metaguide to transfeminine HRT in the UK

a collection of guides and things i have discovered that have been/will be useful to me

note this is skewed towards England, especially the Londonwards side

i also recommend the DIY HRT directory

free physical resources

London-based hormone blood testing services

before having a blood test, ensure you are hydrated (otherwise your blood will be viscous and they will need to poke many holes in you instead of few)

cliniQ: open on Tuesdays, operated out of King's College Hospital on Tuesdays 16:00-to-19:00

they list liver function tests as a separate service but i'm pretty sure they perform them by default on your first visitation; generally you can just explain whatever your reasoning is to the volunteer taking the test and they will add your desired metric to the order form

56T Dean Street: open on Tuesdays, open on Wednesdays 16:30-to-19:00

note that your GP will also likely be willing to perform the tests as well

for both, book in advance via email

both offer quite similar ranges of services (they also will administer injections if you have proof that they're from prescriptions, and provide screenings/vaccines for STIs)

transferring records between services operating in different counties is difficult and annoying and unreliable

cliniQ is willing to provide a recommendation that one's GP offer a 'bridge prescription' but they require an in-person appointment with a doctor to do this; note that unlike blood tests (which they offer to walk-ins), their doctors are in short supply, and you must book such appointments about 3 months in advance

if you do get a prescription, it is a good idea to get a HRT prepayment certificate; they cost £19.80 rather than the £9.90 per prescription item, so will save you money if you collect your prescription > twice yearly

subcutaneous injection administration guide

(written for me by my friend sophie)

Supplies needed:

Injection vial

Insulin needles

(recommended 29g 1ml/100 units, but like any insulin needle works)

Sharps disposal bin

(this is not quite necessary, you can get away with using ie. soya milk cartons at least for the duration in which they're stationary)

70% isopropyl alcohol wipes

Plasters

(very optional)

Before first ever injection, feel free to practice by injecting water into an orange

Before injection:

Use 70% IPA wipe on vial stopper

If you feel haven't showered in the past few days use 70% IPA wipe spiralling outwards where you would inject (optional)

Remove the caps of the needle and draw air up to the amount you are injecting (25 units)

Put the needle through the vial stopper

Inject air into the vial

Turn vial upside down

Draw until there's enough fluid in the needle (might need to go up to like 40 units)

Push the air and extra fluid in the needle back in to get to your actual dosage, feel free to tap the needle to help the air out whilst doing this

Remove the needle

if you are using separate needles, put the drawing one into your sharps bin before retrieving your injecting one

Injection:

If you are particularly thin feel free to hold the skin so that you are easier to inject

Push the needle into the injection site at a 45 degree angle oriented so that the bevel of the needle points up

Inject

Hold needle in for a few seconds

Remove needle

After injection:

If some injection fluid spills out don't worry it's not much, feel free to hold with your finger to stop it coming out

If some blood spills out don't worry you just hit a capillary, feel free to hold with your finger to stop it coming out (you can use a plaster if you want)

Do alternate injection sides (like switch between left and right)

getting injection equipment

if you have an address that can safely receive packages, exchangesupplies.org offers exceedingly cheap supplies

if you do not, THNX (17:00-19:00 on the 2nd Monday of each month at Common Press Bookshop in London) provides it for free in person (no booking necessary)

once you have said equipment, the expendible parts are either replaceable over-the-counter (ie. IPA wipes) or via Boots's harm reduction needle replacement programme (bring your sharps bin ask at the till)

transharmreduction.org's page gives lists for further needle exchanges in Scotland/Ireland

on fixed vs. separate needles

from cursory internet searches, one finds what seems to be a pretty decisive consensus in favour of using separate needles

metal is malleable, and needles' tips are thin enough for this to be an issue; perforating the stopper can blunt the tip

however, a brief summary of my discussion with an acquaintance more well-versed is

needles contain dead space in which for the oil to be stuck and lost when you dispose of them; insulin needles typically have little of this, and are only discarded once instead of twice

less propensity for human error and more consistent doses

fixed needles are generally thin enough that repeated stabbing into a vial's stopper isn't going to core it

with those from THNX, this isn't a problem either way

in the event of needle-sharing/accidents, less dead space reduces disease risk

more convenient

note that THNX is willing to provide both

on subcutaneous vs. intramuscular

air bubbles are only a risk in intravenous injections, not either subq or IM

with subq you will only be at risk of hitting capillaries, not larger vessels

however, IM may be more effective per μg, since subq leads to some oil permeating through the surface of the skin

regarding irritation

anecdote from friend who is quite experienced

post injection pain depends, a small amount of pain is normal and is mostly down to luck. sometimes people have irritation in the injection site that lasts a few days. it's normally not all too serious. larger injections can cause more irritation, as can larger needles size (larger sizes are smaller gauges, so 27G is bigger than 29G). irritation can generally be reduced by doing IM instead of SubQ (and for context, I get pain/irritation when I SubQ instead of IM, but your mileage may vary), in which case the vastus lateralis site on the thigh is best for that.

anecdotally from me, the first injection i had (administered by someone else) was of 10mg in 0.25ml, and the second (by me, with some hesitancy) was of about 5mg in 0.125ml; the second caused a small raised lump to develop lasting for 5 days while the first did not, so it may be somewhat down to the technique

personal remarks

following my first injection on 2025-10-28

i am quite underweight, which (among other things) makes blood withdrawal upon me significantly harder, typically entailing multiple stabs in both arms, and (worst of all) wiggling the needle around after it's already pierced the skin to look for evasive veins

i was under the impression this would make injections into subcutaneous fat harder, but that was not the case at all! initially, my injector was going to try using my leg fat (through the fabric of my leggings), but ultimately chose my abdomen; abdominal fat is always feasible!

in fact, i had a blood test earlier the same day, of five stabbings, compared to each of which it was quite painless!

the pain you do experience from it does not typically last more than a day; it will likely hurt more the following evening than the night of the injection