Injection Alternatives

Prescribing nasal sprays as an alternative to injectable hormone blockers.


Some gender-affirming medications are given by injections and it can be hard to find someone to administer these safely for you. GenderGP has alternatives in the form of Puberty Blocker Nasal Spray and Testosterone Gels.

Nasal Spray Puberty Blockers

Hormone Blockers have been used for many years to suppress natural sex hormone production in trans youth and adults. Although the medication is not licensed for this use, we know it to be both safe and effective at suppressing puberty in adolescents, and the ongoing effects of sex hormones in adults.

In the UK, most blockers are given by injection, either monthly or three-monthly. However, in other countries, other methods of delivery are used – such as implants (a small pellet placed under the skin), and nasal sprays.

Injections and implants require a level of expertise – a nurse, midwife or doctor – to either administer the injection, or to teach someone else to do it. They also have the disadvantage of being expensive, as well as needing to be refrigerated when stored.

Nasal sprays seem to offer an ideal solution as an alternative in cases where administration is a challenge, or a needle phobia exists. While awareness around nasal sprays is increasing (over recent years we have seen their use in administering the flu vaccine among young people), as a method of delivery they are still relatively unknown and therefore not as widely used, or evaluated.

Their use in conditions such as endometriosis is well-known and evaluated, but their use in the suppression of puberty in trans patients is less well tested. However, there is no evidence to suggest that they are not a viable alternative to injections.

The spray is given twice a day, with a blood test being carried out after four weeks to ensure that hormones are being suppressed. Three-monthly blood testing, then enables us to monitor that they are working effectively.

If you would like to try a nasal spray to suppress your natural hormone production, as an alternative to your usual injectable blocker, please ask a member of the GenderGP team.

We can prescribe two options: Suprafect and Synarel. Synarel has a longer shelf life (four weeks) but there are occasional supply issues. Please ask the team for more information.

Either of these nasal sprays can be used to replace your current blocker (Decapeptyl, Spironolactone, Cyproterone or Bicalutamide). For trans feminine people using finasteride for prevention of male pattern hair loss, this can be continued alongside the nasal spray at 1mg a day.


Testosterone Gel

Testosterone can be easily prescribed as a gel instead of injection. This gives a nice, steady, daily dose and once it is dry on the skin it is not transferable to anyone coming into close contact with you.