You may remember there were problems with my estradiol blood levels before my surgery in October, and to try to increase my estradiol absorption, and my endocrinologist moved me from an insulin syringe to a syringe with a larger, and longer, 23 gauge needle so I could inject it into muscle instead of into fat. (For some odd reason the needle gets bigger as the gauge increases, not the other way around as you’d expect.) There’s just one problem with it, though. The estradiol valerate I’m injecting is so thick it can’t get into the syringe easily through a 23 gauge needle. After looking at several things and consulting with my doctor, his nurse, and my pharmacist, we’ve changed me to an 18 gauge needle, and by Jove, we’ve got it!

My old insulin syringe vs the new, larger syringeThe problem is that my new syringe is much bigger than my old one, not just the needle on top of it. Because of the larger diameter, the syringe isn’t able to create enough vacuum to draw the fluid into the tube.

I saw Jamie, my endocrinologist’s nurse, on Friday and she says she has the same problem with her patients on testosterone therapy (trans-males). Estradiol Valerate is a very thick fluid, almost like maple syrup, and the hole at the end of a 23 gauge needle simply isn’t larger enough for the diameter of the syringe. Dr. Hamnvik, my endocrinologist, suggested a larger needle, and my new syringe includes a locking tip which allows me to change just the needle rather than the whole syringe. This is good news because I wasn’t sure if my insurance will pay for new syringes so soon after paying for a year’s worth of syringes in November.

Why do I need new needles? Because the insulin syringe gets the medicine into the fat under the skin, but my estradiol isn’t being absorbed well enough there so Dr. Hamnvik wants me to inject the estradiol into a muscle. Needless to say, we need a longer needle to do that, and we can’t swap out needles with insulin syringes like we can with the new ones.

The new needles for my estradiol. The 23 gauge needle is on the left.When I saw Jaime on Friday I brought along my bottle of estradiol and a couple of the newer syringes and we were able to confirm that the larger needle does in fact, work for getting the fluid into the syringe. It turns out I could draw the needed half a milliliter of estradiol through the 18 gauge needle but it took time, and the whole time I had to fight against the vacuum trying to pull the syringe’s plunger back into the syringe. She got a few 18 gauge needles and confirmed that not only could we swap out the needles, I can draw the fluid into the syringe. Once the estradiol is in the syringe I can either inject it into my leg with the larger needles or swap back to the 18 gauge needle for the injection. As you can see in the picture the 18 gauge needle is pretty big, an inch in length compared to the inch and a half for the 23 gauge needle, and I’d rather not use the longer needle for an injection if I can avoid it. I need to get it into my muscle, and an inch is plenty deep enough. For comparison, the insulin syringe uses a 31 gauge needle that’s 5/16 of an inch long.

Ever since my surgeon took me off my post-operative restrictions I’ve had to use the smaller insulin syringe to give myself my weekly estradiol injections into my stomach, but today I was finally able to inject it into the muscle of my leg. I did find three issues, however. As I learned Friday, I have to make sure the needle’s locked onto the syringe or it can get pretty messy. I also have to make sure there’s air at the top of the syringe when I change the needle to prevent any spillage.

The second issue is that putting a needle into my thigh muscle hurts more than putting a needle into my fat, and I have to make sure I don’t jerk my leg as the needle goes in. The third issue is simply a result of how thick the estradiol is. As I said before, it’s like maple syrup so it doesn’t go in as easily as it does with my diabetes needle. This goes back to the vacuum issue I talked about. I ended up holding the syringe in place with one hand while the other pushed the plunger so I don’t end up moving the needle around while it’s in my leg. It turns out the fluid was going into my leg more easily than I realized, but next week I may try the injection with the 23 gauge needle and see if the estradiol goes in any more easily.

Now my leg’s sore, and hopefully, that will go away fairly quickly, but I’m glad I can finally inject my estradiol into my leg. We’ll have to wait to see if that helps absorption, but we’ll have to wait four weeks and four days before we can draw blood to run that test.

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