# HRT We're going to be taking 7mg which is 0.175ml of a 40ml/mg Estrogen Enanthate vial The dosage can be calculated by taking the desired mg / vial amount Aiming for 7 from a 40ml/mg vial: 7 / 40 = 0.175ml > * Note that around 0.1mL of fluid will be lost with each injection due to > needle dead space. ## Supplies We can get the supplies from: - [Exchange Supplies](https://www.exchangesupplies.org/) You need to have: - Uniswab pre-injection alcohol swabs - Unifix 1ml luer slip syringe - Terumo: Pink sharp drawing up needle 18G 38mm (1½ inch) A sharp needle for initially piercing the stopper - BD: Blunt drawing up needle 18G 40mm (1½ inch) A blunt needle for all other medication draws - Unisharp: Orange 25G 16mm (5/8 inch) needle A needle for subcutaneous injections ## HRT Sources - [Otokonoko Pharmaceuticals](https://otkph.com.py/product/estradiol-valerate/) - [Astro Vials](https://astrovials.com/) To find other sources you can check the following: - [https://hrt.coffee/](https://hrt.coffee/) - [https://hrtcafe.net/](https://hrtcafe.net/) - [https://diyhrt.market/](https://diyhrt.market/) ## How to administer an injection Before you inject you should inspect the vial, if there's any discoloration in the oil, suspended dust or particles then discard the vial. Next clean the target area and the rubber vial cap with an alcohol wipe. Then pull air into the syringe to the required dosage and place the needle on top of the stopper with the eye facing up, gently push into the cap at 45 degrees and move to a 90 degree angle in one smooth motion. This will prevent vial coring. You should use a sharp drawing needle for the first time piercing the vial, all other times you should use a blunt one. Push the air into the vial and allow it to suck the medication back into the syringe. Next take out the needle and prime it by pushing the plunger till a drop is pushed out. Switch over to your injection needle. You should inject either into the fat on your tummy, outer thigh half way between the start of your thigh and you knee, or the fat on the upper outer quadrant of your bum. Loosely pinch a patch of fat. Insert the needle at a 45 degree angle. press the plunger slowly. Wait a couple of seconds and then slowly remove the needle. Clean the site again with a fresh alcohol wipe. Place the needle in a clearly marked used-sharps-box. Congrats: You've started on estrogen! You may get a small hard lump aroud the injection site, this will usually pass in a week. This is part of the reason for alternating sides. ### Questions #### Should I inject at the same site each time? No! You should switch site each time. I.e. switching which leg you inject each time #### The medication leaked out, is that okay? Yes that's fine, chances are that's not actually medication. What it's more likely to be is various fluids, be it fat, plasma or whatever else. If any medication is included in this, then it's going to be a small amount mixed mixed with the other things I've mentioned #### How deep should do I have to insert the needle? If you're doing subq, you want to take it all the way at a 45deg angle, with pinched skin. So long as you're pinching enough skin it'll be fine #### Can I go too deep with subq? You can, however your vial is likely to be fine with both subq and IM, so There's no real issue with going too deep. However the site might ache a bit #### My injection site is red? If it itches you've likely mildly alergic to the carrier oil, you can try IM or you can try a different carrier oil to see if that works better for you If it doesn't itch then it's likely that you just disturbed some of the blood vessels in that area, it'll be fine in a day or two Of course, check and rule out infection first, make sure you also work as sterile and clean as possible #### I can feel a lump under my skin? This is likely to just be you can feel the medication reservoir ## Useful Resources - [DIY HRT UK](https://diyhrtuk.org/) - [Transfem Science](https://transfemscience.org/) - [How to synthesise estrogen](https://groups.io/g/MTFHRT/wiki/29602) - [Transfem Intro](https://transfemscience.org/articles/transfem-intro/) - [DIY HRT Directory 2](https://diyhrt.info/transfem) ### Blood tests Aim for 100 to 200 pg/mL (367–734 pmol/L) for estradiol levels and less than 50 ng/dL (1.7 nmol/L) for testosterone levels #### Note Estradiol levels below 50 pg/mL (184 pmol/L) in adults are concentration-dependently associated with menopausal symptoms, including hot flashes, depressive mood changes, defeminization (e.g., breast atrophy, loss of feminine fat distribution), accelerated skin aging, and bone density loss with increased risk of bone fracture. ### Look at the potential of producing your own vials - [Estrodiol Enanthate Vial Production](https://groups.io/g/MTFHRT/wiki/29602#Cook-your-injectable-estradiol-by-yourself) ### Reasonable dosages Here are some reasonable dosages for estradiol injections used in transfeminine hormone therapy: - Estradiol Valerate (EV): 4mg every 5 days (0.1mL, assuming a 40mg/mL vial) - Estradiol Cypionate (EC): 5mg every 7 days (~0.13mL, assuming a 40mg/mL vial) - Estradiol Enanthate (EEn): 7mg every 10 days (~0.18mL, assuming a 40mg/mL vial)* > * If you prefer easier-to-measure amounts, try these alternate dosages: > > Estradiol Cypionate (EC): 6mg every 7 days (0.15mL, assuming a 40mg/mL vial) > Estradiol Enanthate (EEn): 8mg every 10 days (0.20mL, assuming a 40mg/mL vial) > * Note that around 0.1mL of fluid will be lost with each injection due to > needle dead space. ### An Estrogen Levels Calculator [Estrogen Levels Calculator](https://advsim.transfemscience.org/?r=1&e=1&d1=3.6&ra=4&i1=1&dl1=&s=0&h=0&u=mlr&xm=90&cc=1) [Estrogen Levels Calculator 2](https://estrannai.se/#it0__cu,3,4,1-cu,4,5,1-cu,7,10,2) ### Estrogen Dosage Table [A table comparing estrogen dosages](https://transfemscience.org/articles/e2-equivalent-doses/#table-of-comparable-estradiol-dosages) | Route | Low dose | Moderate dose | High dose | Very high dose | |----------------------------|-----------------------|------------------------|------------------------|-------------------------| | Orala | 2 mg/day | 4 mg/day | 8 mg/day | 12 mg/day | | Sublingual/buccalb | 0.5–1 mg/day | 1–2 mg/day | 2–4 mg/day | 3–6 mg/day | | Transdermal patchc,d | 50–100 μg/day | 100–200 μg/day | 200–400 μg/day | 300–600 μg/day | | Transdermal gelc | 1.5 mg/day | 3 mg/day | 6 mg/day | 9 mg/day | | Injections (i.m. or s.c.)e | 1 mg/week | 2 mg/week | 4 mg/week | 6 mg/week | | Pellet implant (s.c.) | 25 mg/6 months | 50 mg/6 months | 100 mg/6 months | 150 mg/6 months | | ~Average estradiol level | 50 pg/mL (184 pmol/L) | 100 pg/mL (367 pmol/L) | 200 pg/mL (734 pmol/L) | 300 pg/mL (1101 pmol/L) | | Equivalent cycle phase | Follicular | Whole cycle | Luteal | Ovulation | a For oral estradiol. Oral estradiol 1.5 mg is equivalent to about 2mg oral estradiol valerate (Wiki). b Based on sublingual estradiol having ~2- to 5-fold greater bioavailability than oral estradiol per studies (Wiki; Sam, 2021). c Much lower doses of transdermal estradiol can be used in the case of genital application relative to conventional skin sites (potentially e.g. 5-fold lower doses for similar estradiol levels) (Aly., 2019). d Different patch brands may result in differing estradiol levels (Rohr, Nauert, & Stehle, 1999; Langley et al., 2008; Farahmand & Maibach, 2009; Langley et al., 2015). e For i.m. or s.c. injection, total dose per week of an estradiol ester like estradiol valerate, estradiol cypionate, estradiol enanthate, or estradiol benzoate. Differences in molecular weight between these esters are minor (Table) and can be ignored for simplicity. Optimal injection intervals vary depending on the ester and doses should be scaled by injection interval to match the listed total dose per week (Aly, 2021). #### Notes These doses are not absolute and should be considered only a rough guideline. They represent a generalized model based on many different studies with often very different individual findings. There is also an assumption that estradiol levels scale linearly or proportionally with dose, which may or may not actually be the case. One study found lower bioavailability of oral estradiol at high doses for instance (Kuhnz, Gansau, & Mahler, 1993). These doses are approximate equivalent or comparable doses and don’t necessarily correspond to typical or recommended clinical doses. Injectable estradiol formulations are generally used at higher doses than other routes and forms of estradiol for instance (Aly, 2021). The comparable doses are based on total estradiol exposure rather than therapeutic estrogenic potency. Time-related variations in sex hormone levels have been reported to modify potency of sex hormone preparations (Aly, 2021). However, this has not been factored in to the table here due to a lack of available data and analysis on the influence. In any case, it may be relevant to routes with large fluctuations in estradiol levels like sublingual administration and shorter-acting injections. A transdermal estradiol spray sold under the brand name Lenzetto is available. In a study in postmenopausal women, mean baseline-adjusted estradiol levels with Lenzetto over the course of a week following achievement of steady state were about 6 pg/mL pre-treatment, 13 pg/mL with 1 spray/day (1.53 mg/day), 19 pg/mL with 2 sprays/day (3.06 mg/day), and 26 pg/mL with 3 sprays/day (4.59 mg/day) (Morton et al., 2009; Graph). Hence, this form of estradiol appears to achieve relatively low estradiol levels that likely aren’t well-suited for transfeminine people. No data are available on higher doses (i.e., more sprays per day) and so this formulation has not been included in the table.