how to cope mentally during gaps in HRT
how to cope mentally during gaps in HRT
I recently had an injection that seemed to go wrong (CW: blood, I inject EV subq and I hit something like a capillary, there was a lot of blood and it bruised badly afterwards). Within a couple days I felt unusually dysphoric as a result of what I assume was a failure for the oil to depot and slowly release over time.
I get these "dysphoric thoughts" that maybe the estrogen is causing the problems, that I don't have objective proof that I'm trans, etc. Lots of doubt, paranoia, and increasing amounts of anxiety and irrational fear (about transition, but also in general, e.g. thinking spiders are in my bed), and I start to experience depression and anhedonia (things aren't as pleasurable, everything feels pretty flat emotionally, I just feel "bad").
Of course when I inject again and it goes well, I feel much better and I forget about these problems.
I was just wondering if anyone has advice on how to deal with dysphoria when there are gaps in the HRT. Obviously in the long term, surgery will fix the hormone issue and I suspect that will fix this problem. Until then, though, I am stuck in a rather fragile place where I feel normal (even good, even amazing) when my estrogen levels are high and suppressing my testosterone. Any small slip in that and I barely function as a person.
Before HRT I would just do whatever I could to increase mental well-being:
- physical exertion (aerobic exercise, weightlifting, etc.)
- going outside and getting sunshine
- keeping up with hydration
- keeping good sleep hygiene (sleeping enough, going to sleep at the same times, etc.)
- meditation every day
But now it feels harder for me to "bootstrap" when there are gaps in HRT and my hormones aren't right, it's like I'm no longer used to how hard it was before.
Anyway - any tips or thoughts, would like to hear other's experiences.
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If it helps, it's unlikely you hit a vein with SubQ injections, especially if you did it at 45 degree and especially if your needle is short enough and you aren't hitting the muscle. So it's a bigger chance you didn't, and your E is fine, even if you got hurt. If you are with a doctor (or if you are on DIY then the doctor is yourself), talk with them about injecting more often (and maybe a higher dosage) just in case. For some people the ups and downs can cause mood swings and stuff. It's also important to know mood swings are not reliable as estrogen indicators, since they are influenced by many factors. A better though not completely reliable option is (cw sex and AMAB genital mention)
spoiler
check on the semen on your masturbation, and compare a few days after the injection visually to what you produce the day of the injection. It should remain consistent, most but not all people on good E levels produce a kinda transparent, white-ish watery fluid.
Obviously though, the best way is blood test. But not everyone has that option sadly.
I used a 1/2" needle at 90 degrees into my thigh. I think my thigh has been maybe losing fat? I injected for a couple months without much issue in my thighs, suddenly I've hit some kind of blood supply twice now in the past week or two, this time it bled significantly more and more forcefully, enough that I had to use my hands to prevent the blood from getting on everything, the blood covered my hands and I had to use a rag to clean it all up (the other time there was more like a few drips of blood, but not as forceful or copious).
I inject 5 mg EV every 4 days currently. I consider this dose / frequency enough normally, I've had a couple weeks of it working well for me. I do see an endo, but he is giving me a lot of autonomy to control my dose. I have had blood work twice, once before HRT and once after 2 months or so (before I started this new dose regimen).
Thanks for the semen tip, that is helpful. I have noticed much less semen, even no semen sometimes (esp. before this semi-failed injection). My bad mood seemed to correlate with semen coming back. There are other physiological signs along with the mental symptoms, like erections when I wake up in the morning, or body odor changes (my armpits smell spicier / worse).
It does seem like the depression is correlated with too little estrogen, but I haven't had an issue until this recent injection where the E didn't depot properly (maybe some of it ended up in the blood supply, maybe some of it ended up not in the muscle or fat, but in the skin layer, I don't know why it changed anything, I don't see any explanation as to why it would mess up the depot effect).
It’s worth noting that quantity of semen can vary throughout your progress in HRT. In my case I produced little to almost none around the first 4 months but now (6 months) my semen is in much more quantity but more diluted. That seems pretty normal according to what other trans people go through, in fact you might eventually notice more pre-cum. Some say it could be related to cis women’s lubrication and your body trying to replicate that.
I would incline to say, based on what you say, maybe you are experiencing too little estrogen, but hopefully you are aware that self diagnosing has the problem of confirmation bias and placebo, which is the reason I don’t put them that much weight into them.
My advice is three things: first, next time you inject make sure you have at least one or two inches of fat between your fingers, if you don’t use another area like your tummy. Probably use 45 degrees especially if you’re on the skinny side; besides, imho I don’t get why people that want SubQ inject in 90 degrees anyways, afaik there are no advantages to it and only risks hitting muscle instead, and IM can hit a blood vessel. Second, if you haven’t had issues before this incident then perhaps you have nothing to worry about but make sure to keep in mind your blood test. Third, if it’s an option for you perhaps consider getting estradiol cypionate, or even better enanthate? Those have a longer half life than valerate so they might make your levels more consistent and you could inject less often (people on cypionate commonly inject weekly, and on enanthate every 10 days or even every two weeks).
That makes sense, I have definitely seen an increase in pre-cum. It's surprising how natural all of this feels. It's a huge change, and I was worried when I started HRT how I would feel about all of this.
Thanks for evaluating my account, it does seem like too little estrogen if I had to guess, but I do hate the ambiguity (esp. when I'm in the midst of the dysphoria, when I become paranoid and increasingly susceptible to my internalized transphobia).
I think the advice about injecting at 45 degrees is helpful, I have been injecting at 90 degrees because my endo had a patient who injected too shallowly and now he drives home in his patients that you have to inject subq "deeply".
I wouldn't consider myself on the skinny side, but I admit I have a large build and I might have less fat in some places than I tend to think. It might be that I'm losing some fat around the thigh areas where I reliably had fattier deposits before.
Either way, the advice to inject in the tummy is exactly the conclusion I came to and that's where I injected last time. I have moderate to severe needle phobia and injecting into my thighs was much easier when I first started off, and injecting into the tummy was mentally fraught. Now it seems like it's more difficult but much more doable, I have learned to cope better with injections.
I would love to be taking a different ester like cypionate and esp. enanthate. I talked to my endo about it and he just shrugged and said that's a question for a pharmacist. He doesn't know any that offer other esters and I would have to find someone that would compound it for me. I'm based in the U.S., and I have one trans-fem friend who compounds their own estradiol enanthate. They bought some powder online and they mix it with oil and some preservative to make vials. I think the supplier is China, purchased on sketch websites. All based on Lena's guide.
It's sketch, but I would still consider doing it, esp. to guarantee long-term HRT supply, but with the current supply of EV from official sources I haven't been particularly motivated to take those risks and do all that research to double-check everything myself.
Do you have any advice on finding alternate esters?
Yeah if your insurance covers HRT then it might be for the best to stick with valerate until you find a pharmacy. Sadly I don’t have any tips for getting it officially. I do DIY so I buy EEn from Otokonoko. If you are here then I assume you would avoid using Reddit lol, but you might have a better chance if you ask in one of their subreddits.
Honestly I’ve never injected in thighs and find the tummy more reassuring lol, to me I barely feel it there. Ig people sometimes are built different ig
Regardless, glad I could help :3
Thanks, good to know re Otokonoko, I think I had heard of that before. I see in the /r/TransDIY that they link to https://hrtcafe.net/, I had looked into DIY originally but was spooked about potential risks. If you don't mind me asking, what dose do you take of EEn and how frequently (and how do you inject, and where)? Looking at the injection simulator, and here's a screenshot of what I'm looking at, 15 mg EEn every 14 days gives a similar-ish pattern to my dose of 5 mg EV every 4 days. That dose of EEn seems to peak a bit higher and the trough is a bit lower than EV every 4 days, but a dose of 7 mg EEn every 7 days seems more stable overall.
I can't tell exactly, but I suspect because I'm only 3 months into HRT that the spikiness of EV is actually helping suppress the T more effectively than if I had a more stable and lower dose (for example, I noticed injecting between 3 and 4 mg EV every 3 days was not working well to stabilize my mood and effectively suppress T; it suppressed it to some extent, but not enough it seemed; only with 5 mg did it seem like I was having real relief, and at that point the question was how long that relief lasted before I needed another 5 mg injection).
I do think injecting into my belly has become easier, so I'm not too worried about it now (I've injected into my belly maybe the last three injections now); maybe it was just not the best place for me to start off injecting into (since I have such bad needle phobia).
Thanks for everything! <3