A Difficult Needle to Thread

This blog was written by Logan Merrill for Portal Instruments. All opinions and experiences shared are entirely his own:

Do you know what it’s like to wake up in a different stranger’s house every morning? To open your eyes and immediately feel extremely uncomfortable, alarmed, unsafe, out of place, lost, dizzy, like your world is the most upside-down it’s ever been? Do you remember what it was like to be a kid tagging along to the grocery store with your parents? One second you’re strolling the aisles mesmerized by this new, exciting, and colorful world that’s unfolding right before your eyes, and the next, you’re turning around and feeling your heart fall out of your shorts because you have no idea where your mom just went. That gut-wrenching feeling that stops you dead in your tracks and makes you feel like the wind was just robbed from you was what I was living with nonstop, day in and day out.

I’ve known there was something very different about me for as long as I can physically remember. Every glimpse of an early memory I can get to resurface in my brain has always confirmed one thing; I was born into the wrong body. It wasn’t until my freshman year of college that I even knew what ‘transgender’ was or what that meant for someone. Not knowing what being trans was, not knowing there was help, and not knowing there were other people out there facing the same issues as I was, caused me to deteriorate even more mentally. Keeping everything bottled up to face on my own only caused me to suffer severe depression, anxiety, self-isolation, and one hell of an eating disorder that I still struggle with to this day.

This is going to sound dramatic, I know, but simply existing was such an unbearable and exhausting chore. Every morning I was met with an eerie, unfamiliar, and foreign feeling when I would look into the mirror and be looking into the eyes of someone I didn’t recognize. It wasn’t long before I had every mirrored image in my dorm room covered in fear of catching just one quick glance at myself.  It made me physically ill and angry, it turned me into such an ugly, hateful person. My life had felt like I was constantly drowning above water. Something had to give because I did not plan to keep living life if this is what it entailed.

In the early second semester of my freshman year at college, I remember seeing a friend post on social media that he had just gotten his first dose of “T”. I remember being extremely puzzled, but also comforted by this new sense of life behind his eyes in the post. I began researching what “T” was and that’s how I discovered what being transgender really meant. Every messy, screaming, ugly thought in my head slowly started to fade and things clicked into place, my mind started to make sense. I’m sure anyone having a gender identity crisis would spiral a tad, but the more I learned, the more comforted and valid I felt. The first time I said it aloud to myself in front of the mirror, I had tears welling my eyes as I always did seeing my own reflection, but this time they were tears of relief. I felt like my feet were finally hitting the pavement and I was running from the stranger’s gaze looking back at me through the mirror. I finally got the courage to come out to my mother as transgender over the Easter weekend of 2016. A few short weeks later and I was in the doctor’s office learning how to give myself testosterone injections. The first time that needle pierced my skin, I never felt more alive. I never felt more me.

If you were to take just one quick glance at me, you’d be shocked to know that I, as a 25-year-old grown man, try to fist fight anyone who comes within 5 feet of me with a needle & syringe. I say this because I am covered with tattoos and anytime I tell someone about my difficulties with needles they immediately hit me with ‘but you have so many tattoos! How could you possibly fear needles?” I can’t explain why, but everyone with tattoos will agree with me that they are nowhere close to the same experience.

What’s hysterically ironic is that while needles and injections are the banes of my existence, they’ve also saved my life and kept me alive for the past six years. For me, being a trans man means having to take a weekly dosage of testosterone, administered by myself, intramuscularly into my thigh. Intramuscular injections are a little different than what you might be thinking of when I say ‘self-injection.’ IM Injections are a technique used to deliver a medication deep into the muscles, allowing the medication to be absorbed into the bloodstream quickly. Subcutaneous injections go just below the skin and are what you think of when you imagine a diabetic getting insulin.

You would think that one shot weekly would be a piece of cake, right? Well, I’m sure it is but like I said, I have an eating disorder, so something being a ‘piece of cake’ for me is not the relief it sounds like it would. There are many obstacles I, and so many other trans individuals have to overcome just to get the life-saving medicine we need. Arguably the biggest obstacle is just actually getting your correct prescription. In the 6 years that I have been on testosterone, my prescription has been wrong or incomplete more times than it has been successful. Each time I refill, I get a couple of vials of Testosterone, syringes, and two separately sized needles (one is thicker and used to pull the medicine into the syringe, the smaller of the 2 needle diameters is the one that is plunged into my leg). Almost always, it’s an issue with my needles. When my prescription is ‘filled’, oftentimes I’m left with syringes and testosterone, and no needles to administer it with. Or, I’ll get completely wrong sized needles, which may not seem like a big deal to some reading this, but it is an astronomically large issue when the needle you have to plunge deep into your muscle tissue is now longer or thicker than what you’re used to because of an error. Today (June 7th) was shot day for me and I am currently having to inject my thigh with a needle half an inch longer and one size larger because the prescription was fulfilled incorrectly. I don’t care how much of a wimp this will make me seem, one size larger really does make the world of difference in terms of pain.

I know what you’re thinking, why not just call in the correct size? I have touched base with many of my trans brothers and we have all shared a similar experience of being denied refills on needles that have been deemed ‘too early’ to refill and forced to use what we have. There is such an ugly stigma that tries connecting needle use with drug use. It feels as though each time I need to correct the error in my prescription that I did not make, I have to convince my insurance that my needles aren’t for illegal or recreational drug use. I say the stigma is ugly because society looks at those who use drugs and deems them undeserving of a life worth living. When I have to explain myself that I am not using excess needles for something I shouldn’t be, I feel like I have to prove my existence as a man all over again and it’s exhausting. Also, while this may not be something I have to fight personally, the argument against allowing trans men to serve in the military is oftentimes boiled down to being too difficult to get soldiers their testosterone injection supplies while in the field. I hate to break it to everyone, but it’s difficult to get even while in the civilian world. We, as a society, have found ways to order fresh produce and alcohol from an app on your phone to be delivered the very same day, there has got to be an easier way to get medical supplies.

The actual process of injecting my testosterone is very inconvenient. On shot day, it’s not the simple ‘take your syringe from the package, stab it in your leg, and wait for your mustache to grow’ like I wish it was. The supplies I use on a typical weekly shot day for me include; 1 syringe, 1 larger needle used to pull the liquid with, 1 smaller needle to inject, my vial of testosterone, a bandage, and sterilization supplies. I would love to sit here and tell you about how brave I am when taking my shot, how it only takes me 5 or so minutes to do, just a quick in and out, but that is a bold-faced lie. I spend that amount of time alone just staring at the needle while cowering in my boxers. You wouldn’t normally think the task of throwing something away could be so complex, but the story is a little different when it comes to needles and syringes. It is highly recommended that you dispose of needles in a Sharps container. A Sharps container is a leak-resistant container made from puncture resistant plastic or metal with a tight-fitting lid, with an opening to accommodate depositing a sharp but not large enough for a hand to enter. Sharps containers are reserved for those items that could puncture the skin and help limit the exposure to bloodborne pathogens. Unless you are a hop, skip, and a jump away from a medical facility, it can be difficult to find the appropriate methods of disposing of your shot day supplies.

Traveling with your testosterone prescription can also be tricky sometimes as well. For me, it’s quite the dumpster fire. Every time I have to pack my hormone replacement therapy essentials for a flight or any kind of public transportation, I live in a constant state of anxiety and worry that someone is going to find me out. While it is only the addition of another small bag to carry, it is essentially my lifeline and we have to be extremely careful with those materials falling into others’ hands. Thankfully, I have only been stopped by TSA once and had to explain my testosterone supplies. The agent was extremely respectful and accepting, but with the state our nation is in today, I constantly worry one day I won’t be as lucky as I was when I was stopped by such a nice person. All it takes is one wrong person finding out who I am and there could be trouble. You just don’t know these days, and my safety is something I won’t risk.

All physical inconveniences (such as equipment and supplies, time, space, etc) aside, the biggest obstacle I’ve faced with my hormone replacement therapy is one I haven’t even fully overcome yet, nor will I think I ever will completely. The biggest challenge I have with giving myself testosterone injections is the mental block. I don’t know what holds me back every week, but I have sat in one position with the needle in my hand, ready to plunge, for up to ten minutes at a time, too afraid to get it over with. I know the actual process of stabbing myself, injecting the T, and withdrawing the needle literally only takes about 10 seconds, but for the life of me I can never bring myself to do it. I fist fight off an anxiety attack while my cat silently judges me from the corner of the bathroom. I’ve read all the tips and tricks to an easier and more successful shot, I’ve had others do it, and I’ve even watched motivational speech videos while staring myself down in the mirror like I was about to go out and run the ball in the last play of a Superbowl, I just can’t seem to get over the fears I’ve made up in my mind. On June 13 of 2022 I will have been on testosterone for six full years. With every year, month, and week that passes, it hasn’t gotten any easier for me.

There have been times I’ve been so worked up or just plain afraid to take my shot that I have skipped it altogether. If I am being honest, I have probably shorted myself at least a month or two in the 6 years I’ve been taking testosterone because it can get me so worked up.  When I skip or miss, which I have also missed multiple shot days due to not receiving my prescription correctly/on time, it’s like I’m submerged into a pool of body dysmorphia. There are some physical changes I’ve gone through since starting testosterone that will never reverse, such as my voice being deeper and the facial hair I’ve grown so proud of. Yet somehow in my head, I convince myself that every ounce of progress I’ve made in the past 6 years of hormone replacement therapy is about to be washed away overnight by missing one shot. It’s like the morning after a missed shot day, I wake up, glance into the mirror and suddenly it’s the monster I was prior to testosterone staring back at me like she just made me her greatest con. It’s a face that haunts me and leaves me frozen in fear. Speaking honestly, the dysmorphia is single-handedly the biggest and toughest battle in my transition. There are some days it leaves me crippled in fear and pain, isolating myself from anyone or anything.  Most people run away from serial killers, ghosts, or rabid animals in their nightmares, you know, real fears. Me? I can never run away fast enough from the person I was and she always seems to be right on my heels breathing down my neck.

What’s embarrassing is that I can’t even sit here and tell you exactly what I’m so afraid of. Is it the needle itself? Is it the fear of messing up and convincing myself I’d have to then get my leg amputated?  Is it the pain? You would think. There is no pain in the world I wouldn’t endure to live the life I live, in the body I have now. There was no pain greater than what I was already living through every day before I started testosterone.

Every week as the chill from a cold toilet seat raises the hair on my exposed thighs, I sit and bite my lip to swiss cheese, so nervous to pierce my own skin and inject what to me, is so much more than just testosterone. These injections give me the freedom to live. These injections give me the confidence and courage to make it through another week for the next dose. It is so much more than just testosterone; it’s a deepened voice that greets strangers the past me would do everything I could to avoid. It’s the facial hair that surrounds the smile on my face that had never been there 6 years prior. I think what is so controversial about testosterone and hormone replacement therapy, is that it’s not seen as something ‘medically necessary’ when it comes to the treatment of transgender individuals. This could not be farther from the truth. I am here to tell you that hormone replacement therapy saved my life and was the best thing I could have ever done for myself. My only regret about taking testosterone is that I didn’t make the self-discovery sooner, now I feel as if I’ve shorted myself years of living authentically.  I think of everything that magical liquid has done for me and all that is yet to come on my journey, and with that beautiful thought at the forefront of my mind, the needle slides right in.

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