Putting This Out There, As Fiona’s Work Is Absolutely Incredible And She Deserves More Exposure! Are

Unexpected HRT side-effect #3

So... your sense of smell becomes more sensitive. That’s not particularly unknown (although you’ll hardly find it on the informed consent form). No, the unexpected part is this:

CATS SMELL SO GOOD.

Oh my god! They are like tiny precious babies. All I want to do is inhale my cats (while they look on in utter and well-justified bewilderment).

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

Sandwich

I have friends that are LGBT and (for reasons that are fairly obvious) refuse to eat at Chick-fil-A. However, they have family that continue to do so; and there's been an ongoing conversation on how said friends might convince said family to desist.

During that discussion, the subject of alternatives came up; and how the competing Popeye's chain serves a superior fried chicken sandwich. I wouldn't know - I've never eaten at Popeye's - but there's one in the area and I was exhorted to try it out.

That's exactly what I did - and what I can say is:

I'm not a huge fan of drive-through, but at least my voice training must be working because I got a "Will that be all, ma'am?"... That made my day!

It was a pretty good sandwich! Definitely a viable alternative to Chick-fil-A's; and also doesn't come tinged with the baggage of homophobia.

Would definitely go again!

I have three friends; one transitioned in her thirties, another in her late fifties; the third is transitioning now, in her sixties. All three of them look absolutely incredible.

Honestly, I don’t know where this idea came from that age stops you from transitioning. Yes, there is a possibility that as you age, you may gain more undesirable physical characteristics. You know what else you gain? Time; money; and resources.

The oldest of the three worries a great deal about requiring facial surgery in order to pass. (She doesn’t; but it’s still an understandable concern.) At the same time, she thinks nothing of dropping $35,000 on said surgery.

It’s all trade-offs; what you lack on one side, you gain on the other. ❤️

Baby Trans, listen to me, a 34 year old.

Hi, I'm Trans. I was AFAB and I transitioned, now I just look like a short cis guy.

Here's the thing: I didn't transition until I was about 27ish. I didn't even know I was trans until I was 25.

Don't let anyone tell you to "not bother transitioning after 19"

That's a load of shit. People barely know who they are at 19. Personalities change and develop. Shit I didn't really know who I was until I was about 27-28ish.

You can transition at any age. If you don't feel ready in your teens, or your 20s, take your time. If you are unable to transition at 19 due to medical or economical reasons, you have plenty of time. The clock is not ticking. Take this at your own pace.

You've got a whole long life ahead of you, take one step at a time.

Fire drill

We launched a new website this week. It's a modest undertaking; a small on-demand portal for our customer base to update their service information.

Here’s how it works: the user has to register for the site using the primary email address we have on file. Any other email address? No bueno. This was discussed ad infinitum in the lead-up to the launch.

No sooner is the site live than we start getting issue reports from the customer service team: “This client cannot log in. The site keeps telling them they can’t register because they don’t have the right email address.”

To which IT replies: “Well, are they using the primary email address on file”?

...And customer service says: “No. Why would that matter”?

Turns out that they have a requirement that the customer be able to use any email address on file; and that at no point did they feel like mentioning this.

So anyway, that’s why the first two days of these week ran sixteen hours apiece while IT frantically patched the new system.

To paraphrase my assembly professor:

"The first version of Microsoft Word ran on MS-DOS, and it came on a single 5¼" floppy disk. By Windows 3.1, it came on a dozen 3½" floppy disks. When we got to Windows '97, it came on a CD.

The basic functionality hasn't changed: it's a GUI-driven word processor. So why did Microsoft need all that extra space on the install media? I'll tell you: for that @#$%&! paperclip!

The hardware people create ever-faster, larger, more powerful hardware; and the software people come along and fill it up with junk!"

(As an aside: crotchety old man that he was, my professor was pretty spot-on in his assessment; and critically, was not so much ranting as appealing to the next generation of software developers - myself included - to be more thoughtful in our use of the hardware at our disposal.)

we should globally ban the introduction of more powerful computer hardware for 10-20 years, not as an AI safety thing (though we could frame it as that), but to force programmers to optimize their shit better

Unexpected HRT side-effect #6

I’m not really up to speed on Tumblr etiquette yet, but I believe the polite thing to do when dealing with heavy material is to provide a content preface. To that end: this is a kinda heavy. There’s abuse and stuff.

Sooo... PTSD. This is an actual, unexpected side effect of HRT. Let me explain.

I’ve previously touched on the idea that I have a female-structured brain; that certain parts of it require estrogen to function correctly; and that during the pre-HRT portion of my life, these parts operated poorly (or not at all).

A large - and rather nuanced - group of these malfunctions come under the umbrella heading of ‘emotional processing’ (or lack thereof); including the inability to:

Fully feel my emotions,

Understand them,

Connect them to my thoughts,

Communicate them to others;

...And perhaps most importantly, make sense of (and move past) the various negative events that life likes to throw at us.

Once HRT kicked in and supplied the estrogen my brain so desperately craved, all of this changed! I cannot stress what an incredible experience it was to go from zero to full emotional processing capacity virtually overnight.

The next thing I discovered, however - much to my chagrin - was that far from passing through the troughs of life with a stiff upper lip, rather I had simply deferred my response to those events. Now the bill was due.

I relived a lot of grief and anger: at the loss of loved ones; at lines crossed; at years in the wrong body.

One day, I had a disagreement; the matter was settled amicably, but afterwards I felt ill at ease. Without even understanding why, I gathered up my three animal friends and retreated into our walk-in closet; turned out the lights, and just... sobbed. Great, unrelenting torrent of tears. I didn’t understand what was happening; only that I was terrified, and hurting.

After what felt like hours, my wife coaxed me back into the light and to normalcy.

As night approached the following evening, it happened again. And again. And again. Every night, for months on end.

During these episodes, I would experience repetitive, intrusive thoughts for which I had no context. “Please don’t hurt me!”; “Please stop hurting me!”; “Let me go!”; “Why did he hurt me?”

In retrospect, what I have been able to piece together is as follows:

These events were flashbacks. They relate to a trauma that I have no memory of; perhaps because it happened very early on in my life. Based on the intrusive thoughts - and other indicators, such as an intense phobia of forcible restraint and what I believe may have been unconscious efforts on my part to relive the original acts - I believe the trauma was sexual in nature.

HRT kick-started my brain; and the first item on the agenda was - completely unbeknownst to me - processing this forgotten trauma.

For the curious - I’m much better now; my wife and I are no strangers to PTSD symptoms and well-versed when it comes to handling them. Still; I cannot say that when I undertook that first estradiol shot, that I ever imagined it would unearth this particular landmine in my psyche.

Unexpected HRT side-effect #10

 Confusing simple homonyms.

For context: while I am not dyslexic, there are certain idiosyncrasies with how my brain inputs, organizes, and outputs information that resembles a mild form of that particular disorder.

One example would be: analog clocks confuse me. My brain takes great umbrage at the hour hand - which is the larger unit of measurement - being represented by the smaller hand; and vice versa with the minute hand. If I need to read an analog clock, I have to manually reassert the correct order of the hands in my head; and this happens with each and every attempt.

Another is that certain words have unintuitive spellings (e.g. ‘Wednesday’; ‘business’); and I have to intentionally mispronounce them in my head to recall the correct spelling.

These are not major impediments; but are something I deal with on a daily basis. (As to why this is, I have no idea - there is a known association between left-handedness and dyslexia, so perhaps this has something to do with it; it could also be a result of the structural mismatch between my brain and body).

After starting HRT, I noticed that I was regularly confusing simple homonyms - ‘to’ and ‘too’; ‘now’ and ‘know’; ‘their’ and ‘they’re’; and so on. While I’ve been dealing with this problem my whole life, the actual set of troublesome words has been fixed since childhood; so it’s kind of interesting to see not only the set now expand, but with basic vocabulary that has never posed an issue before!

Two useful additions: First: The Paradox Of Tolerance. Per Karl Popper: “Unlimited tolerance must lead to the disappearance of tolerance. If we extend unlimited tolerance even to those who are intolerant, if we are not prepared to defend a tolerant society against the onslaught of the intolerant, then the tolerant will be destroyed, and tolerance with them... We should therefore claim, in the name of tolerance, the right not to tolerate the intolerant. We should claim that any movement preaching intolerance places itself outside the law...“

Second: this rather instructive video by Innuendo Studios. (Transcript for the reading-inclined.) It succinctly encapsulates the origins and character of modern Conservatism, and how contrary to all assertions, intolerance appears to very much be an intended feature and not a bug.

Conservatives will be like “Why are you holding me accountable for my bigoted beliefs? Whatever happened to tolerance???”

Using downtime to write makes sense to me!

(Every laptop I’ve ever owned has had a small form factor; in large part because I wanted to make sure I could easily crack it open, irrespective of current locale.)

Kudos to you for using your phone in this way, however! (Also, it makes me wonder: due to the differences in writing implement - do you think the phone guides your creativity differently from, say, pen and paper, or a keyboard?)

I’m also all for the in-depth research! I know that there is a danger at times of spending too much time educating oneself, rather than writing; but honestly, if there’s a landmine guaranteed to take a reader out of a story, it’s an incongruent (and easily avoided) factual error.

(It’s also come to my attention via some of my own projects that you simply cannot avoid having to know things in order to accomplish an otherwise simple goal.

Case in point: I have to replace a zipper. I didn’t expect to have to learn about the different materials, sizes, styles, pullers - let alone, the art of trimming a zipper to desired length! And yet: this knowledge is critical to completing the task.)

Likewise: you have to take the time to define your characters, their world, and the events that unfold from both - or, as you note, you may end up with some significant plot SNAFUs. 🙂

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.