How to Inject Testosterone

Testosterone is a hormone produced in the testes in males and the ovaries in females. In men, testosterone levels are typically 7-8 times higher than in women. Although the body naturally produces this hormone, it is sometimes administered via injection to treat certain health conditions. Just like with any other injection under the skin, care must be taken to ensure that testosterone is safely delivered with minimal risk of infection. Begin with Step 1 below:

Know when and why testosterone is prescribed. People turn to testosterone as a treatment for various health issues. It is commonly prescribed for hypogonadism in men, a condition in which the testes do not function properly. However, this is not the only reason testosterone may be needed. Here are some other possible reasons:

• Testosterone is sometimes injected for transgender individuals as part of their gender affirmation and transition process.
• Some women receive testosterone injections to treat androgen deficiency, a condition that can occur post-menopause. The most common symptom of androgen deficiency in women is reduced libido.
• Finally, some men seek testosterone to counteract the typical effects of reduced testosterone production that accompany aging. However, this practice is not well-researched, and many doctors advise against it. A few studies have been conducted, but the results are inconclusive.

Know when not to administer testosterone. As a hormone that can cause significant changes in the body’s functions, testosterone may stimulate or worsen certain conditions. It should not be injected into individuals with prostate cancer or breast cancer. All patients considering testosterone therapy must have a prostate exam and a prostate-specific antigen (PSA) test before and after receiving testosterone to ensure they do not have prostate cancer.

Consult with a doctor. As with any serious medical treatment, you should not take the decision to inject testosterone lightly. Seek medical advice from your doctor before proceeding. Your doctor will assess your condition and goals to determine whether testosterone injections are suitable for you.

Determine testosterone concentration. Testosterone for injection typically comes in the form of testosterone cypionate or testosterone enanthate. These fluids come in various concentrations, so before injecting, you must consider the serum testosterone concentration to determine the correct dose. Testosterone is typically available at concentrations of 100 mg/mL or 200 mg/mL. In other words, some doses of testosterone are twice as concentrated as others. Always check the testosterone concentration before injecting to ensure you're using the correct dose and concentration of testosterone.

Use an appropriate, sterile syringe and needle. Just like with any injection, using a completely new, sterile needle for testosterone injections is very important. A contaminated needle can transmit deadly bloodborne diseases like hepatitis and HIV. Always use a clean needle, sealed in packaging, with a cap when administering testosterone.

• One thing to consider is that testosterone is quite sticky and viscous compared to other injectable medications. Therefore, you should start by using a slightly larger needle (such as 18 or 20 gauge) to draw the required dose. The larger needle may cause significant pain, so you will usually need to replace it with a smaller needle for the actual injection.
• A 3 mL (cc) syringe is typically large enough to hold most testosterone doses.
• If you drop the syringe or needle, dispose of it immediately. Do not reuse it, as it will no longer be sterile.

Wash hands and wear clean gloves. To reduce the risk of infection, it is essential to keep your hands clean when administering testosterone. Wash your hands thoroughly with antibacterial soap and water, then wear clean gloves. If you accidentally touch any surface or object that hasn't been disinfected before the injection, change your gloves to be safe.

Draw the testosterone dose from the vial. Your doctor will specify the recommended injection dose, which is based on the testosterone concentration. For instance, if the prescribed dose is 100 mg, you would need to draw 1 mL of testosterone at 100 mg/mL or 1/2 mL of testosterone at 200 mg/mL. To draw the testosterone from the vial, begin by drawing air into the syringe equivalent to the required dose. Then, sterilize the vial opening with an alcohol swab and insert the needle through the rubber stopper. Push the air into the vial, then flip the vial upside down to draw the precise amount of testosterone needed.

• Injecting air into the vial increases pressure inside, helping to draw testosterone more easily due to its thick consistency.

Switch to a smaller needle. A larger needle can be quite painful. There’s no need to endure this discomfort, especially if you need to inject testosterone regularly. After drawing the testosterone into the syringe, remove the needle from the vial and hold the needle upright in front of you. Draw a small amount of air into the syringe to create space between the medication and the plunger to avoid spillage. Using your clean, gloved hand, carefully remove the larger needle and replace it with a smaller one (e.g., 23 gauge).

• Ensure that the second needle is still in its sterile packaging.

Remove air bubbles from the syringe. Injecting air into the body can cause a serious condition known as air embolism. To prevent this, make sure there are no air bubbles in the syringe before administering the testosterone. Follow these steps:

• Hold the syringe with the needle facing up and in front of you.
• Observe the air bubbles inside the syringe and gently tap the side to make them rise to the top.
• Once no bubbles remain, slowly press the plunger to expel the air at the top of the syringe. Stop once a small drop of medication appears at the needle tip. Be cautious not to spill excess medication.

Prepare the injection site. Testosterone injections are typically administered intramuscularly, directly into the muscle. Two easily accessible injection sites are the outer thigh (upper, outer part) and the gluteal muscle (upper, rear part of the thigh, such as the buttocks). While these are the most common sites, other areas are also viable. Regardless of where you choose to inject, always sterilize the area with an alcohol swab to kill bacteria and prevent infection.

• If injecting into the gluteal muscle, aim for the upper, outer portion of the buttocks. This means choosing the upper-left or upper-right corner of the glute. These areas have easily accessible muscle tissue, helping you avoid hitting nerves or blood vessels in other regions.

Inject the testosterone. Hold the syringe containing the medication at a 90-degree angle to the sterilized injection site. Quickly and steadily insert the needle into the muscle. Before pressing the plunger, slightly pull back on it. If blood enters the syringe, remove the needle and select a different site, as this indicates that you’ve hit a vein. Inject the medication at a controlled, steady pace.

• You may feel slight discomfort, pressure, a pinch, or a mild burning sensation. This is normal. However, if the pain becomes severe or sharp, stop the injection and consult your doctor.

Care for the injection site after administering the injection. After fully pressing the plunger, gently remove the needle from the injection site. Check the area for any bleeding, and if necessary, apply a sterile bandage and/or a clean cotton ball. Dispose of the used needle and syringe in a sharps container.

• If you don’t have a designated sharps container, use a sturdy, non-scratching container, such as a detergent bottle. Ensure it has a secure lid. Take the container to your doctor’s office or pharmacy for proper disposal.
• If you notice increased redness, swelling, or unusual pain around the injection site, seek immediate medical attention.

• Use a larger needle for drawing the medication. You can switch to a smaller needle when injecting testosterone.
• The smaller the gauge number, the larger the needle. For instance, an 18-gauge needle is larger than a 25-gauge needle.
• You can use an insulin pen for injections since needle size is less critical. The oil in the medication isn’t thick enough to prevent it from flowing, but it might take a bit longer to draw into a small needle.
• Syringes come in various lengths. Commonly used are 2.5 cm and 3.8 cm needles. If you have a larger build, you might opt for the 3.8 cm length, while the 2.5 cm length is better for thinner muscles.
• After injecting, massage the area in a circular motion to help distribute the medication and reduce swelling or pain.