@jordanmford's needle size advice for HRT, fact-checked

What did @jordanmford actually say?

Jordan walked through a self-administered intramuscular estrogen injection in real time, including mistakes. She described swapping to a thinner needle for injection after drawing, aspirating to check for blood return, flexing the muscle to locate the injection site, and disposing of sharps properly. She also noted that flexing "so you can see the muscle" helps reduce pain. The video is raw and unscripted, which is actually useful context for evaluating the advice.

Key procedural claims: use a thick needle to draw, switch to a thinner needle to inject, draw slightly more than your dose and push back to remove air bubbles, aspirate after insertion, and if no blood draws back "you're good." She also recommended alcohol-wiping both the thigh and the vial top before injection.

Does the science back this up?

Some of it, yes. The needle-swap technique is standard practice and well-supported. The aspiration recommendation, however, is where this video runs into a real problem with current clinical guidance. The rest of the procedural steps are largely reasonable for home IM injection.

Drawing medication with a larger-bore needle (typically 18-21G) and switching to a smaller one (23-25G) for injection is endorsed by nursing and pharmacy practice standards. It reduces injection-site pain and tissue trauma, and avoids dulling the needle tip before skin puncture. The alcohol wipe on the rubber stopper of the vial is also correct, per CDC injection safety guidance.

Air bubble removal by drawing excess and pushing back is a reasonable technique, though clinical protocols typically just flick and push bubbles to the needle tip rather than cycling fluid back into the vial, which carries a small contamination risk if not done carefully.

What did they get wrong (or right)?

The aspiration step is the most significant clinical issue here. Jordan says "if it doesn't pull up any blood, you're good," treating blood return as the safety check for correct placement. Current guidance from the WHO, CDC, and the Advisory Committee on Immunization Practices (ACIP) no longer recommends aspiration before IM injections at standard sites like the vastus lateralis (outer thigh). The 2020 CDC immunization guidelines explicitly state aspiration is unnecessary for IM injections in the deltoid or thigh.

The reasoning: major blood vessels in these sites are small enough that accidental intravenous injection is extremely unlikely, and aspiration adds pain without meaningful safety benefit. That said, some clinicians still teach it for depot hormone injections specifically, and the evidence isn't entirely one-sided, so this is "misleading" rather than flatly wrong.

What she got right: flexing the muscle before injection actually does reduce pain perception by engaging the tissue and is consistent with standard patient education. Disposing of used needles in a sharps container (her "needle drawer") is correct and legally required in most jurisdictions. Cleaning the vial top is correct. The needle-swap is correct.

What should you actually know?

If you're self-administering IM estrogen at home, a few things matter more than this video covers. Site rotation is critical. Injecting the same spot repeatedly causes lipohypertrophy, which changes absorption rates. Jordan doesn't mention rotating sites at all.

Injection angle for the vastus lateralis should be 90 degrees to the skin surface for IM delivery in most adults. The video isn't explicit about this. Injecting at an angle risks subcutaneous delivery instead of intramuscular, which alters the pharmacokinetics of estradiol cypionate or valerate significantly (Dobs et al., 1999, Journal of Clinical Endocrinology and Metabolism).

The "flexing to see the muscle" tip is genuinely useful for leaner individuals. For individuals with higher body fat at the injection site, the recommended approach is to use a longer needle to reliably reach the muscle belly, as subcutaneous fat depth varies considerably (Chan et al., 2006, Vaccine).

Finally: if you're on a regulated telehealth platform, your prescriber should have walked you through injection technique at the point of prescription. If they didn't, that's a gap in your care worth asking about.