Knowledge is power. As we head into uncertain times, we are sharing a limited series of QueerCME TikTok videos here on the QueerDoc blog. We’re starting with a short discussion on extending the shelf life of estradiol valerate vials.
QueerDoc’s sibling company is QueerCME, where we teach gender affirming care to other clinicians and providers (CME is short for Continuing Medical Education. Medical professionals are required to complete continuing education every year to maintain their licensing.)
The videos we share are not meant to be medical advice, and they are recorded with a clinical audience in mind, so we may use clinical terminology. But, we think these might be useful in the days ahead. As always, we recommend seeking advice from your prescriber if you have any questions about the video content. Transcript included below.
Tags:
Estradiol valerate, estrogen, single-use vials, sterile technique, storage and handling, injections, expiration dates, best practices, harm reduction.
A note on “shelf life”:
“Shelf life” refers to the amount of time a product can be stored before it becomes unusable. If we want to get technical, shelf life is a calculation for how long we can expect the product, when stored as recommended, to stay effective and to not break down. Shelf life is not the expiration date. For medicines, expiration date is pretty much always a year and is often shorter than the shelf life.
Related QueerDoc Resources:
- Self-Injections (step-by-step instructions for good technique!)
- Single-Use Vials: Are They Really One-Time Only Use?
- 1/8/24 Less Ouch! Tips for Less Painful Injections
- The Scoop On Syringes: Aiming For Volume
- Also check out our Video Library
- Outside resource with visuals for safer injections: Fenway Health’s Hormone Injection Guide
Link to TikTok video if the embed does not work:
Harm Reduction – Extending the Shelf Life of Estradiol Valerate Vials
Video Transcript:
A video of Dr. Beal addressing the camera. They have a dark blue shirt, red lips and red hoop earrings, and their hair is pulled back. This video was recorded the day after a live QueerCME event about prescribing estradiol in transgender medicine.
Transcript:
yeah so yesterday there were lots of comments about um
Estradiol Valerate and like
duration and safety and efficacy um
and so there’s not a lot of research on how long Estradiol Valerate is good
or self stable post expiration date by the manufacturer
you know data seems to suggest like
it might be stable for two to five years um um
as long as it looks okay
so let’s talk about how to make sure your route is safe
also this is all harm reduction
I wanna be really really clear
I can’t get medical advice online um
or on TikTok um um
rate in ultimately like
it’s much more ideal that you can like
follow the manufacturer’s instructions and blah blah blah um
but most of us can’t afford a vial estrogen every month um
anyways so we’ve already been doing this for a while
um but um
okay so let’s talk um
you want to store your Estradiol Valerate vials in the original container
the carton that paper box that came in
they are light sensitive so we want them in nice dark spaces um
right and we want them to be 20 to 25 degrees Celsius
which is like 66 to like 77 degrees Fahrenheit
so kind of like room temperature for most people um
and then you I generally recommend not throwing them in bathrooms um
for any medications whether it’s pressed tablets or vials
bathrooms just tend can get um
have less temperature stability
than the rest of the house
they can also have a lot of humidity um
which for files typically not a major issue
but with press tablets and stuff
if they’re not sealed well and get soggy
it’s uncommon
but also there’s like a lot of poop particulates flying around your bathroom
so better safe than sorry anyways
um
inspect your vial alright
so we’re checking our vial out
we wanna check for the expiration date
um again um
you’re using it kind of quote unquote
your own risk if you’re using it past expiration date
um but we do kind of think there is like
quite a bit of flexibility on that
although again no published research or literature to like
back that up just community wisdom
um and then things you wanna look for the um
liquids of oil and the Estradiol Valerate should be clear to like
light yellowish but clear
um and it might have crystallized
so the this actually might have come out of solution
it is okay to reclast crystallize it by placing it in a bowl of warm water
I don’t typically recommend microwaving it at all
but placing in a bowl of warm water
the crystals will go back until solution
if it is cloudy at all though
you do not want to use that
that’s a um
concerning finding so
don’t use a file that is cloudy if there’s anything else floating in it besides
um crystals
especially before you’ve opened it
or potentially cord it do not use it um
and then make sure you know everything like
the looks as expected so the labels on it
and then the rubber stopper looks nice and like
healthy so that it stayed sealed and sterile
so the rubber stopper hasn’t shrunk or pulled away from the edges
or gotten dryer crumbly
okay um
so we’ve inspected it and now we’re gonna open it
and so again
it’s manufacture recommended that you dispose of a vial 28 days after puncture
um and again
there’s not a lot of research or literature that I’m aware of saying
like the shelf life passed at 28 days
you know the risk with using files passed at 28 days is there’s like
this increased risk of contamination
and possible infection from injecting with it
um community wisdom has said that vials are like
safe to use for anywhere from like
three to six months possibly longer um
after puncture if you follow good um
aseptic techniques I’m so cleaning the top off with alcohol
always using sterile supplies when drawing from your vial
and not sharing your supplies or vials with anyone else
although sometimes
again from a harm reduction perspective
we may do that but in general
if you can keep one vial to one human
more ideal less risk of infection and contamination
um
and the other thing that’s gonna happen right
is the more punctures in the vial um
the more holes you’re gonna get in that rubber stopper
and the potential for coring
and so the smaller the needle you’re drawing from
the smaller gauge not the length but the gauge um
the last you’ll do that and so typically
you know when we’re not talking about harm reduction
I generally don’t recommend drawing for
through a needle that smaller than a 21 gauge
just cause um
it’s much much slower process to draw through a smaller needle and it um
can be a little bit obnoxious um
but I’m definitely have patients and can you members that um
draw through a 23 to 25 gauge and
and also inject with that
so that’s their injection needle as well as their jaw needle um
and then I definitely also have some patients who use insulin syringes
which are usually like 30 gauge um
right and so again
once you punctured it you wanna follow the same storage instructions
so I like keep it in that cardboard box um
keep it out of late keep it at room temperature
always inspect it um for um
prior to use um
for each injection um
so these are some safety tips and harm reduction tips
to help extend the duration of your um
hormones that you already have available or are in accessing currently
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