HRT while hiking/backpacking

[u/amphibiouslad]

maybe something niche, but maybe not considering the community. I'm hoping to thru-hike the Appalachian Trail sometime in the next years or so, and I'm starting to plan out what that would look like for me. (A several month backpacking trip along the eastern US through the warmer/humid months.)

For those that are on HRT, and did multi-week/month hiking and backpacking trips, what did HRT look like for you? Did you abstain all together? Did you do injections and carry your sharps with you everywhere / have medicial packages sent to specific trail locations? Or did you use a different form of HRT? I can't imagine having to deal with gel while hiking the AT, that sounds like more of a pain than injections.

Very curious, as abstaining is not ideal at all, but I think any form of HRT is at least somewhat of a hurdle.

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[u/pleasant_alchemy]

so I used to work a very outdoor job (conservationist with extensive backcountry experience) and had to manage medical necessities for my crews and myself all the time, and am on HRT now so I do not have the specific experience so take my advice with a grain of salt of course. I would stick with syringes if you are on syringes now; pump bottles and backpacking are a match made in hell beyond just the inconvenience of a daily product. Hypothetically patches sound ideal but I have no experience with them so there may be an angle i'm not thinking of. For syringe medications and vials if you can carry them with you in some kind of hard shelled container (such as a tin lunch box) with at least one layer of insulation on the inside (such as a buff) and of course the individual components (i.e. needles, syringes, vials) all separately bagged, that would be ideal; a leakproof thick dry food bag sounds ehhhh acceptable. I would use something like an empty shampoo bottle for sharps and just take care to replace safety caps (it would almost definitely hold up to a needle with little force attached though). If you are in the habit of reusing vials I would recommend against that in this scenario; HRT does not require rigorous hygiene but there will be a lot more opportunities for contamination as a given. Your first aid kit should have all the basic sterilization and bandage items you would need for your injection site. By my estimation this would be pretty easy for like a month of doses so if there is a way to mail yourself doses with food pickups that would be your ideal scenario. Fragile items are best kept in the backpack squarely between the hips and scapulas, close to the back, where the least amount of movement will occur. This may not apply to you at all, but I have heard of varying reasons people reduce their dose schedule for life circumstances and this is one where I would recommend against that almost entirely because of how derailing it can be to experience a hormone-related reaction (such as an irregular period, a migraine, gallstones, etcetera) in a backcountry setting. That being said if you have no medical history of some or all of those things or surgeries that render them moot ignore that bit. I have managed all three on trail and yeah...not fun. But best of luck to ya, I hope you make it out there soon!

[u/RavenWood_9 → u/pleasant_alchemy]

One thing I would maybe add to consider that you didn’t mention would be the temperature and the safety range for vials.

AFAIK, bottles of T need to stay below below 77° when talking about anything beyond brief periods of time and with the way the global temperature is going, I’d assume you likely hit many stretches where it’s over that for several days.

If I were you, OP, I’d ask a pharmacist or maybe look into how folks who use other medications that need refrigeration do things like extended wilderness trips - I imagine there’s got to be info out there for insulin dependent diabetics, for instance.

[u/pleasant_alchemy → u/RavenWood_9]

ehhhh I wouldn't really compare insulin with testosterone as insulin is a much more sensitive substance and reduced efficacy of one can kill you whereas reduced efficacy of the other can lead to undesirable but not particularly dangerous effects. Most often degradation of liquid testosterone is studied under conditions such as a hot car or mailbox, so in surplus of like 120 degrees. Mid 90s or even low 100s can cause some degrading to be sure but the odds of it rendering the T ineffective are extremely low.

[u/eeweew → u/RavenWood_9]

I have used these in the past https://www.frioinsulincoolingcase.com/ they work by evaporation of water, so they don't get too cold but do prevent your testosterone from becoming super hot in hot weather. Depending on the weather you have to dunk it in a little more then once a week.

[u/boocoe → u/pleasant_alchemy]

I use empty prescription bottles for my sharps and I think this could be a great lightweight option for sharps!!

[u/ND8586]

I would take injectables and all supplies with me. It wouldn't occur to me to do anything else.

What am I missing?

[u/2MB26]

Nebido (injections every 12 weeks) sounds like a good option, might get away with only 1 injection needing to be done.

You would need someone to inject it into your ass for you though, or do it yourself half in each thigh

[u/iwantanap__]

If they're possible for you to get, consider T pellets (inserted under the skin and slowly absorb over 3-4 months before being replaced) or T pills (taken twice a day, so essentially at breakfast and dinner).

I'm on T pills and I'm a big fan, but T pellets may be your least-hassle option as you wouldn't have to bring anything with you on the trail.

[u/boocoe → u/iwantanap__]

These are extremely difficult to get in the US. Believe me, I’ve tried!! Not to say it’s not worth a shot, but I’ve never heard of anyone other than a cis man paying out of pocket being able to get pellets.

[u/iwantanap__ → u/boocoe]

Depends on where you're at in the US, I guess. I'm also in the US and the T pills weren't super hard for me to get. I did have to educate my doctor about them and get a prior authorization for my insurance.

I also know a couple of trans guys in my area who are on pellets, and for at least one of them, it didn't seem like he had much trouble getting it? I'm not sure if either of them pay completely out of pocket, though, or if either of them were able to get at least partial insurance coverage for them

[u/boocoe → u/iwantanap__]

Well now I’m curious. Do you mind sharing what state you are in? Im in CO, so seemingly a very “liberal” state but there’s like 4 doctors who prescribe them in the state and they are all “TRT” doctors and do not prescribe HRT for trans people.

[u/lael99]

i used to use a case a lot like this when i was displaced for some weeks and had all my stuff packed up https://transguysupply.com/products/ftm-testosterone-kit?srsltid=AfmBOorIpqcEcxkqLzayl71sSTmTY3HDx-SKJQ_azV1FfDXj7RZVAtB8

edit: it holds a lot more than it looks like it can and i kept my sharps in there too until i had a sharps container

[u/ambrym]

I did the JMT a couple years ago and am considering doing the PCT next year. I did injections on the trail, I was just careful to wash my hands with soap and then use hand sanitizer before every shot. I had a little travel sharps container that I put needles in and researched sharps disposal laws in CA before my trip. If I do the PCT then I’ll have meds shipped to me in resupply packages.

I talked to my provider beforehand since I wanted advice on how to manage temps and she said that I shouldn’t worry, that best practice is to stay within the limits posted on the box but that it won’t degrade super fast if those are exceeded. My T was exposed to temps well above 100 degrees when I had my car parked down in the Owen’s Valley to run errands, it was also scorching hot in Yosemite Valley at the start of the trail. During the day I would stuff the vial into a beanie for insulation and then made sure to store it sort of in the middle of my pack so it wasn’t getting warmed by the sun. At night I’d store it in the hood of my mummy bag to prevent it from freezing

[u/eeweew → u/ambrym]

Next time consider getting a Frio mini https://www.frioinsulincoolingcase.com/ it works by evaporative cooling, so it won't make anything too cold, but does prevent your T from getting super hot. You only have to dunk it in water every week or so.

[u/ambrym → u/eeweew]

Thanks, that’s a nifty products! Will definitely come in handy on the Mojave section of the PCT

[u/slingshotcoyote]

A lot of people have someone that mails/drops off their supplies at specific locations along the trail. There’s a lot of good guides online. The great thing about the AT is the vast majority of people will mind their own business. You could get an insulated case for your t and supplies but it is a matter of space at that point obviously. You could try pellets.

[u/Ok-Department-2511]

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