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Preface

Hi everyone!

I am really scared of needles. When I was a child, I was scared of getting vaccinated. I was a very anxious child, and the idea of a needle going into me was terrifying, not just because of the pain but also because of the foreign object going into me. I felt overwhelmed, and so I bolted - I ran out of the pediatrician's office and into the hallway and tried to flee. Staff captured me and held me down and forcefully injected, which was extremely painful and traumatizing.

Since then, I have always had really difficult experiences with needles. They unnerve me, it's hard to think about them going into me, and it's easy for me to feel anxious anticipating any blood draws or vaccines. I have never fully fainted around needles (I have always tried my best to cope), but I have nearly fainted several times despite my best attempts.

For these reasons, it has been a life-long fear of mine that I would become dependent on a medication I have to inject.

Yet of all the options, I still chose to inject my sex hormones. There are lots of reasons why I believe this is the best method (esp. compared to oral or sublingual routes), but I wanted to share some tips and tricks for other trans folks who have fear of needles like I do so that they can be empowered to inject hormones too.

Tips and Tricks for Injecting Hormones

Location: do the injection somewhere that you will be safe if you pass out (somewhere soft and flat, for example). It helps if the place is comforting as well - free from noise, distractions, stress, etc. Do what you can to create a safe and comforting environment.

Position: when you are injecting, keep your legs propped up (when you start to faint, blood can rush to the legs and keeping them level with your heart can slow or prevent fainting). I like to sit on a couch with my back supported, and use a firm pillow under my knees so that my legs can completely relax while remaining elevated and my legs level with my heart.

Blood Pressure: to help avoid fainting, do what you can to increase your blood pressure:

• be as cold as you can tolerate (it shunts blood to your core from your extremities and increases blood pressure)
• drink lots of water and "overhydrate" before injecting (this also helps reduce pain)
• if you've recently woken up or have been lying down for a long time, move around a little first and get the blood flowing - go up and down some stairs, etc.

Subq: to help with needle phobia I choose to inject subcutaneously (into fat) rather than intramuscularly. This is because subq injections can be done with a smaller gauge (not as thick) and shorter needle, so there is less pain and less anticipation of a big needle going into the body; I use 27G 1/2" needles (the grey ones) to inject and I barely feel any pain, sometimes there is literally no pain.

Draping: drape blankets over the parts of your body you're not injecting into to make it easier to forget you're injecting into your body (instead, make the injection site a foreign object, essentially dissociate from it and treat it as if it's all just mechanical, don't identify with the part you're injecting into).

Body part: inject into body parts that you don't find as disturbing to inject into; I find injecting into my belly much more distressing than injecting into my thigh (note: where you inject is constrained by the method you use, you can't just inject anywhere - I'm relying on you knowing where you can or can't inject, but figure out among those options which places are easier or harder for you mentally, if there is any difference at all).

Short break: especially when I first started injections I found it helpful to take a short break between drawing medication into the syringe and injecting; essentially this is about titrating exposure and minimizing built-up fear and anticipation. Over time I have found the need to do this has gone down, but I suggest it anyway - do something else, think about something else, don't look at needles or think about injecting at all for a few minutes after drawing up medication and before injection. (Note: don't take too long of a break, there are concerns about sterility and generally this advice would go against medical practice, but I think given the context a short break is acceptable and a helpful way to cope when you first start injecting.)

Quick jab, not slow push: when injecting subq (I don't do IM, so I can't say if this applies), pinching the fat and injecting quickly in a forceful and committed way helps avoid pain. Slowly pushing the needle in is not only more painful but much harder psychologically (it gives you time to think about it and panic), so it's better to almost surprise yourself and let your hands do the motion without having to think about it too much, and doing it quickly means you can't hype up the fear as its happening

Look away: I prefer not to look as the needle is going in, or out, and I like to keep a finger in the way of being able to see where the syringe meets the body while pushing the plunger down. Thinking about the needle in my body is part of what freaks me out and not seeing it helps reduce exposure - this may or may not apply to your needle phobia, and obviously you want to know you're injecting in the right place - so I look and orient where I want to jab first, and sometimes I try to look at more neutral parts of the syringe (i.e. not the needle) to help coordinate the injection.

Don't aspirate: subq injections of small volumes don't require aspiration (that's where you pull back a little on the plunger to see if there's blood which indicates you've accidentally hit a vein), so don't fret about whether you have hit anything.

Mental Simplicity: keep the injection mentally simple. I find it best to keep my mind elsewhere while the needle is in me, and to only think about the injection as little as is necessary to do it. Make it procedural and stay narrow-minded. Keep yourself from thinking anything beyond that simple procedure (like: OK, thrust needle in; good, now slowly increase pressure on plunger; good now slowly remove needle). Fill the gaps between steps in your mind with a distraction - I like to look out a window and take in a view, others might find music helpful. Don't think about what you shouldn't be thinking about, instead actively distract yourself with something else.

Contextualize the pain: This tip is a bit weird, but sometimes my anxiety builds up such fear around injecting I almost cannot physically do it, and in those moments I find it helpful to take a deep breath and then think about other times I have experienced much worse pain or physical trauma. Remembering those instances, and in particular how those sensations were not as bad as I would have thought and how I survived those helps put the injection into perspective: this barely registers as painful, and is causing almost no physical damage to me. Don't do this for a physical trauma that you are still disturbed by, it works best for cases where you're not distressed by the example. Most people have stubbed their toe and that hurts so much more than the injection, but you may have a better example - experiment and find what's helpful.

Reframe the needle: this mental trick might be too specific to me, there have been times where I have had things impale me by accident (like when gardening a dry reed of grass once shunted into my hand, or one time a stray sewing needle left on a bed ended up poking into my leg, etc.) - in my experience these events were not traumatizing or fainting type episodes, there was something just matter of fact and not fear-inducing about these experiences for me, so sometimes I like to pretend that I'm not pushing a needle into me, but instead I think of it like that reed of grass - a benign object, nothing to be scared of. Somehow this bypasses some of my needle phobia. I suspect it's because my needle phobia is based on medical trauma and by taking it out of the medical context in my mind I find it much easier to cope with. Depending on where your needle phobia comes from or what you are sensitive to this may or may not help (it may even make it worse, so be sensitive to your needs).

Control: finally, I would just say that my needle phobia is minimal when injecting myself now and I realized having control over the injection was important to managing and overcoming that fear. I have more needle phobia when others draw blood now than when I inject myself, and at first the relationship was inverse: injecting myself seemed so much worse than having my blood drawn. Also each injection seems easier than the last for me, and if you can successfully inject without panicking or experiencing fear or other negative emotions, having those "positive" or at least neutral injection experiences helps build a little bit of mental safety, and you want to protect that sense of safety. You may not have control over this, but for me that has meant to whatever extent I could, I try to reduce exposure to negative experiences with needles and emphasize positive experiences (and when I've had a negative experience, I try to give myself time to recover before re-exposing myself, so I didn't "spoil" the next experience as much).

Positive Associations: eat something sweet right after your injection as a way to build positive association with injections (there is actually research showing this helps, that's part of the reasoning behind having candy at pediatrician's offices). Likewise you can use fun bandaids (I use Welly bandaids) as a way to build some positive associations into your injections.

Prologue

All I can say is that injections were literally mentally impossible for me when I first started.

There were times I broke down sobbing after a particularly difficult injection.

There were times due to dissociation and distraction that I jabbed the needle in too quickly and the needle bounced in and out of me and I had to redo the injection.

There were times I sat there with the needle in hand and it took 20 - 30 minutes of mental struggle before I could get my hand to do the action of pushing the needle into me.

So I won't lie, there were some difficult moments - but overall, injecting was so much easier than I had built it up to be in my head. So many injections were easy, and shockingly I found more and more of them were pain-free.

These days I barely have to think about my injections at all - I practice none of these accommodations (except sometimes making sure I've had a little food and water if I'm injecting first thing in the morning and I'm a little woozy, just as a safety precaution). Injections are easy, and they get so much easier over time.

If you are worried about injections, I get it - but this is something you can learn to do, even with a needle phobia.

Lastly, I want to allow this to be a space for others to give their own stories and suggestions, and I want to encourage anyone who is confused or who is curious to feel free to ask me any questions they have. I'm an open book and wish to be helpful.

Thanks so much!