Hi! I’ve been using gel for several months, but a few weeks ago I made the change to injections. Each injection has resulted in some pains in random areas in my left leg, but mostly concentrated in the muscles below the knee. I also started waking up with muscle spasms in the same leg, which is something I used to have before puberty. The pain mostly subsides after a day or two.

I suspect the issue is vasodilation which I understand is more common in women than men because estrogen dilates the blood vessels, but I wanted to hear other peoples thoughts.

Wearing overknee socks (to compress) helps, as does ice and exercise/movement, which I think is in favour of this being vasodilation.

I will be bringing this up with a doctor in a couple of weeks, but I’m afraid he won’t be able to help much or have someone to refer me to as competence regarding trans stuff is pretty low here in Norway (also I’m diy).

I would like to know as much as possible about what this could be so I have something to present to him.

  • mjsaber@lemmy.blahaj.zone
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    3 months ago

    Estrogen does not dilate blood vessels, and vasodilation won’t cause pain. It’s very unlikely that the hormone is causing the pain.

    I have a few questions, if you don’t mind? You said you are doing the injections subcutaneous. Where are you injecting? What length of needle are you using? Subcutaneous injections are relatively painless and shouldn’t be causing any of the issues you are describing, but if you’re using a needle that is too big or injecting in a bad spot the pain could be related to injection site soreness.

    Pain in the legs and below the knee could be a sign of deep vein thrombosis. It’s very unlikely, but estrogen can make you more susceptible to blood clots. You are at higher risk for this if you smoke cigarettes (especially if you’re over 35), if you have a more sedentary lifestyle, or if your serum estrogen level is too high. Subcutaneous injections tend to lead to higher serum estrogen levels, which can put you at a higher risk for blood clots.

    You said you are DIY, is anyone checking your estrogen levels? What dose of estrogen are you taking, and how often?

    It’s pretty unlikely the pain is from a DVT, but that is a very serious complication you need to rule out (a dislodged clot from a DVT that travels to your lungs can cause a pulmonary embolism, which can potentially be fatal).

    I hope this doesn’t come across as condescending, but these are the questions I would ask if you were a patient.

    • WillStealYourUsername@lemmy.blahaj.zoneOP
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      3 months ago

      I hope this doesn’t come across as condescending

      Not at all! I posted this to hopefully figure out more stuff. I’m not a doctor and I expected to get some things wrong, and I very much appreciate your input <3

      What length of needle are you using? Where are you injecting? […] the pain could be related to injection site soreness.

      0.33 mm (29 G) x 12.7 mm insulin needles. In my thigh at 45 degrees per the video on the diywiki. I’m not an english speaker so I had to search around, the area that hurts is my calves, so I doubt it’s injection soreness.

      deep vein thrombosis

      I hope not! As I’m on monotherapy my levels are certainly higher than the levels of cis women, but I figured the risks of clood clots were long term, and I’ve only been on E for like half a year. No smoking or drugs. I’ve been very sedentary up until recently. I started doing a lot of walks and doing some semi-regular exercise, mostly focused on my legs. On average I take a walk a day (less during winter), and I’ve been doing this for a year. I’m unsure when I started exercising? One or two months ago? I suppose the exercise kinda lines up as well.

      is anyone checking your estrogen levels? What dose of estrogen are you taking, and how often?

      I did my first blood test for hormone levels last wednesday, but I haven’t received the results yet. I was gonna talk to my doctor about all this during the same appointment were I asked for the blood test, but he was away on holidays so I had some other random doctor as a substitute. I was not comfortable coming out to the substitute. I take 4mg every wednesday. I’ve taken 4-5 doses at this point. I took gel before this, but it was a bit of a mess in terms of how much I took and how often which isn’t good, so I figured injections were more my thing.

      Estrogen does not dilate blood vessels

      I might have been hasty. Found some mentions of weakened veins and leg pains being more common in women, and a reddit thread from a lady experiencing something similar after 4 months of hrt. I’m not sure where I got vasodilation from to be honest, but it got stuck in my brain.

      • mjsaber@lemmy.blahaj.zone
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        3 months ago

        Thank you for the thought-out response.

        It doesn’t sound like site soreness, and if you’re using insulin needles, those are too small to get into the muscle anyway.

        Your dose might be a little high, but I doubt it’s so high that it’s putting you at a risk for blood clots.

        It honestly sounds like it could just be soreness from exercising more if you started doing that around the same time as injections, and your body isn’t used to it. It could also be an electrolyte imbalance, as some others mentioned, but if you’re young and relatively healthy that’s fairly unlikely.

        I usually start with the most likely scenario and move from there. It’s pretty unlikely to be a DVT, injection site soreness, or electrolyte imbalance, so it’s likely just soreness. If you aren’t already, try adding some light stretching before or after you exercise. Applying heat should help, too, if it’s just muscle soreness. I would bring all this up with your doctor so they are able to rule out the more serious stuff, but I would not be overly concerned about it.

        On a somewhat related note, when looking up medical information I would stick with Mayo Clinic or Cleveland Clinic for general medical stuff. For trans specific info, Fenway Health is the gold standard (imo), someone linked to them in a different response. You can also check WPATH standards of care 8, but that’s meant as more of a reference for medical professionals and it might be a bit dense.

        Please let us know how it goes, and keep asking questions! It’s best to get from medical professionals, but sadly folks like us don’t always have that luxury.

        • dandelion@lemmy.blahaj.zone
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          3 months ago

          Yeah, I suspect it’s just dehydration and electrolyte imbalance from the increased exercise - I had a similar thing happen when I went from sedentary to regular exercise.

          • WillStealYourUsername@lemmy.blahaj.zoneOP
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            3 months ago

            I’m sure that explains the cramps, but the pain/discomfort happens within an hour or two after injection and lasts for a couple of days, which is the part that I’m worried about. But they might be connected in some way so taking the advice I’ve been given here seems like the way to go. I’ve bought magnesium, bought some banana smoothies, had some fried creamed spinach with broccoli, and made sure to drink lots. Hopefully there won’t be any issues (or at least milder symptoms) with the next injection. Also gonna go grab some of those electrolyte sports drinks.

            Thanks again <3

            Edit: Also chocolate contains lots of potassium as well ! Treating myself as we speak

            • dandelion@lemmy.blahaj.zone
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              3 months ago

              Awesome - I really hope the cramps go away. I was happy to hear you were starting to exercise more too, and to see now that you are really taking care of yourself is just so heart-warming!! ❤️ ❤️ ❤️

  • NelDel@lemmy.one
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    3 months ago

    Just out of curiosity are you intramuscular or subq injections? Im sorry I haven’t really experienced those sensations on subq

      • dandelion@lemmy.blahaj.zone
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        3 months ago

        Where are you injecting? Why do you think the muscle spams are caused by the injections (and not, for example, lack of hydration or sodium or potassium deficiencies)?

        If it were vasodilation you would be able to measure your blood pressure to tell, since vasodilation lowers blood pressure. My blood pressure hasn’t changed significantly since injecting estradiol subq, so I doubt estrogen is going to significantly cause vasodilation.

        • WillStealYourUsername@lemmy.blahaj.zoneOP
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          3 months ago

          I’m injecting in the thigh, alternating between left and right, with the discomfort being strongest the first two days after injection. I don’t know that the spasms are caused by the injections (I don’t think they are, I think they are related to estrogen, but that they started around the same time as I started injecting so I felt I had to mention it).

          I do often wake up dehydrated despite drinking lots of water and might also have a potassium deficiency (I had a slight deficiency a year ago). I actually took a blood test a week ago which among other things checked my creatine levels and they were on the low side as well. I will be looking into this, thank you.

          I had something which was probably vasoconstriction when taking ADHD meds prior to starting hrt which was so uncomfortable and painful I had to stop. I tried the medication again after HRT and the side effects had significantly lessened, but this could be for any number of reasons. The side effects from the stims affected both legs, but the left leg was affected more.

          I don’t regularly check my blood pressure and doubt I have records of earlier tests to compare to unfortunately.

          Estrogen is known to be linked to vascular function and increases the risks of vasodilation or at least to certain vascular issues, per my light skimming of the web at least. This is not to say that it is something most people have to worry about.

          My pet theory is that I have some sensitive vasculature or whatever the proper term is in my left leg causing changes from stims and estrogen to be extra noticeable, but if it’s just a diet thing then that would be a huge relief.

          • dandelion@lemmy.blahaj.zone
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            3 months ago

            Where exactly in the thigh are you injecting? Are the spasms happening in the muscles near the injection site (i.e. are they localized), or are injections in one place on the thigh while spasms are happening elsewhere like in the calves for example?

            Hitting nerves can cause spasms like that, but if you are selecting the recommended sites and using a short-enough needle (like half inch), you shouldn’t be hitting nerves. I have had a physical therapist use needles to force muscles to spasm, it can be really uncomfortable and the spasms happen while the needle is in the muscle bed, so you would be able to tell (and it sounds like this isn’t happening).

            Here is an injection guide that shows sites for injecting subq in the thigh, to check against: PDF link, Archive.org PDF link.

            I used to inject in the thighs, but I found my abdomen had more fat and was less vascular than my thighs, so it has become a preferred injection site for me. You might experiment and just see if injecting in the abdomen makes any difference.

            If you really think it is vasodilation, you could get a blood pressure monitor and use it at home and keep a log (common recommendation is take a reading once in the morning and once in the evening; taking a bath, stress, exercise, and other things can influence blood pressure and throw off readings). Having a log would give you something more concrete to present to your doctor. Keeping track of changes to medication in that log would also be helpful.

            I would try drinking more water and including some electrolytes with that water (there are sport electrolyte tablets you can put in water, but vitamin packets like emergen-c also often have electrolytes; you can also just use some table salt for the sodium).

            You can also try incorporating more potassium rich foods in your diet like bananas, cooked spinach, sweet potatoes, button mushrooms, broccoli, etc. I used to get spasms like this before bed late at night in bed and often it was a combination of dehydration and not replenishing electrolytes after too much exercise.

            You might add to your blood pressure log changes in diet and a report about your spasms. Collecting all that information may seem like a lot at first, but it may be clarifying such that you identify and solve the problem and don’t need to keep track anymore.

            I sometimes have trouble staying hydrated through the day, but I find if I carry a water bottle with me everywhere I am more likely to drink enough water.

            Also remember to drink lots of water with your meals, as digestion takes a lot of water (and if you are eating like the average person, you probably aren’t getting enough water from your food, so incorporating more fruits and vegetables can help keep you hydrated as well - think cucumbers, tomatoes, berries, watermelon, lettuce, etc.; this lowers the burden of how much extra water you need to drink with a meal).

            I am not finding much about estrogen causing vasodilation just searching around, but I am super curious if you find something on that. Would also like to hear updates as you have them. Hope you figure it out and resolve the spasms!!

            • WillStealYourUsername@lemmy.blahaj.zoneOP
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              3 months ago

              Are the spasms happening in the muscles near the injection site

              Calves is the word! The spasms are happening in the calves.

              Where exactly in the thigh are you injecting?

              Video I used to learn how to do sub-q. I watched some other guides as well, including one longer one going into more detail, but this was the video I kept checking over and over.

              Hitting nerves can cause spasms like that

              The cramps happen when I wake up (or the cramps wake me up), so it doesn’t sound like a nerve thing. However you mentioned dehydration, and when I wake up is when I’m at my most dehydrated.

              You can also try incorporating more potassium rich foods in your diet

              I already eat a lot of broccoli and I will try adding spinach and sweet potatoes as well.

              I would try drinking more water and including some electrolytes

              More water is difficult, but electrolytes and sodium is doable.

              you could get a blood pressure monitor and use it at home and keep a log

              Remembering and bothering to fill out any kind of log will be difficult for me, but it sounds like a good idea. I’ll try. Perhaps a general hrt log is the way to go.

              you probably aren’t getting enough water from your food

              I eat mostly veggies (they’re maybe not the wateriest kinds however), noodles, bread and cheese, lots and lots of eggs, and meat substitutes. I think my dinners at least contain decent amounts of water, unsure about my other meals. I think I drink enough? I drink probably 1-3 liters a day, but I don’t keep track.

              I am not finding much about estrogen causing vasodilation

              One study. A larger study. I haven’t actually read these, but a quick skim seems to suggest that estrogen promotes some kind of vasodilation or is at least involved. I found these in a reddit thread by searching “vasodilation” “estrogen” and “reddit”. It might not be relevant to my issues however (the reddit threads were talking about spider angioma), I can’t really interpret this kinda stuff.

              I mentioned in another reply here that I was unsure where I got the term vasodilation from. This is the thread that suggested to me that my issues were related to my blood vessels. They don’t use the word, but somehow from there I got to vasodilation.

              Thank you for taking the time to write this stuff <3 I will try to make some dietary changes, skip my next dose, and then have a chat with my doctor in two weeks.

              • dandelion@lemmy.blahaj.zone
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                3 months ago

                Ah, I used to get spasms in my calves at night and the early morning too - they are called a “charley horse”. Definitely drink more water, maybe ensuring you drink enough water before bed. Eating more bananas and so on should help, too.

                You can also practice stretching the calves, I found this helped reduce my charley horses: https://www.youtube.com/watch?v=u4o0Fz6MFe0

                Do you exercise much or at all? Taking walks every day might also help, if that is possible. I got charley horses the most when I was engaging in a lot of exercise, but I also had them when I was sedentary. The way we sit all day often promotes tightness in the muscles, so stretching is a good idea regardless (esp. hip and hamstring stretches).

                In the Reddit thread where they speculated their leg pain was about blood vessels, they mentioned they are often dehydrated - another overlap in possible causes.

                Looking up the general guideline, it looks like 3 litres is the recommended amount to drink: https://newsinhealth.nih.gov/2023/05/hydrating-health

                It seems to vary based on age, weight, activity level, etc. - so this is highly contextual, you probably just need to drink more water, particularly before bed. (That can be tricky, drinking water right before bed can cause you to wake up at night to urinate, so you want to drink enough water at night up until around an hour before bed, and empty your bladder right before bed.)

                Anyway - thank you for the links, that was helpful. I definitely found some changes to my circulation with estrogen, I noticed I don’t feel as warm as I used to, though strangely it just feels like my temperature is “normal” now, it is colder than it was pre-HRT. So there are definitely changes, and maybe they are playing some role in your spasms, but I don’t think the solution is to stop your HRT but to encourage better health through hydration, diet, and stretching.

                Since you are DIY, if at all possible finding a way to get blood labs is a good idea so you can verify your levels are reasonable. However, since you are injecting, the risks from too much estrogen aren’t that great (assuming the estradiol you sourced is pure / good quality and so on, that seems to be the greater risk with DIY).

                Usually an overdose of estradiol can be felt with symptoms like headaches, fatigue, nausea, and fluid retention.

  • amethyst@lemmy.blahaj.zone
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    3 months ago

    I had something vaguely (very vaguely) similar happen a bit after I started taking progesterone. At around that time, I started getting a random stiffness/weirdness/almost-pain at the front of my right leg, maybe a third of the way down. It did feel a little bit like a muscle cramp, but localized to a very specific (and consistent) area. I only ever noticed it when walking.

    Touching and massaging that area didn’t hurt or feel any different, and there wasn’t anything visibly different either, other than it being the location of a fairly noticible vein. Since it wasn’t a particularly strong sensation, I never went to the doctor. In the end, it just kind of stopped happening at some point.

    This probably isn’t that helpful to you, but wanted to describe my experience since it at least had a couple things in common!

    • WillStealYourUsername@lemmy.blahaj.zoneOP
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      3 months ago

      Actually I noticed some rather pronounced veins on my calves after my leg started hurting. For me it was opposite, with walking pretty much immediately removing any discomfort. I’m glad it cleared up for you eventually !