Anticistamines:

Always DIY; never Detransition

Okay, so everything is pretty fucked: access is blocked, prescriptions are hard to get, insurance is scarce, and generics are sold out, so things get expensive. Yes yes, quite fucked all the way around. So, let’s skip a few steps, and just make it and give it away for free, shall we?

Let’s rock.

In the event that you aren’t looking to make them from scratch, but rather you got one of our vials [or would like to] we shall address the basic questions everyone asks when coming across our stuff: What is it? How do I use it? How do I know it’s safe?

We’ll address these questions and more, just read on. Instructions for making it yourself are a bit more involved, and will be forthcoming.

What is it?
This is Estradiol enanthate (A.K.A. EEn), it was chosen for a handful of reasons. Most people use valerate or cypionate, but enanthate is much subtler and smoother in the fluctuation levels in the body, and seems to cause less in the way of mood swings and such [details below]. EEn is used outside the US for HRT quite commonly. The vial contains roughly a year’s worth of HRT depending on how you dose. It can be injected either intramuscularly or subcutaneously. Details on that in the next section.

The specific formula of this injectable was selected for easy distribution and long shelf life. If you have other means to access HRT medication, we urge using those first, and giving ours to those who are blocked from access.

Let’s make the application of Estradiol as safe and convenient as possible for anyone who wants it.

Instructions

This particular formulation is best administered using intramuscular injection into the thigh [1] once a week [2]. There is plenty of information on how to self-administer IM medication elsewhere on the internet. The following highlights info that is specific to 40mg / ml Estradiol Enanthate.

There are a few things which are important to keep in mind. First is that since it’s a year’s worth, you’re going to have to be extremely vigilant about keeping your vial uncontaminated. Being careful about this is just a matter of paying attention, and making it a ritual of sorts, so that you do it the same every time. It should go without saying, but don’t dose if you’re wasted or exhausted; just wait until tomorrow. Designate a place where you’ll do it, and make a surface which is easy to clean. Either you can go nuts, and use a sterile drape, or you can just use something non-porous like aluminum foil [shiny side up] or plastic wrap which you can wipe down with alcohol, or chlorhexidine.

Check the vial for any contamination. Small air bubbles are normal, any solids or strings floating in solution are signs for contamination. Do not use a contaminated vial. Wipe down the top of the vial using an alcohol or chlorhexidine pad thouroughly and carefully before every use. Again: given that these vials are designed to be used many times, they require more care to avoid contamination. Using a 23G or 25G needle [3] attached to a 1ml syringe, withdraw 0.2ml of solution [4].

Remove the needle used for withdrawing and swap it for a 25G or 27G, 1″ or 1-1/2″ needle. If you don’t have easy access to needles, you can use the same needle for both withdrawing & injecting, it will just be less comfortable. Never reuse or share needles.

Since the concentration of estradiol is fairly high, it is important to have good control over the small amount of liquid you are injecting. Be aware of dead volume in the tip of the syringe and the needle itself. Holding the syringe needle-up, push in the plunger until you see a drop of liquid forming at the tip of the injection needle. Whatever volume is left in the syringe after priming is the amount of liquid that will end up in your body. You will see that you actually need to withdraw 0.25 – 0.3ml of liquid in order to deliver 0.2ml of estradiol. Administer the injection into your muscle tissue at least 1 inch (5cm) deep.

After use, we recommend putting the vial cap back on to protect the diaphragm from dust between injections. Store the vial in a dark place at room temperature [5]. If you think your room might get above 25°C (77°F) during summer, store the vial in a fridge and remove it 2-3h before use (You can also just do this anyway).

Information

These were manufactured in a cleanroom microfactory. That’s why they look like they came from a factory: they did. Particulate count in the air is continuously monitored, the active pharmaceutical ingredient of every batch is tested for purity and composition, and the oils, preservatives, and substrates are all US pharmacopia grade ingredients. The vials and caps are sterilized in an autoclave, and are filled under a laminar flow hood fed from a HEPA filter. Details of sterile compounding technique will be covered in the entry on how to set up production yourself.

Please don’t hoard these: despite the fact that they will keep for the full year that it will take to use them up, they won’t keep for three years, so if you take a bunch in hopes of doomsday prepping, or having a decade’s worth, it’s not going to work. Just share them, and we can work on getting you more next year, okay?

[1] IM vs subQ: Estradiol enanthate can be administered both intramuscularly and subcutaneously. While many people prefer “subQ” injections, we recommend starting with IM injection. The 40 mg / ml Estradiol Enanthate contains a high concentration of benzyl alcohol as a preservative. This makes distribution easier and allows for a longer period of safe use after the vial is opened. Unfortunately, benzyl alcohol is known to sometimes cause discomfort at the injection site. However, most of these effects only occur in the skin layer and do not cause issues if the injection is applied into muscle tissue, hence our recommendation for IM. This is different for everyone, so we encourage you to try both, and determine which injection works better for you, since both provide the same absorption rate into the bloodstream [6].

[2] Estradiol Enanthate: When estradiol dissolved in oil is injected into tissue, it forms a “depo”, and estradiol is slowly absorbed into the bloodstream. Depending on what specific oil and estradiol ester is used, the rate of absorption can vary widely. The two most common estradiol esters used for injections in the United States are estradiol valerate (Delestrogen) and cypionate (Depo-Estradiol). While cypionate has an acceptable half-life for weekly injections, valerate is known to cause rapid fluctuation of circulating estrogen levels and is typically injected twice a week. A longer half-life contributes to more stable levels and reduces the occurrence of mood swings.

This injection uses estradiol enanthate as the active ingredient. Estradiol enanthate (EEn) is an estradiol ester with a longer biological half-life than cypionate. EEn is used commercially outside of the US in preparations like Perlutal or Topasel.

Fig. 1 shows the expected levels from weekly injections with various estradiol esters. If you want to learn more about the difference between estradiol esters, transfemscience.org provides a great source of information backed by scientific research.

[3] Avoiding Contamination: If used correctly, one 10ml vial of Estradiol Enanthate can last up to a year (50 weeks of weekly 0.2ml injections). While the estradiol and carrier oil are sterile and fairly stable in unopened condition, the largest risk for your vial to go bad is from external contamination. External contamination can occur if bacteria or fungi are introduced to the vial from contaminated withdrawal needles, or more likely, contaminaton building up on the diaphragm, and then pushed into the vial by a sterile needle. This is why it is critical to keep that surface as clean as possible. Additionally, in order to make sure the diaphragm maintains a good seal until the vial is empty, use the smallest needle size possible to withdraw.

[4] Dosage: Effective dosing of estradiol in transfeminine people is a controversial topic. With the current medical system, blood tests are used as the first measure to adjust dosage in order to reproduce the levels that are common in cis women. This enables a streamlined treatment of patients who experience gender dysphoria, but often fails to address the patient’s individual transition goals.

For people who are unsure about what dosage to start with, we recommend weekly injections of 0.2ml (8mg per week -> ~1mg per day) of EEn. Depending on your metabolism, this will result in steady state levels around 200-500 pg / ml, sufficient to induce medical transition. After 4-6 weeks you will have some feeling for how estrogen affects your mood (before vs after your day of injection). We encourage you to adjust your dosage up or down depending on what feels best for you (up to a reasonable dose of ~0.3ml (12mg). After settling on your personal dose for some weeks, test your blood levels to make sure your dosage is safe and sustainable. If you want to get an idea what levels to expect from a given dosage, the Injectable Estradiol Simulator can provide a useful estimation.

[5] Storage: It is important to keep the vial in a clean environment. If you notice any contamination, please dispose of it.