There are plenty of ways to get hormones (gel, patches, pills, pellets, sprays, etc) but the most common way is injections. Hormones (testosterone or oestrogen/estradiol) are thick oily substances and need to be drawn up with a bigger gauge before they are injected. 

Injections can be done with 1cc/ml syringes or 3cc/ml syringes, typically once or twice a week. Best practice is drawing with one needle, then switching the needle off the barrel to the injection needle. Some folks don’t like switching needles and will use either the drawing needle to inject, or the injection needle to draw. Drawing is done from vials or ampoules. Syringe or needle filters are necessary if drawing from glass ampoules to avoid small glass shards. They need to have a 5 micron filter or smaller. Most needle exchanges carry syringe filters (wheel filters) that have smaller filters than 5 micron.

There are two types of injections:

IM Injections (intramuscular)
- Needles are 1.5 inches long, usually between 22g and 25g. Providers often prescribe 22g, however the gauge can be much smaller for less painful injections. 
- Typically done in the thigh or butt.
- Some people (smaller or skinnier) use needles that are 1 inch long instead of 1.5 inches. 

SubQ Injections (subcutaneous)
- Needles are ⅝ inches long, usually 25g. 
- Typically done in the stomach or thigh.

Carrying supplies needed for HRT is incredibly important as many trans people do not get their hormones from a physician but from other sources (friends, family, black market, online pharmacies, etc) and do not have access to the right gauge sizes for injections. DIY (Do It Yourself) hormones or street hormones are very common. If possible, when acquiring hormones from a non-medical setting, it’s important to try and make sure that they are as safe as possible. Expired hormones should be avoided, as well as hormones that might have been tampered with. Having a regular, trusted supplier is recommended. 

Maintaining a schedule for hormones is key. This can be difficult for those who have trouble accessing their hormones and supplies and/or those who are unhoused. It’s important to work with people to try and find the best way to create a realistic schedule that works for them. Skipping a shot for a day or two isn’t too disruptive, but having fluctuating hormone levels will lead to mood swings and uneven levels. It is also important to keep levels stable so that their effects are consistent. Hormone Replacement Therapy effects are likely to be delayed or minimized if hormones are not taken reliably. 

A very important part of Hormone Replacement Therapy is getting hormone levels monitored, which can be difficult for folks without health insurance or those who face barriers accessing healthcare. Not all clinics provide the blood tests necessary and it is often expensive. Excess or uneven testosterone can convert to estrogen, and put people at risk of cancer or liver damage. Excess or uneven estrogen can cause anxiety and migraines, and put people at risk for blood clots. Finding providers who can do the required blood tests is often very difficult.

Hormones should be monitored every three months the first year, and once or twice a year thereafter. This is especially true for those who take unprescribed hormones and might be taking the wrong dosage, or kind of hormone. Liver and cholesterol levels should also be monitored. 

Some people believe that subcutaneous injections work less well than intramuscular. They are just different injection types. SubQ injections tend to be less painful for some folks.