Why do a subcutaneous testosterone injection?
Traditionally intramuscular injections were always used when injecting testosterone.
This is partly because large volumes were injected into the muscle and left a ‘depot’ of oil. This means that the testosterone is released over time from the ‘depot’ or store of oil left in the muscle tissue.
More recent research into testosterone dosing has indicated that more frequent, smaller dosing results in less side effects and improved, steadier testosterone and oestrogen levels. Smaller injections are therefore warranted, and subcutaneous testosterone injections have become more common.
Which is best – intramuscular or subcutaneous testosterone injections?
Subcutaneous injections are now the preferred way to inject testosterone such as enanthate and cypionate. This is for a few reasons.
1. It is safer as there is less chance of injecting testosterone oil into a blood vessel.
2. It is easier to teach.
3. The injection site can be seen more easily.
4. They cause less muscle damage and scar tissue.
5. Some evidence suggests they require a lower dose to achieve the same level of testosterone as Intramuscular.
6. The testosterone is released more slowly and therefore leads to less oestrogen, DHT and haematocrit spikes. All three of these things can increase side effects from TRT.
Intramuscular injections are still preferred over subcutaneous testosterone injections for certain preparations. This is true for Sustanon which has more irritating preservatives which make subcutaneous injections painful. Nebido is also too large an injection (4ml) to safely inject subcutaneously.
How to safely do a Subcutaneous testosterone injection
Step 1: Find a comfortable, well-lit place to sit and clean your work area
- Firstly you will want to arrange everything you will need for injecting so that you have everything ready in front of you and don’t need to touch anything which isn’t clean after washing your hands.
For testosterone enanthate or cypionate you will require:
- 1 ampoule of enanthate or your multiuse vial of cypionate/enanthate
- 1 filter needle (18G) if you are drawing from an ampoule
- 1 injecting needle (25G, 27G or 30G 0.5 inch length) either with a fixed syringe (if a multiuse vial) or a separate syringe
- 1 or 2 alcohol wipes
- Sharps bin for disposing of needles and syringes
2. Check the expiration date on the medication. Do not use medication with particles, medication that is discoloured or has expired.
3. Wash your hands thoroughly with soap, and dry off with paper towel or kitchen roll if possible.
Hand washing is one of the most important things you can do to prevent infection.
Step 2: Selecting and Preparing the Injection Site
Injecting subcutaneously into the belly fat
Injecting into the belly fat area is recommended as it doesn’t have any structures such as blood vessels and nerves close to the skin. It also tends to have a decent layer of adipose (fat) tissue under the skin so that you do not accidentally inject too deep past the subcutaneous layer.
The belly area is also easily accessible and viewable to allow easy injections.
These are the areas you can inject subcutaneously. We recommend the abdomen area in purple around the belly button.
Option 2 – Subcutaneous injection in the thigh:
Injecting subcutaneously into the thigh can be slightly less comfortable than the belly fat and for most men it is harder to achieve due to less body fat in this area.
Look at your thigh and divide it horizontally into 3 equal parts. The injection will go in outer middle third.
This area is midway down the first part of the thigh – between your knee and hip. It is not best for men with lower body fat levels but may be worth considering if you are rotating injection sites.
Step 3: Preparing the Injection Dose
- Check over the packaging of the syringes and needles you are going to use and make sure they have not been opened or damaged. If they ave been they are not sterile and should not be used.
- If you are using Enanthate, then break open the ampoule as if you are snapping a twig, aiming to break the ampoule at the neck under the side with the dot on (it will not break at the dot, but under it at the thinnest part of the ampoule). If you are using Cypionate or a multi-use vial then get the vial out and alcohol swab the grey rubber.
- Open the syringe and needle packages carefully. Be careful not to touch the open end of the syringe or needle against anything, including your hands. If you are using a multi-use vial then open your fixed needle/syringe.
- If drawing from an ampoule then open the 18G needle package carefully, taking care not to touch the open end of the needle against anything, including your hands. Screw the 18G needle onto the end of the syringe.
- Pull the 18G needle cover straight off the needle. Do not let the needle touch any surfaces.
- Insert the 18G needle into the ampoule and slowly pull back on the plunger. Draw up with the syringe until the plunger is at the dose prescribed by your doctor.
- Take the needle carefully out of the ampoule and turn the syringe upside down so you can check for air bubbles in the syringe. If there are air bubbles, pull back more on the plunger to bring more air into the syringe. Tap the barrel of the syringe to help the air bubbles to rise to the top of the syringe (Do not touch the needle with your fingers). You can then push the air out of the syringe by pushing on the plunger. You can leave a little bit of air where the needle meets the syringe which can be pushed out later before you inject. It is not as important to remove air when injecting subcutaneously as it is very unlikely to inject air into a blood vessel and cause injury.
- If you are using an ampoule then you can now remove the 18G needle and replace it with the 27G, 29G or 30G, 0.5-1 inch needle. You should leave the needle cover on until you are ready to give the injection.
- Make sure that the dose in the syringe is the dose prescribed by your doctor. Ask your doctor or Optimale if you’re not sure.
Step 4: Injecting the testosterone subcutaneously
1. Wipe the injection site skin with an alcohol swab; then let it dry in the air.
2. Slightly hold the skin around (don’t pinch too hard) so that the skin is away from the muscle beneath – ensuring a subcutaneous injection.
3. Using one quick and firm motion, insert the needle into the belly fat at a 45 degree angle.
4. There is no need to ‘aspirate’ with a subcutaneous injection. You can slowly push down on the plunger to complete the injection.
5. When you finish injecting the full dose of the medication subcutaneously, remove the needle slowly and at the same angle that you inserted the needle. There may be a small amount of oil and/or blood that comes from the hole. This is nothing to be alarmed about.
6. Gently wipe the area of the injection with an alcohol wipe and dispose of the needle and syringe in the sharps bin provided!
Tips for Reducing Subcutaneous Testosterone injection irritation
- Inject medicine that is at room temperature.
- Let the skin dry after using alcohol wipes before injecting.
- Break through the skin quickly with the needle – don’t slowly press it in.
- Don’t change the direction of the needle as it goes in or comes out.
- Do not reuse disposable needles – this increases infection risk and blunts the needle causing trauma and pain.
Instructions for Disposing of “Sharps” (needles):
Improper disposal of syringes and other sharp objects can pose a health risk and damage the environment.
Please always dispose of your used syringes and needles using a sharps box.
The sharps bin should then be taken to one of the recommended locations as per NHS guidelines – https://www.nhs.uk/chq/Pages/2421.aspx
You can also request that sharps bins are picked up from your house by the local council.
Dr Chris Airey
This article has been medically reviewed for accuracy by Dr Airey on 7th August 2020.
Dr Chris Airey is a fully registered UK doctor with the GMC (General Medical Council) Reference No: 7490533.
He trained at the University Hospital Southampton and graduated as a Doctor with a joint Bachelor of Medicine and a Bachelor of Surgery, plus a Masters in Medical Science, completing his research project in the Medical Neurosciences Department.
He is undertaking a Master of Science course in Endocrinology and is a member of the European Society for Sexual Medicine, and the Androgen Society.
He has personal experience with taking Testosterone Replacement Therapy and is a pioneer in UK treatment protocols for Testosterone Deficiency Syndrome.