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Syringes and Gender-Affirming Hormone Medications: Ensuring You Get the Right Dose

Content Warning: Needle Imagery
This document contains images depicting needles, which may trigger anxiety or discomfort in some individuals. Your well-being is important to us, and we encourage you to prioritize your mental and emotional health while engaging with this content.

Planned Parenthood of Michigan prescribes injectable testosterone and estradiol (estrogen) for gender-affirming hormone care. When using injectable medications, it is important to ensure you are measuring/drawing-up the correct amount of medication. The dose of injectable medication depends both on the concentration of the medication (amount of medication in a specific volume) and the volume of medication injected.

How can I figure out how much medication I am supposed to inject?

You will want to look for a label on your medication with your specific prescription instructions. The label may be on the box or packaging, or the medication vial itself. It is important to check this label each time you pick up a prescription as this volume you inject may change based on dose adjustments or based on changes in the concentration of medication prescribed. This label also contains important information about whether the vial is intended for single-use (where the vial is used for one injection and extra medicine is thrown away) or whether the vial can be used for multiple doses (multiuse, or multi-dose).

What size syringe is recommended?

We recommend using 1mL syringes for injectable hormones because it is usually easier to draw up accurate doses of small volumes of medications using small syringes. This may be less of a concern for someone using a medication requiring them to measure 0.5 mL than for someone needing to accurately measure 0.15 mL.

What type of syringe is recommended?

We recommend using “Luer lock” syringes (where the needle screws on the syringe) rather than slip-tip (where the needle tip slides straight onto the syringe) as the Luer lock connection tends to be more secure for injecting oil-based medications like hormones.

Why can getting the correct injection supplies be challenging?

People may have trouble obtaining the exact injection supplies prescribed for a number of reasons: insurance may only cover a specific brand or size, insurance may not cover injection supplies, a person may not have insurance, or the pharmacy may only stock one syringe size (for example: 3 mL instead of 1 mL) and may make substitutions based on what they have in stock. As a result, or by preference, people may choose to purchase syringes over the counter or online. If you need more information about purchasing injection supplies, this information may be helpful.

Using Your Syringe

To make this process easier and ensure all people using injectable hormones know how to translate what is written on a prescription to their syringes, these images show commonly prescribed medication volumes in both 1 mL and 3 mL syringes. Two common volumes prescribed for hormones are 0.15 mL and 0.4 mL, shown in both 1 mL and 3 mL syringes.

If you have any questions about how to take your medications or about your prescription, please reach out to your clinician. Please do not adjust your dose without consulting with your prescriber. View these videos to learn or review how to perform your injection.

1 mL Syringes

Dosage examples using a 1 mL syringe

3 mL Syringe

Dosage examples using a 3 mL syringe.

Common Questions

How do I read a syringe?

The hash marks on the tube of the syringe indicate a certain number of milliliters or fractions of a milliliter. Most syringes include incremental hash marks between larger, numbered ones. The volumes discussed here are in milliliters (mL) which may be used interchangeably with the term “cc.”

  • On a 1 mL syringe, each of the smallest lines count for 0.02 mL, and the longer lines indicate 0.1 mL intervals.
  • On a 3 mL syringe, the smallest lines count for 0.1 mL intervals, the longer lines indicate 0.5 mL intervals.

Do I need to draw up “extra” (beyond the prescribed volume) to account for medication “lost” or left in the needle and tip of the syringe?

No. The volume of medication prescribed accounts for “loss” in the syringe tip and needle. You should draw your medication up so that the plunger is at the correct dose line as shown above, and then switch the needle on your syringe from your “draw” needle (usually 18–20 gauge) to your “injection” needle (usually 22–25 gauge) and proceed directly with your injection as shown in these videos

How long can I use one vial of medication?

Injectable medication vials are packaged and labeled for single-use or multiuse. Most commonly, testosterone is available as a single-use 1 mL vial and delestrogen is available as a 10 mL multiuse vial. This labeling has to do with the preservatives, packaging, and testing a particular medication and vial has gone through. 

Most patients using single-use testosterone vials will be instructed to inject a small amount of the volume in the vial (example 0.4 mL of a 1 mL vial); the remainder of the medication in the single-use vial should be discarded. Said another way, a person prescribed a 0.4 mL dose of testosterone each week, who is provided 1 mL single-use vials by the pharmacy, will need a new 1 mL vial each week (discarding the extra medication each week). We recognize that some people use single-use vials for several doses but cannot recommend this given the package labeling. 

Multiuse vials are most common for delestrogen but are occasionally available for testosterone. Multiuse vials are intended for use for 28 days after the vial is punctured (the first dose is removed). For people doing weekly injections, this means a multiuse vial can be used for 4 injections over the course of 4 weeks. In the setting of a 5 mL vial of delestrogen, this typically means there will be a large volume of remaining medication after 28 days that should be discarded. We recognize that some people use multiuse vials for more than 28 days after puncturing but cannot recommend this given the package labeling.


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