6 Tips for Dealing with Needle Anxiety

For us trans and non-binary folks who first start gender-affirming hormone therapy (GAHT, also known as HRT), we often feel a ton of excitement about our transition and the physical changes that will come with it. We might be overwhelmed with feelings of relief, stress, joy, and many more emotions.

For those of us who choose to take injectable medication, however, we might also feel needle anxiety—a perfectly normal and common fear of needles. For some folks, we might fear all needles; for others, the idea of having to give ourselves a shot on a regular basis might be really tough to imagine.

If you're feeling needle anxiety, you're not alone! Even though self-injection meds are common in our community, that doesn't mean all of us don't feel a little bit (or maybe a whole lot) of anxiety. Here are some tips to help you manage that stress and work through it.

1. Talk to your doctor

Be open with your healthcare providers so they can help support you.

• Ask your doctor for a few demonstrations on how to inject, and/or talk through the steps together. They may also have a handout or visual guide to take home that itemizes out the steps of your injection, which is handy if you're feeling nervous in the moment.
• Ask if you can administer your shot during an appointment. That way, you can practice with them present, so they can help guide you through start to finish. This can help build your confidence that yes, you can do it!
• Discuss which injection site might work best for you. You might have an easier time with a different spot, like your thigh, glute, upper arm, or stomach. Talk with them about your injection type, too, especially if you're concerned about pain/discomfort. A subcutaneous injection might be easier than an intramuscular one since it typically uses a much smaller, thinner needle.
• Ask about autoinjectors. Autoinjectors are spring-loaded devices that allow you to push a button and self-inject, therefore taking a lot of the anxiety out of giving yourself a shot.

2. Create a comforting routine

We want to go into each shot feeling calm and confident. A relaxing, predictable routine can help. Eventually, you'll get into a rhythm that is perfect for you and will make each shot easier.

• Pick a location that feels right to you. As long where you do your shot is a calm, clean, and stress-free place, you can do your shot anywhere. For many of us, this might be a bathroom or bedroom where we can close the door and have privacy, but if your favorite chair in the living room makes you feel most at ease, try doing your shot there. Candles, essential oils, and a change in lighting can also help you set the right vibe.
• Focus on your breathing. Leading up to and during your shot, be mindful of your breathing, and take deep, slow breaths in through your nose and out through your mouth. If you feel yourself getting anxious, you can rest your hand on your belly and focus on fully releasing your breath to connect more with your body. Breathing exercises help decrease your heart rate, chill you out, and help you focus.
• Pick the right clothes. For some of us, having to roll up a sleeve or pull down a pant leg might be a trigger for anxiety. Make sure what you're wearing is comfortable and gives you easy access to your injection site.
• Add some fun. Colorful bandages or doing something special following your shot can make a big difference mentally. Maybe you can set a reward following each shot, such as going for a walk outside, treating yourself with a gift or special snack, or making time for a hobby.

3. Listen to music

Music can make such a big difference in our mood, especially if we're feeling stressed.

• Put on your favorite jams as you're setting up your medication and preparing to inject. This can be any music that makes you feel good. (Singing along is a great distractor, too!)
• When it's time to do your shot, pick a new song to listen to. The more time that passes, the easier it might be for your anxiety to build. So, make a deal with yourself that before that song finishes, you will complete your shot. That way, you won't feel rushed, but you've still set a time limit for yourself to help you follow through.

4. Visualize it going well

Go into each shot with the right frame of mind.

• Before each shot, imagine each step going smoothly. Some folks find it helpful to visualize the shot start-to-finish while breathing deeply and slowly. Focus on everything going exactly as planned. 
• Remind yourself you can do this. You might want to try some positive affirmations aloud to yourself, such as, "I know I can do this. I am prepared and capable. I am giving myself the care I deserve. I believe in me."

5. Build a support team

Close friends, family, or other trusted folks in your life can help support you.

• Sometimes, just talking openly to others about anxiety can be a huge help. They can offer emotional support before your shot, or celebrate your victory afterwards!
• You might consider seeing if a trusted person in your life (like a spouse, family member, or friend) can be trained to administer injections on our behalf. If this is something they are comfortable helping with, talk to your doctor about training them.

6. Focus on the "why"

Recall that you're taking this medication to live your life more authentically. That's a really beautiful and worthwhile thing. Focus on the positive changes that HRT will bring for you—physically, mentally, emotionally, and spiritually—and use that as motivation to keep trying.

In the end, facing needle anxiety isn't easy, but it's doable. It takes time, practice, and dedication. You're not alone, and you've got this!