So I’ve been doing subcutaneous E injections for close to 11 months at this point¹, and my most recent one turned out kinda weird. It hurt a bit more than usual going in, there was a lot less resistance when pushing the plunger in (got everything injected in less time than normal), and there was significantly more blood than I’m used to after removing the needle (typically there’s only a tiny speck if anything, this time nearly the entire cotton part of the band-aid is stained red). It’s been about 2 days now and there’s a ~1cm diameter bruise at the injection spot, which is also something I haven’t seen before.
The only thing I can think of is that I must’ve gotten unlucky and managed to hit a blood vessel. If that is the case though, my understanding of how injections work tells me that this will dramatically affect the release curve - rather than being deposited into fat tissue and slowly being released into the bloodstream, I assume this would mean much of the EEn was dumped directly into the blood where it would then be converted into E2 and consumed/destroyed within hours or a few days at most. Am I overthinking this? Should I do another shot to make sure my levels don’t crash down in case my hypothesis is correct, or should I just stick to my usual weekly schedule?
¹ probably not relevant, but including this anyway: I’m injecting 0.13 mL of EEn (40 mg/mL, in MCT oil) once per week using 30G, 1/2in long needles
The only thing I can think of is that I must’ve gotten unlucky and managed to hit a blood vessel. If that is the case though, my understanding of how injections work tells me that this will dramatically affect the release curve - rather than being deposited into fat tissue and slowly being released into the bloodstream, I assume this would mean much of the EEn was dumped directly into the blood where it would then be converted into E2 and consumed/destroyed within hours or a few days at most.
upvote for good reasoning and at least trying to understand what actually happens in the body. unfortunately i cannot help you on this specific question, as i take finasteride which works a bit differently.
First: am not a doctor, and even if I was, I’m not your doctor, and even if I was, I can’t examine you online.
Okay, risk assessment is what you need to focus on.
In terms of risk, the big thing to worry about with estrogen is clotting. That’s the worst thing that can happen when it’s injected straight into the bloodstream. It isn’t a guarantee, just worst case possibility. Iirc, the exact degree of risk has multiple variables, so you’d want to look into that to determine if you need to do more than email a doctor (I scrolled comments before chiming in).
That being said, the risk of that is highest the closer to the time of injection, and chances are low that you got a significant dose fully into the bloodstream. See, the really big vessels are either deep enough that getting the tip in just right to inject into them is unlikely, orthey’re close enough to the surface to avoid visually.
The smaller vessels, you just aren’t going to get the full dose into even if you manage to get the tip dead center at first, because injecting tends to move the needle.
Since you report bleeding initially, then bruising, but no other symptoms I would place your risk of short term clotting problems being acceptably low, but non zero. So don’t fuck around if you start having unusual pains, trouble breathing, weakness in extremities, etc. 911 or your local equivalent fast. You don’t want to fuck around with clots. Even if they don’t kill, they can cause permanent disability. So, again, do not hesitate if you have unusual symptoms. It really is better to spend the day in an er and be safe than try to avoid it and be dead.
Now, trying to do a second dose? No. Absolutely not. There is absolutely no reason to add risk when you’re on a weekly cycle, and the worst case scenario of a drop in levels is so minor in comparison. Yes, you might suffer some heavy mood shifts. You might experience odd sensory flashes; hot, cold, crawly, itchy. That’s about it from entirely missing a single dose. And you didn’t, so let what is in your system do its job. You absolutely got some into the subQ fat, and it will carry you through.
As a hypothesis? I strongly suspect you nicked a vessel on the way in. It happens. Fairly commonly. I’d say that diabetics I’ve helped with their injections have it happen as often as weekly. Some more often. They inject daily, or more often, so it’s a good comparison to guesstimate occurrence over time. When I’ve had to do subQ on myself here and there over the years (not hrt or insulin, but still relevant), I’ve hit vessels maybe 2/10 times, and I’m fairly familiar with my body’s overall blood system. Never hit a big one, but I’ve nicked smaller ones. Happens with IM too as far as that goes.
Anyway. Like I said at first, I’m not a doctor. Consulting one is your safest option. You’ve already said you plan to, so follow any advice they’re willing to give over anything you read here.
This is fantastic and exactly the sort of reply I’d been hoping for, thank you <3
🏆Wish I could give you awards, because this was straight gold.
from our readings, when steroids (such as estradiol) have been injected into blood vessels in prior incidents, many of those involved have noted feeling absolutely awful right after injection. if you felt anything like that, we’d conjecture it is because you injected into a vessel. get help if that’s the situation!
in your case, you may have gone through a vessel, but then past it into different tissue, like fat or muscle—ultimately not into your (flowing) blood. nonetheless, such an action could damage that passageway enough to cause blood to leak out, so a bruise! we’ve seen it before.
you did say you’re doing sub-q with half-inch needles though. there are certainly vessels close to the surface of the skin, but it is still possible you did simply inject into one of them, and you just haven’t had a notable reaction, as of the current moment anyways.
if you’d rather not talk to your doctor about being trans and DIY HRT (which depending on where you are is totally fair), then that’s understandable. we’d suggest at the very minimum to make sure that the injection site doesn’t get infected, and if you don’t start to feel ill then it is possible you did just damage a vessel without injecting into it. that is no guarantee, of course.
if you do start to feel not good, please seek medical attention! but otherwise do what you need to stay safe wherever you live. if you feel safe with the hospital, we’d absolutely encourage you to still go either way. if you don’t, remain on the lookout for any concerns and remember you may still just need to go, in spite of any concerns with how you may be treated sadly.
we will reiterate: if you can access any medical care that is not going to be a threat to your safety, please go for it!
thanks for the response :3
honestly the other user’s comment freaked me out and i ended up reposting this to a bunch of places (asking both my original question and how reasonable the other response was), and so far all the other responses i’ve gotten back have been either “that seems totally within the range of normal” or “probably not a problem, maybe consider having it looked at if the bruising gets worse or it starts hurting”, alongside a healthy smattering of “wow that person is way overreacting”.
that said, i do appreciate y’all’s concern and somewhat more critical take, and agree that it’d rather not take any unnecessary risks (even though it’s pretty unlikey to be ER-worthy and jumping directly to cardiac tissue necrosis is most definitely an overreaction).
i think i’ll go ahead and treat this as “potentially serious, but not urgent”: my next step (after i sleep, because it is now 2:45am and i am still winding down from the brief adrenaline shot of “fuck do i have to go to the ER”) is gonna be to shoot an email to this one doctor (not mine) a few towns over who i’ve heard is very actively supportive of DIY, and see if he has anything to say or knows who i should reach out to. and failing that, i have a few other potential local contacts who might be able to help me get in touch with doctors who won’t be weird about me injecting myself with graymarket estrogen without medical supervision.
with regards to the other user’s comment, they are not wrong in that there are medications that can cause tissue necrosis, and this being the circulatory system that can include the heart.
but in re estradiol specifically (and steroids in general), we tried looking but weren’t able to reach any meaningful conclusion about any tissue necrosis.
there doesn’t look to be much literature surrounding this topic, at least that we could find anyways. there is this review, which provides examples of medications that while causing pain and discomfort when accidentally injected into a vessel otherwise did not result in considerable complications. there are of course other cases with other medications that went far worse, but notably there didn’t look to be any steroidal medications among them. the only thing we can really conclude is that tissue necrosis in the heart is not a given. but this doesn’t mean it’s out of the question entirely either.
this tutorial about accidental intra-arterial injections states:
Whilst the exact pathophysiology is unclear (and likely varies by drug) thrombosis is believed to represent a final common pathway. This may then lead to tissue ischaemia and necrosis.
the whole thing appears to be a very broad generalization, one that surrounds a) some medications often used in hospitals and what to do if a medic mistakenly injects something into a vessel, and b) illicit drug use. but again, there is nothing in specific about estradiol or any steroids.
otherwise the most specific stuff we could find were anecdotes from online forums, which frequently mentioned elevated heartrate, it feeling awful in general, but often not being problematic beyond that. most of these accounts were about testosterone, which is a different drug, but it is also a steroid; the number of molecules injected was also more numerous than you would ever do in pretty much all of those internet posts we read.
there isn’t a satisfying answer—there is only a considerable lack of information. with what little is out there though, we’d guess that you won’t die and that you might be just fine given some time and caution, albeit getting checked out by a medical professional is still a good idea. well either that or more likely from your description you just punctured a vessel of some kind.
stay safe, stay comfy, and keep calm!
wow, what a thoroughly researched comment, thanks so much for digging all that up! even if there doesn’t seem to be much existing research wrt. estradiol, i now A) have an understanding of what they were getting at, and B) have quite a few specific things to ask the doctor.
thank you!! we would not call it thorough by any means, but then again anything evidence-based goes a long way compared to pure conjecture, i.e. so much of the internet. we just wanna make the world a better place.
on a more personal level we’d say we absolutely disparage fearmongering and saying scary stuff to get someone/many to do stuff, even if it is good stuff. the stress and fear associated with a blown-out concern can in the end be harder to deal with than the concern itself, and leads to real difficulties for all involved! hell, being frequently stressed for extended periods of time is a proven health risk. stress has its valid places but we shouldn’t try and cause undue amounts of it.
please do be curious though, we like super admire that. best wishes <3
I agree with the top comment of this thread. I had an injection the other night that hurt more than usual and some of the actual liquid pushed back out the injection site. Still a bit sore a day later. I just didn’t fully relax my leg I think. Something like that. Some combo of not getting the needle far enough and my leg being a bit tense. I was kind of rushing so maybe that’s part of it. Wasn’t really able to do the regular ritual.
Definitely monitor and such. Doesn’t seem so out of the ordinary that you need to out yourself to you doctor right away, but seek medical attention if it doesn’t improve from how you described it. Like bruising hopefully starts to fade from here on out.
Could go to an urgent care or something that isn’t your doc?? Just say it happened with your prescribed meds or something. Should be able to keep those records separate if you play your cards right. Some folks might have thoughts on that for other reasons, but it’s always something I keep in the back of my head if I am ever doing DIY.
Go to an ER or call your physician immediately. Your problem isn’t hormone levels, per se, it’s anything from tissue death to blood clots.
You need a professional answer, one way or another.
that seems like a bit of a leap and is bordering on alarmist. they said they have a bruise, not that their tissue is dying… its very common to get a big bruise from a rough or poorly done injection or blood draw. given that its already been a couple days and they havent said anything about other symptoms i really doubt they need to go to the ER unless something new develops.
Okay, that is definitely an answer I was neither expecting nor hoping for… I guess I’ll call my doctor when they open up tomorrow (it’s 1am here) and simultaneously come out and admit I’ve been doing DIY HRT for nearly a year, sounds fun :|
Just for my understanding: what exactly are you referring to when you say “tissue death”? Blood clots as a result of very high blood estrogen make sense to me, but are you suggesting that I mighr have already fucked up a previous injection and my most recent one went into an existing pocket of necrotic tissue?
Well, it’s your cardiac tissue necrosis. Or nothing at all because you just hit a capillary and some scar tissue or whatever then kept going through, but that’s what the professional is supposed to determine instead of randoms from the Internet.
