this post was submitted on 03 Aug 2024
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submitted 3 months ago* (last edited 3 months ago) by [email protected] to c/[email protected]
 

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.

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[–] [email protected] 3 points 3 months ago* (last edited 3 months ago) (1 children)

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.

[–] [email protected] 6 points 3 months ago* (last edited 3 months ago) (1 children)

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!!

[–] [email protected] 3 points 3 months ago (1 children)

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.

[–] [email protected] 2 points 3 months ago* (last edited 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.