Escalator

Good thing

I did a good thing today.

It makes me think... maybe I have value after all.

Flowers

One of the first additions to my all-new female wardrobe was a floral raglan shirt. I own multiple dresses adorned with flowers; and my most recent clothing purchase was a pair of floral-bedecked high-tops.

As a kid, I spent a lot of time drawing flowers. I loved laying out the stems and leaves in intricate, rhythmic patterns; punctuated by colorful collections of petals.

I’ve documented previously my experience with PTSD-type issues; and during one such episode, I opted to seek calm via art therapy. I immediately defaulted to drawing a collection of flowers; each one different; ever-overlapping one another.

Incredibly, it only occurs to me now - far into my transition - that I love flowers.

It is a powerful testament to gender norms - to the guilt and fear they breed; the warping effect they have on our view of ourselves and the world around us - that only now, decades after the fact, that I can acknowledge this love.

After months of silly overwork, I finally got to see my stylist! I feel so much better now that my hair is both multicolored and a more manageable length. 🙂

The second song is now up for preview from my friend’s new album, Sleepyhead. It is by turns pretty, and pretty raw; go listen now!

(Original from wintersbucky; via feed-the-roses.)

I went the injectable route at the advice of a friend; and I always wanted to share my knowledge on this subject with others. Talk about perfect timing, too - it’s injection day!

Disclaimer: there’s a lot of room for variation in terms of what’s injected, how it’s injected, etc.; be sure to ask for and follow the instructions of your provider.

Medications

I inject 1ml of 5mg/ml Estradiol Cypionate (brand name: “Depo-Estradiol”), every two weeks; and 1ml of 150mg/ml Medroxy-Progesterone Acetate (brand name: “Depo-Provera”) every ninety days.

Keep a diary of your injections; and in particular the manufacturer, lot, expiration, and serial number of every medication (all of which will be clearly printed on the packaging). This information can be helpful when identifying issues.

Vials

Both medications come in little glass vials. There’s a sterile plastic cap on top (which you break off); and underneath, a rubber seal designed to prevent air from entering the vial.

The Progesterone comes in a single-use vial, containing just one dose; you dispose of the vial afterwards. The Estradiol comes in a multi-use vial, containing five doses; you keep the vial for next time.

Note: there is a risk that multi-use vials can become contaminated with bacteria. Be sure to follow the injection process carefully; maintain sterility; and store your medication in an appropriate location and at the correct temperature, per the instructions.

In medical settings, multi-use vials are good for 30 days after opening; at which point they are disposed of. In my case, I’m keeping the vial for 52 days. I wouldn’t recommend pushing too far past that, as the longer the vial is in use, the higher the risk of contamination.

Injectable supplies

Each injection requires the following:

A syringe,

A large needle (mine are 18g, 1.5′ long, and pink),

A small needle (likewise, 25g, 1′ long, and light blue),

Two alcohol pads,

A Band-Aid (mine has llamas on it)!

Normally you’ll be proscribed a syringe with one of the needles already attached; and the other needle by itself. Alcohol pads and Band-Aids can be purchased from your local pharmacy.

Needles

During the injection process, you will need to switch the needle attached to the syringe. The syringes I use feature a “Luer-Lock” connection, which means they screw on and off.

Each needle comes with a protective plastic cap; you always want the cap on the needle when attaching or removing it from the syringe. (Safety aside, the needles are intentionally designed to make them difficult to add or remove without the cap attached.)

There’s a reason there are two needles: when you need to suck fluid into the syringe, it’s very difficult if the needle is too small. (This is why blood draw needles tend to be on the bigger side.) When you need to squirt fluid out of the needle, however, the size doesn’t matter as much. (Plus: smaller needles cause less discomfort when poking people!)

So the big needle is going to be what you use to draw your medication; and the small needle is what you use to inject it. (When I started my regimen, I asked my provider if a nurse could show me what to do. I wasn’t aware at the time that there were different needles involved; so when I saw the big needle, I was terrified!)

Drawing the medication

First things first: wash your hands! (At every step, you want to prevent the possibility of germs getting into your supplies or worse, into you!)

Take your vial, remove and discard the plastic cap, and clean the surface of the rubber seal with an alcohol pad. (This prevents contaminants from being carried into the vial.)

Next, you attach the large needle to the syringe, and withdraw the plunger so that it contains the same amount of air as the medication you wish to withdraw. (In my case, 1ml.) The plunger will have a rubber seal that meets the inside of the syringe surface; the top of the seal is what you will be measuring against.

Hold the vial level, and with the syringe pointing down, insert the needle through the rubber seal of the vial. Now, carefully turn everything upside down: you should have the syringe pointing up, and the vial pointing down (with the medication pooling around the seal).

Inject the air in the syringe into the empty space in the top of the vial; this will help keep the pressure in the vial constant. Submerge the needle tip in the medication, and gently draw it into the syringe.

It’s normal to have some air left in the syringe; or to accidentally draw some in from the vial. You can squirt some medication back into the syringe to remove the air bubbles; or tap the syringe to shake them free. Tiny air bubbles are normal and harmless; but you don’t want a large bubble in there!

When finished, withdraw the needle from the vial smoothly and quickly. (This is a non-issue with thicker medications, such as Estradiol; but with a thinner medication - such as Progesterone - withdrawing the needle slowly can cause a small amount of medication to squirt out of the vial.)

Preparing the injection

Remove the large needle from the syringe and replace it with the small one. Push the plunger ever so slightly; if you see a tiny drop of medication at the end of the small syringe; this confirms that there’s no air remaining.

You should now have a filled syringe, ready to go!

These injections are intramuscular; that is to say, the goal is to create a 'depot’ (i.e. little bubble) of the medication in a muscle. This is exactly the same as most vaccinations; except they are normally delivered in the deltoid muscle of the arm, whereas these injections will be delivered to the vastus lateralis muscle in the upper thigh.

(Location is determined by a number of factors; primarily, the size of the depot being created. Vaccinations tend to involve very small amounts of fluid; and so it is more convenient to inject them into the likewise smaller deltoid.)

Imagine the top of your thigh is divided horizontally into three sections, and you can see the dividing lines. The line nearest your body is the target. It is recommended that you rotate your injection site with every shot. My rotation schedule looks like this:

Outside of the left thigh,

Outside of the right thigh,

Middle of the left thigh,

Middle of the right thigh,

Inside of the left thigh,

Inside of the right thigh.

Keep in mind that some spots are more awkward to access than others. (Today’s injection was in the outside right thigh; as I’m left-handed, having to reach across my body is a nuisance.)

Once you know where the injection will be going, clean the area with your other alcohol pad. Give it some time for the alcohol on your skin to evaporate. (You can fan air over the skin to speed up this process.)

If there is still alcohol on your skin when you perform the injection, it will be carried into your tissue and create a burning sensation. This is not dangerous; but it is unpleasant and something you will want to avoid.

Inserting the needle

Everything is ready! (Also, there are no images for this part; I needed both hands here for what I was doing.)

Sit on a chair or similar object, so you can your thighs are horizontal and your lower legs vertical. Find a position where your muscles are relaxed. (Tense muscle tissue is harder to penetrate; it won’t stop you from completing the injection, but it can cause more discomfort.)

Take the syringe in your dominant hand, and hold it like a throwing dart. With your other hand, pull the skin of your thigh taut, towards your knee. (This is the “Z-Track” method - it helps to prevent your medication from leaking back out of the injection site.) Take care not to place your fingers on the area you just cleaned.

Now, the part that gets people: you have to stick the needle in your thigh. Understandably, there is fear that this will hurt. It’s okay if you need a minute to work up the courage! Try to keep in mind that if you do everything right, discomfort should be minimal.

When you are ready: stick the needle in, quickly and smoothly, at a 90º angle.

Do not hesitate. (I totally get it - but if the needle doesn’t fully insert, you’re either going to have to push it the rest of the way, or remove it and try again. The faster and more confidently you insert the needle, the less you will feel it!)

Don’t worry about it going too far in. There’s a plastic nub at the end of the needle, designed specifically to prevent this from happening.

If everything has gone to plan, then the needle should be fully inserted in the thigh, and no longer visible. You can now remove the hand holding your skin taut. (This can feel a little weird at first, as the underlying tissue is trying to move back into position against the needle.)

Delivering the medication

With one hand, hold the tip of the syringe steady against your skin (so that you don’t accidentally withdraw the needle). With the other, slowly depress the plunger, injecting the medication into your muscle.

How slow? Slow. Nursing guidelines recommend ten seconds per 1ml of fluid injected. I normally double that. (Also: as aforementioned, Estradiol is frequently delivered in an oil-based medium, which makes it thicker. Thicker fluids take longer - and more effort - to push through a small needle. When in doubt, go slower.)

Cleanup

Once the medication is fully delivered, carefully remove the needle, and place the cap back on. You might see a drop of either medication or blood at the injection site; this is normal. Cover with a Band-Aid. You’re done!

Place both of your capped needles in a solid container. (I use an old prescription bottle.) This way, when you dispose of them, there’s no danger of someone getting poked by a used needle.

All other supplies should be disposed of (barring the aforementioned multi-use vials). Tempting though it might be to save time and money, do not reuse syringes or needles. (This is just asking for an infection!)

Aftercare

It’s normal for the injection site to be sore the next day (as if you had an invisible bruise). This is because the act of creating the bubble of medication in the muscle does a small amount of damage.

It’s not normal for the site to swell; turn red; itch; or become hot to the touch. These are signs of an infection. Such infections are easy to treat (usually with a course of antibiotics); but it’s important to seek medical attention quickly, as they can cause serious complications if left unattended. (This is especially true of the red patch grows rapidly!)

What can go wrong?

I’m not going to lie: lots of things.

A couple of times, inserting the needle has triggered a leg spasm. This doesn’t hurt; it just feels really, really weird.

Occasionally I will accidentally hit a blood vessel with the needle. (This is unavoidable; you can’t see them from the surface.) This doesn’t pose an issue other than being mildly painful.

I once hit a nerve the same way. The pain from doing so left me in tears. (I want to stress however, that this happened once in fifty-seven shots.)

There was a syringe with a defective plunger that wouldn’t depress the whole way. That was frustrating; but simply meant I had to start over and go again.

Likewise, I had a friend whose needle detached from the syringe while it was still in her thigh. Obviously, an upsetting scenario; but one that can be avoided by ensuring that the needles are firmly locked into place prior to use.

If you have questions or issues, and need help - be sure to ask to talk to a nurse at your provider’s office! They spend a lot of time poking people in various ways, and have a wealth of expertise to offer.

Another really resource is trans men! The amount of information they’ve gathered on the analogous act of injecting Testosterone is staggering! When I run into a problem I’ve never seen before, they are my first port of call.

What can go right?

If you perfect your technique and can overcome the mental hurdle of sticking a needle in yourself, the process can be quick and discomfort-free!

On the science side: different methods of administering Estradiol have corresponding levels of bioavailability (i.e. how much of the Estradiol actually ends up in your system and doing what it’s supposed to instead of, say, accidentally being digested). Of these, intramuscular injection has the highest degree of bioavailability .

Additionally, the hormone levels of cis women are not static; there’s a complex interplay at work where they rise and fall. Injecting Estradiol every two weeks more closely resembles this cycle than taking the same amount of medication every day.

A final plus: you only have to remember to take your medication fortnightly!

In conclusion

I hope this is helpful to every trans woman thinking about going down the injectable rabbit hole. It can be rather daunting; but if you’re willing to invest the time and effort, it can be incredible rewarding!

why the fuck did I willingly switch to injectable estrogen im fucking terrified of needles

Unexpected HRT side-effect #8

Skittering!

Strictly speaking I started HRT on year ago; but my endocrinologist didn’t want to go full-throttle with dosages until he had established that doing so would, in fact, not cause me to die (which seems perfectly reasonable).

It really wasn’t until around... April-ish?... that my levels actually got to where they needed to be; and the moment it happened, it was like a switch in my body just flipped.

Then I started skittering around the apartment. I would bounce off the walls! Dance in the kitchen. There was shimmying. Oh so much shimmying!

I told my spouse: “Sorry, I don’t know why I do this. I guess it’s just a thing!”

I’ll never forget their response: “You don’t need to apologize. It means you’re happy.” Beat. “I’ve... I’ve waited so long for this. For you to be happy.”

Of course, this does rather make it sound as if the preceding years were spent in unspeakable misery, and this was not the case. It might be accurate however to say that I spent a lot of time giving my love to others and never reserving any for myself. Undoubtedly there are greater acts of loving oneself out there; but I figure committing to turn one’s gender upside down is up there!

Here’s to my newfound physical expression of joyousness!

Immediacy is a big plus. (I understand all too well how easy it is to forget an idea if you don’t externalize it right away! And that’s to say nothing of the scourge that is Not Enough Time And Energy; which I know you know all too well. 🙂)

Regarding the fanfic asks: 📈, 🛠️, and 🤗!

📈 How many fics do you have?

Uh. UH. I... they're kind of spread over a few different areas, and are we counting only active fics?

Upwards of ten active WIPs. I don't want to chase down every WIP I have somewhere, or even the completed little one shots.

🛠What tools/programs/apps do you use to write?

I do ninety percent of my writing in gdocs. It's quick, easy, and I can do it on my phone because I'm a madlad.

In terms of 'tools', just stuff for names. I've been using a lot of wiktionary to research the meaning behind various kanji to help create names for Naruto/Bleach, and occasionally even get to use it for some wordplay. Otherwise, random name generators, behindthename, top 100 baby names - that kind of stuff.

🤗 What advice would you give to new fanfic writers that are just getting started?

This kind of goes for any writer or creative but: create for yourself first. Pleasing your audience is great! It feels great! But don't chase them.

Make something for yourself first, be happy with it, satisfied, and let that be enough. And then, if people like it, that's great! If they don't, well, who cares? You didn't make it for them.

Lip service

There’s only a handful of hairs left on my top lip; everything else has been obliterated via laser hair removal and electrolysis. All the same, I get pretty self-conscious about the few surviving stragglers and run a razor over them every now and then.

I just did that now, and somehow managed to lop the top off of two hair follicles (which are of course, as is their want, bleeding profusely).

HOW?! This is like playing Minesweeper with a 5 x 5 grid and literally one mine in the bottom left corner, and still somehow hitting it on the first try!

'Standard Clitoris™'

Apologies for those that read the title with confusion and / or an injured sense of propriety; there is critical context here, I promise!

Act I:

Two years ago, I contacted Mt. Sinai's Center For Transgender Medicine And Surgery; with the intent of pursuing gender reassignment.

(The people there are lovely; but this was still an incredibly involved and rather stressful process, as (a) my health insurer required numerous hurdles be jumped before they would authorize the surgery; and (b) the Mt. SInai health system is located in New York, whereas I am quite definitively not.)

I ended up consulting with renowned vaginoplasty surgeon Dr. Miro Djordjevic. For those not in the know, Dr. Miro originates from Serbia; and while he speaks excellent English, he also has a flair for creating unusual turns of phrase that are as delightful as they are unexpected.

To transcribe this conversation (to the best of my recollection):

"Dr. Miro - what level of control do you have over the appearance of the new vulva?"

"Oh, Lauren; many young girls, they come in here with pictures of other women, they say: 'Dr. Miro, please can you make my new vagina look like this'. And I say, 'I cannot, I am sorry; for the final appearance is very dependent on your individual anatomy'. However, I understand this, and I will give you a very good vagina, a very beautiful vagina; you will see."

"Ah! This makes sense to me. Let me rephrase my question: once I am healed, I hope to have my clitoris pierced; but I understand that this requires the anatomy to be a certain way."

"Lauren, in many surgeries, you are the first girl that has asked this. But! The clitoris, this I can change! You tell me what size your clitoris should be, and I will do this for you."

Act II:

Thus, I visited my local piercing parlor; and provided my piercer with a once-in-a-lifetime opportunity to specify the exact dimensions and (and other qualities) of the clitoris that they would, in future, be piercing.

The takeaways were surprisingly straightforward:

The clitoris needed to be large enough to pierce (with an overall diameter of 10mm suggested as an appropriate target).

There needed to be sufficient space between the clitoris and clitoral hood to comfortably fit a Q-Tip.

So armed, I prepared for the day of surgery (a tale in its own right).

Act III:

It is the 9th of February, 2023; and I am currently sitting in the pre-op room, meeting the vast team of individuals who will shortly be participating in the surgical revamp of my genitalia (or the critical task of ensuring that I remain wholly unconscious during said revamp, but not so unconscious that, say, my heart stops).

It is here that I see Dr. Miro once again; and remind him of our previous conversation and my subsequent fact-finding mission regarding clitoral anatomy as it pertains to piercing suitability:

"Okay, so: my piercer says that the clitoris should be around 10mm in diameter; and that there should be enough space between the clitoris and hood to fit a Q-Tip."

...To which Dr. Miro wryly shook his head, and proceeded to hew from his English lexicon a brand-new term that has lived with me ever since:

"Lauren, Lauren! Why didn't you say? This is Standard Clitoris™! This is what I was going to give you anyway!"

...And so it was, as I rapidly drifted towards my robotically-assisted neovaginal destiny (and away from consciousness), that the primary thought looping through my mind was: "I should have known: the Standard Clitoris™"!