outwards. Allow the skin to air dry.
● Pull the cap off your needle. Pinch the muscle or fat of the injection site.
● When you insert the needle intramuscularly, you will want it at a 90 degree angle to your site,
ideally parallel to the floor.
● When injecting subcutaneously, insert the needle at a 45 degree angle to the site. You can
also inject subcutaneously at a 90 degree angle if that is more comfortable.
● Holding the syringe like a pencil, insert the needle ¾ to 1 inch in a smooth, single motion
through the skin and into the muscle.
● For subcutaneous injections, insert it ⅜ to ⅝ of the way in to the fat. Hold the needle steady.
● Once the needle is fully in, push the plunger all the way down on a count of 5 seconds.
● When finished, pull the needle straight out at the same angle you injected and immediately cap
it and dispose in the sharps bin.
● Lightly press a cotton ball or sterile gauze pad on the injection site until any bleeding has
stopped.
● Apply your bandage.
Disposing of your injection supplies:
● To discard your injection supplies, you can purchase a sharps bin at the pharmacy.
● You can also use a laundry detergent bottle or a milk carton as long as it is made with a thick
plastic material.
● Clearly write ‘sharps’ on the container with tape and marker. Affix label to container and
securely fasten the top each time you use it. Once the container is ¾ filled, cap it and secure
the lid with tape. You can dispose of it in your regular trash.
● All of your injection supplies are meant for single use, which means you use them once and
then you immediately put them in your sharps container.
Injection tips:
● Make this process your own! Some people listen to music or have special setup kits, some
people light aromatherapy candles or ask for a loved one to be in the room with them. A
comfortable environment can make injections much easier.
● Storage and organization is helpful to make sure all your supplies are in order. Stealth Bros.
makes dopp kit containers and you can also find a portable hard case kit from Transguy
Supply.
● Relax and keep your muscles warm; being tense means the injection is more likely to be
painful.
● Use your dominant hand to inject on the opposite side for your first time.
● Make sure your feet are flat on the ground if injecting into the thigh.
● Rotate your injection sites weekly.
● Make sure to shake your medication well and keep at room temperature to prevent
crystallization and help check for contaminants
● Never use medication that has expired or looks contaminated.
● Never forget hygiene at any step of the process; it helps prevent infection.
● Needle sizes are measured in gauges. The smaller the number for the gauge, the thicker the
diameter of the needle. For example, a 21 gauge needle is thicker than a 26 gauge needle.
Intramuscular needles will be thicker than subcutaneous needles.
● Never let your needles touch any surfaces and keep the caps on until you are about to draw or
inject.
● Never let go of the vial during air insertion and drawing up medication.
● The needle can be inserted more quickly with a darting action or slowly, depending on your
level of comfort
● For intramuscular injections, you may feel some burning, tingling, or pressure as your
medication enters your muscle. You also may feel a bit of soreness or mild swelling for a few
days at the injection site.
● Some medications are suspended in a thick oil, so make sure they are at room temperature to
make the oil more comfortable to inject.
● If you develop signs of infection such as a fever above 101 degrees Fahrenheit or see redness
or drainage from injection site, call a medical professional.
● Some people can be allergic to the oil suspension for Testosterone, with Testosterone
Cypionate suspended in Cottonseed Oil and Testosterone Enanthate suspended in Sesame
Oil.
● Never dispose of sharps containers in recycling, only trash or a medical facility that accepts
sharps containers.
Works Cited
● Callen-Lorde Protocols for the Provision of Hormone Therapy, 2022.
● Planned Parenthood of Greater Texas, Inc. Hormone Therapy Self Injection Guide, 2018.
● Planned Parenthood South Atlantic Gender-Affirming Welcome Packet, 2021.
● Virginia League for Planned Parenthood Gender-Affirming Welcome Packet, 2021.
