I am not a doctor. I do not work in medicine. I am not a medical professional in any capacity. I am a layperson offering lay opinions based on the extent of my own education and experiences. All information and assertions below should be treated accordingly as mere opinion rather than statement of fact or medical advice. This guide prioritizes community moral truth where scientific research falters. Basically, don’t get mad at me.
In simple terms, the brain does not care which hormone it has, just as long as it has enough. If there are consistently enough hormones in your body, it stops producing more. The “consistent” part is what injections are capable of that other administration routes struggle with. Trying to do sufficient monotherapy on pills, for instance, is very likely impossible in most situations. In more specific terms regarding the HPG axis, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are suppressed by increased serum estradiol levels, thus inhibiting GnRH production and by extension testosterone production in the testes.
No. Leakage can happen for any number of reasons and is rarely enough to make a difference, so you do not need to do another injection. For the future, make sure to leave the needle in for 5-10 seconds before retracting and then apply pressure afterwards. You might consider using the air lock technique mentioned above if you are particularly concerned about leakage.
No. Leakage can happen for any number of reasons and is rarely enough to make a difference, so you do not need to do another injection. For the future, make sure to leave the needle in for 5-10 seconds before retracting and then apply pressure afterwards. You might consider using the air lock technique mentioned above or the Z-track method if you are particularly concerned about leakage.
It is important to understand that this is extremely understudied so exact figures cannot be stated, and given the seriousness of pregnancy, I urge you to practice safe sex and lean on the side of caution where possible. HRT itself can, and likely will, make you infertile eventually, but only through full suppression of the HPG axis (See Question 2.3) over a long time span. In other words, if you haven’t had bottom surgery of any kind and you are on an HRT regimen that is less capable of HPG axis suppression (such as pills), then this is more of a consideration.
If the HPG axis is not suppressed then it is fully possible to impregnate someone, and the timeline for sperm maturation is long enough that this is true even after the HPG axis has been initially suppressed for multiple months. Please take this very seriously. Full HPG axis suppression for at minimum six months, perhaps closer to a year out of an abundance of caution, is recommended.
Though the text is primarily my voice, this document would not be even half as good without the contributions, feedback, and suggestions from others involved at every step along the way. A good reminder as ever that transition is not something best done alone.
Many thanks to Q, R, RM, and S in alphabetical order for close review and generally being fun nerds to talk to; love y’all. Special thanks to CB and J for close review that also inspired some very good bits. Thanks to KG for additional intersex information. Thanks to w [sic] for additional injection resources. Thanks to BIR collectively for a plethora of crucial nerd nitpicks. Appreciation for general review from C, JTP, K, S, and V. Thanks to everyone on Bluesky who encouraged me to write this up in the first place, and everyone over the years sharing knowledge. And of course: much appreciation to all HRT nerds, even when we disagree, since we’re all trying to do the best for our community where we’ve otherwise been let down. Keep up the good work everyone.
Many thanks to Q, R, RM, and S in alphabetical order for close review and generally being fun nerds to talk to; love y’all. Special thanks to CB and J for close review that also inspired some very good bits. Thanks to KG for additional intersex information. Thanks to w [sic] for additional injection resources. Thanks to BIR collectively for a plethora of crucial nerd nitpicks. Appreciation for general review from C, JTP, K, S, and V. Thanks to E for web dev assistance. Thanks to everyone on Bluesky who encouraged me to write this up in the first place, and everyone over the years sharing knowledge. And of course: much appreciation to all HRT nerds, even when we disagree, since we’re all trying to do the best for our community where we’ve otherwise been let down. Keep up the good work everyone.
Shout out to my IB Chemistry HL teacher many years ago who quite reasonably doubted my studiousness even though I’m now putting much of that knowledge to use for the art of transsexuality; go figure.
Source code available here on GitHub.
Full Compilation Datetime: Tue Oct 14 22:40:07 2025
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(There aren’t LaTeXML bindings for datetime2, hanging, or hyphenat, so the formatting is slightly ugly. If you’d really like to help me out, please write those bindings!!!)
2025-10-14: Reduced the pithiness and expanded the usefulness of Question 11.25 per repeat request because I guess there is public health utility to doing so. 19.8k words.
2025-10-17: Dark mode! And a font toggle off. Plus a few links. 19.8 words.