Gender-affirming hormone therapy (GAHT, also called HRT or hormone replacement therapy) should support your transition goals and help alleviate your gender dysphoria. If you need estrogen for your gender transition, any method of taking this powerful medication will create the same changes. You may have an option to choose to take your E as injections, patches, pills, and other medication options. Being aware of your body’s sensitivities and transition goals will help you make the best choice for your treatment. And remember, you can always change the dosage or injection method later.
Subcutaneous (Sub-Q or SQ) and intramuscular (IM) injections of estrogen or estradiol will both transform your body, emotions, and sense of gender identity alignment. While both are effective, the two ways of taking E as an injection work slightly differently. This article describes the difference between the two types of injections.
Intramuscular (IM) injections
Intramuscular injections are also called IM injections. When you take estrogen this way, the medication is absorbed faster due to the concentration of blood vessels in the vastus lateralis, the prominent muscle on the side of the thighs that is the most common site for IM injections.
The IM injection needle is large, about 1 to 1.5 inches in length, so it can break through the skin and reach the muscle beneath. When you are taking E as an IM injection, you need to:
- Hold the needle at a 90-degree angle
- Ensure that the muscle area is relaxed
- Keep the motion of your hand straight and level while injecting
These techniques will lessen bruising, bleeding, and soreness as you pinch the muscle with your nondominant hand.
Subcutaneous (SubQ) injections
Subcutaneous injections are also called Sub-Q or SQ injections. This type of injection goes under your skin rather than into your muscle. The most common injection site for Sub-Q injections is the lower abdomen, top of the leg, or side of the thigh.
Subcutaneous injections have slower absorption rates due to the sparsity of blood vessels in skin and fat tissue, but they are easier and less painful to perform. The needles for Sub-Q injections are smaller, as they only need to go through the skin. When you are taking E as a SQ injection, you need to:
- Use a needle that is typically ⅝ inches in length
- Insert the needle at a 45 to 90-degree angle
- Pick an area of your skin that is not bruised or damaged
Many people prefer Sub-Q injections because the angle of the injection doesn’t have to be at a 90-degree angle. Instead of going straight in and straight out, Sub-Q injection technique allows more flexibility. The injections can be done at a different angle depending on your mobility and comfort.
Comparing IM and Sub-Q injections
Though both IM and Sub-Q injections can be administered daily, weekly, bi-weekly, or monthly, the spread of your dosage will affect how your body responds long-term. Common IM and Sub-Q injections of estradiol are typically 5 mg/mL or 20 mg/mL once per week, but they can also come in doses of 10 mg/mL and 40 mg/mL. Your dosage will change based on your injection frequency, your transition goals, and your unique body composition.
The differences between IM and Sub-Q injections are the size of the needle, the method of injection, and the angle of injection. The effects of either method will be the same—you won’t “transition faster” using one method.
Our Care Team suggests that the most important thing to consider when deciding how to take your estrogen is your personal comfort and preferences. The more consistent you can be with your injections, the more likely it is your mood and hormone levels will remain stable. If you pick a method that doesn’t work for you and you find yourself avoiding or delaying your shot, talk to your Care Team about switching.
Changing how you take your estrogen
There are many ways to take E. Some people stick with the same method throughout their gender transition. Other people change methods for different reasons, such as:
- Medical provider recommendation
- Cost of the medication
- Changes in mobility or ability
- Availability of the medication
Some people begin with IM injections and then change to Sub-Q injections after their body fat has shifted. Estrogen creates some noticeable physical changes, including where your body stores fat and how thick your skin is. These changes may make Sub-Q injections easier after your hips and thighs have filled out. Other people find that they prefer to keep doing IM injections, which become less uncomfortable with practice.
If needles make you squeamish, talk to your medical provider about your options. You may want to try a method without injections, such as patches or estradiol pills. You can also learn about how to rotate your injection sites and injecting in a different area of your body to give your skin a break. (Some people find that the larger needle used for IM injections can make the area around the injection site feel sore or tender.)
If you have mobility issues, including hand or grip strength, the ability to reach or bend your arm, or other needs, you can still take your estrogen. Some people with mobility issues, including chronic pain or carpal tunnel, prefer to take Sub-Q injections in the stomach area. They say these are easier to do than IM injections. If someone else helps you with your injections, your medical provider can help educate them about how to safely perform an IM or Sub-Q injection on another person.
When you’re deciding how to inject E, it’s key to know your own body’s sensitivities, your abilities, and your preferred method. Talk to your gender-affirming health care provider about your transition goals. And be honest about your anxieties! Your doctor can support you while you determine which injection method of estrogen will be best for you.
Aleena Ortiz (he/she/they) is an independent world traveler, freelance writer, and contract book reviewer at Foreword Magazine. They obtained a Bachelor of Arts in Religion with a focus on Buddhism, Daoism, and Shintō at Reed College in May 2021. Eager to explore fictive worlds with respect to cultural sensitivity and the complexities of human emotion, he has published over 1 million words online over the last decade. Aleena strives to create space for nuanced understanding of historically underrepresented groups through her analyses of media and in fiction writing.
As the largest provider of gender-affirming care for the trans and nonbinary community, Plume is committed to providing information about many types of information, including questions about hormones like estrogen and testosterone, gender transitioning tips and experiences, and guidance on social transition and self care.
While we strive to include a diverse range of voices and expertise, not everything will be for every person. Each individual’s experience is unique, and the information Plume provides is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
Always first seek the advice of your primary and/or specialist physician, the Plume Care Team, or other qualified health provider with any questions you may have regarding a medical condition, your mental health and emotional needs, or your health care needs regarding gender-affirming hormone therapy. If you are experiencing an emergency, including a mental health crisis, call 911 or reach out to Trans LifeLine.
