Gender-Affirming Care

00:00:06:10 - 00:00:31:22 Dr. Patrick Virgil Hello again. I'm Doctor Pat. I'm here with our needle exchange. I am here to give you an important public service announcement about how to obtain your syringes and your needles. We are, of course, always welcome to come down to you our needle exchange. We will talk more about that. I do want to say, though, before we get started, you should always use new, clean, sterile equipment. 00:00:31:22 - 00:00:58:00 Dr. Patrick Virgil For me, that's always have clean works because that is the best way to prevent infections and prevent getting things like viral hepatitis and HIV. With that said, obtaining these materials can be challenging even in the best of times, and times have gotten even more challenging since then. So I have heard many people tell me that obtaining some of these supplies has gotten to be very difficult. 00:00:58:02 - 00:01:43:12 Dr. Patrick Virgil So I wanted to speak to that. If you're on injectable HRT, you may be able to get a prescription from your medical provider for the supplies. But I will tell you firsthand that pharmacies don't always give you the correct sizes that you need, even if it's directly and on the prescription. And sadly, sometimes pharmacies use theirs, and particularly personnel pharmacies use this as a way to try to restrict access, and so they may be forced to give out the prescription for the HRT, but then they will flat out lie and say that you need a prescription for the needles are syringes, or say they didn't get one or otherwise try to make things difficult. 00:01:43:14 - 00:02:13:00 Dr. Patrick Virgil In most states you can in fact buy these without being a medical provider and without having a prescription. There are states that do restrict this, and in other states there might be restrictions about how many can you buy at a time? Check your own state laws around that. Here in Washington state, we are in an A plus, a free list because you can buy these unlimited with no restrictions. 00:02:13:02 - 00:02:36:07 Dr. Patrick Virgil With that said, you can try to buy these from a pharmacy, but I will tell you that it's often times easier to buy them from an online reputable medical supply company. If you don't know what that is, ask around. Ask other people who they have used and had good luck with. Another great resource is of course, your local needle exchange. 00:02:36:13 - 00:02:58:22 Dr. Patrick Virgil There are syringe exchanges all throughout the country. They will carry a whole variety of different sizes. Many of them do stock the particular sizes that we need for doing HRT injections, which are a little bit different than, for using other types of substances. Best way to try to find your local exchange. You can again ask around. 00:02:58:23 - 00:09:11:20 Dr. Patrick Virgil You may already know of that, but the NASEN directory nasen.org is one of the more comprehensive directories that exists for getting connected and making sure that you always have clean works.

00:00:06:29 - 00:00:36:13 Dr. Patrick Virgil Hi everyone. I'm Doctor Pat, I'm here with the Tacoma Needle Exchange, and we're going to go through basic techniques for doing HRT shots, both subcutaneous and intramuscular. The shots themselves are relatively simple and will walk through both of them. The hardest part of it, honestly, is just getting the syringe loaded properly. I'm going to demonstrate this with sterile water, which is relatively easy to work with, but the actual hormones are suspended in a thick, viscous oil. 00:00:36:13 - 00:00:56:27 Dr. Patrick Virgil And most of what I'm going to show you is how to draw the medication up with a larger needle, get the air bubbles out, switch over to your smaller injection needle, and then we can walk through the actual injections. So when you first get the medication for the virus, it's going to come with a plastic cap like this. 00:00:56:28 - 00:01:20:19 Dr. Patrick Virgil It's just a protective dust cover. All you have to do is take it off and you'll see the gray rubber stopper. Then you're going to take one of your alcohol cells, and you just sort of scrub the top of it for about five seconds. Then you're going to set that aside and grab one of your syringes. 00:01:20:21 - 00:01:45:27 Dr. Patrick Virgil And one of your large needles. I'm using an 18 gauge because I do find that it's easiest. You can use smaller gauges to draw, but it is more difficult. And we can go through that at a subsequent video. But for day, we'll use an 18 gauge. Now, when you take liquid out of the vial, you want to put the same amount of air into the vial as the liquid that you're going to take out. 00:01:45:27 - 00:01:55:08 Dr. Patrick Virgil This helps keep the pressure equal. That way you don't end up creating a vacuum later. 00:01:55:11 - 00:02:18:23 Dr. Patrick Virgil Then the needle just goes right there in the middle of the circle all the way in. You're going to flip the entire thing. You're going to push all of that air in. Now, when you first start drawing back, you'll see a large air bubble there. And that's normal. You don't want to go slowly and see if you can get it down to the bottom. 00:02:18:25 - 00:02:41:14 Dr. Patrick Virgil And if you can't, you can try flicking the syringe to try to work it to the top. We've got it partway up. As long as the needle stays within the vial and doesn't come out everything sterile, you can go ahead and push all of that liquid and the air bubbles right back into the vial, and that should get rid of the air bubble. 00:02:41:15 - 00:03:07:27 Dr. Patrick Virgil Then finally, when you draw back, you should get just liquid. Now you can go ahead and take the needle straight out. There's still medication that is in the needle and the hub of the needle, and we want that back. So when you're holding the syringe upright, you can just pull back on the syringe again and suck it all back into this fridge and you'll see that there's another large air gap. 00:03:07:29 - 00:03:32:26 Dr. Patrick Virgil That's fine. Now we're going to change needles. A good way of doing this without poking yourself is if you keep the needle cap on something stable, like this table here, you can just sort of scoop the edge of the needle into the cap, and then you can go ahead and click it and secure it. Twist off the needle. 00:03:32:28 - 00:03:44:04 Dr. Patrick Virgil Now we're going to move to our actual injection needle. 00:03:44:06 - 00:04:04:28 Dr. Patrick Virgil Just going to screw that on. And remember there's still air at the top of this. So we're going to want to push that air out. And you're going to slowly push back on the syringe until you first start seeing liquid at the top. I'm going to go ahead and remove this so you can see it easier. 00:04:05:00 - 00:04:34:16 Dr. Patrick Virgil And when you first see that drop of liquid come out, you should be back at the same mark on the syringe as what you started with when you loaded with the larger needle. Now we're going to set that aside for just a minute and we'll talk about different types of injections, both subcutaneous and intramuscular. For most people, I usually recommend starting with subcutaneous shots because it's easier. 00:04:34:18 - 00:05:03:23 Dr. Patrick Virgil They’re smaller needles. Many prefer those. However, some people have injection site reactions and they don't do well with subcutaneous or their levels seem to be a little bit unstable and a little bit erratic, and switching to intramuscular might be best for that. There's several different areas on the body that have a layer of subcutaneous fat. I think most people have a little bit of a roll around the belly button. 00:05:03:26 - 00:05:10:05 Dr. Patrick Virgil I think this is the easiest for a lot of people. So we're going to show this. 00:05:10:07 - 00:05:42:18 Dr. Patrick Virgil Now. The safe zone to inject is about 2 to 3 fingers away from the belly button on either side. And anywhere in this zone where you still have, where you still have what they say, an inch to pinch, then you can go ahead and use that. Once you've picked your injection spot, you're going to want to make sure you clean it with an alcohol pad. 00:05:42:21 - 00:06:08:03 Dr. Patrick Virgil Now, the injection itself is relatively simple. It goes straight in perpendicular to the skin. Like this. I like to use a 5/8 inch needle. Anywhere from three quarters to one half is a pretty good length for subcutaneous injection. 00:06:08:06 - 00:06:31:15 Dr. Patrick Virgil And it often helps to have a little bit of tension on the skin, so it's good to pinch it like this. Go straight in and then slowly press down on the plunger. It helps to go relatively slow with this, and then wait about five seconds after you reach the edge of the plunger and then you pull straight out. 00:06:31:17 - 00:06:56:28 Dr. Patrick Virgil And it's just that simple. The other place that's easiest for you to do your own self injections is the top of the thigh. If you feel the thigh, you will see that there are several large sort of tubular shaped muscles here. There's one on the top and then there's one on each side. You do not want to use the one that's closest in towards the groin, because that's where the large blood vessels and the nerves run. 00:06:56:29 - 00:07:18:16 Dr. Patrick Virgil You don't want to hit that, but the top or the outer side is fine. And you want to use a site that's about halfway to a third of the length of the leg. When you get down closer to the knee, there's just not enough muscle there to hit, and you'll be able to feel it when you're pinching. 00:07:18:18 - 00:07:29:15 Dr. Patrick Virgil So when you pick your site, I'm going to use side of the thigh here. You just take an alcohol pad. 00:07:29:18 - 00:07:33:13 Dr. Patrick Virgil And you clean the area. 00:07:33:15 - 00:08:16:23 Dr. Patrick Virgil The injection itself is relatively simple. You're going to take the needle and you're going to go perpendicular to the skin all the way in to the end of the needle. Once you are in, you're going to press down on the plunger slowly and then count to about five to give the viscous oil enough time to go through. 00:08:16:26 - 00:08:26:23 Dr. Patrick Virgil You may notice a little bit more bleeding with this shot. You may not. 00:08:26:26 - 00:08:58:10 Dr. Patrick Virgil And there we go. One thing I did want to mention was reusing vials. A number of the larger vials will be multiple use, and what that means is that you can take several doses out of the same vial. So there's a couple of things about that I wanted to mention. First, you will notice that sometimes you'll see what looks like puncture holes at the top of the of the vial in the gray rubber. 00:08:58:16 - 00:09:21:18 Dr. Patrick Virgil This is a self-sealing system. And so even though you'll see those divots there, it should seal itself. So the first thing you want to check is make sure that the seal is good. That's not obviously leaking. The next thing you want to do is just check the contents of the vial and make sure it's clear if it's cloudy or if there's any particulate matter floating in it. 00:09:21:19 - 00:09:44:08 Dr. Patrick Virgil You want to set it aside, throw it out and get a new file. Last thing I'll say is that the rubber stopper with the large 18 gauge drawer needle, you can actually core through it kind of like an Apple core and have the rubber end up in the vial. So you do want to make sure that you're not seeing that in there. 00:09:44:11 - 00:10:12:04 Dr. Patrick Virgil So that's the basic injection technique. For most people this works pretty well. There are some variations on it, such as using different techniques for loading the syringe. This is the one that I learned and it's the one that I find the easiest. We are going to do a couple more videos to talk about several different aspects of HRT shots, so be on the lookout for those. 00:10:12:07 - 00:10:15:09 Dr. Patrick Virgil That's all for now. And thank you so much for joining me.