How to Inject Testosterone Intramuscularly, Shallow IM or Subcutaneously ?

[fifty]

True. That blue and gray diagram is not good.

 

[Vince]

Best Injection site, no aspiration needed, avoids all nerves

 

[Nelson Vergel]

I strongly advise against injecting in the legs. Too many potential problems with bleeding and pain.

 

[Nelson Vergel]

Is there a story behind how Sub-Q injections of testosterone came about? ​

By D. Bruce

Here is a summary of the timeline:

1) Over 10-15 years ago there were several progressive doctors in the cash HRT/TRT space who at some point realized subcutaneous administration of testosterone cypionate or enanthate not only absorbed as effectively as IM. They also found that more frequent subcutaneous injections yielded more stable levels than a once per week IM injection. Some of these doctors started writing about it including TRT expert Dr. Eugene Shippen who wrote the book "The Testosterone Syndrome". These doctors may have also found old studies (or did small observational studies themselves) showing that oil-based hormone injections can be administered SC with efficacy.

2) Over the years as TRT became more prevalent, experts and physicians have attempted to develop novel ways to administer testosterone. This lead to more formal studies being done on the effects of subcutaneous testosterone injections.

3) In addition to formal studies, many progressive doctors also experimented and observed that SC delivery is equal if not superior (in pharmacokinetics) over single larger dosed IM injections.

Selection of studies to review:


A 52-Week Study of Dose-Adjusted Subcutaneous Testosterone Enanthate in Oil Self-Administered via Disposable Auto-injector. - PubMed - NCBI


Serum Testosterone Concentrations Remain Stable Between Injections in Patients Receiving Subcutaneous Testosterone. - PubMed - NCBI


Subcutaneous Testosterone: An Effective Delivery Mechanism for Masculinizing Young Transgender Men. - PubMed - NCBI


Pharmacokinetics, safety, and patient acceptability of subcutaneous versus intramuscular testosterone injection for gender-affirming therapy: A pil... - PubMed - NCBI


Daily subcutaneous testosterone for management of testosterone deficiency. - PubMed - NCBI


Subcutaneous administration of testosterone. A pilot study report. Al-Futaisi AM, Al-Zakwani IS, Almahrezi AM, Morris D. Source Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman.

Abstract

OBJECTIVE: To investigate the effect of low doses of subcutaneous testosterone in hypogonadal men since the intramuscular route, which is the most widely used form of testosterone replacement therapy, is inconvenient to many patients.

METHODS: All men with primary and secondary hypogonadism attending the reproductive endocrine clinic at Royal Victoria Hospital, Montreal, Quebec, Canada, were invited to participate in the study. Subjects were enrolled from January 2002 till December 2002. Patients were asked to self-administer weekly low doses of testosterone enanthate using 0.5 ml insulin syringe.

RESULTS: A total of 22 patients were enrolled in the study. The mean trough was 14.48 +/- 3.14 nmol/L and peak total testosterone was 21.65 +/- 7.32 nmol/L. For the free testosterone, the average trough was 59.94 +/- 20.60 pmol/L and the peak was 85.17 +/- 32.88 pmol/L. All of the patients delivered testosterone with ease and no local reactions were reported.

CONCLUSION: Therapy with weekly subcutaneous testosterone produced serum levels that were within the normal range in 100% of patients for both peak and trough levels. This is the first report, which demonstrated the efficacy of delivering weekly testosterone using this cheap, safe, and less painful subcutaneous route.

UPDATE: Self-Administered Testosterone Injection Meets Main Goal In Late-Stage Study. Reuters (2/26/2015, Grover) reports that an experimental once-weekly testosterone injection, testosterone enanthate that is to be marketed as QuickShot Testosterone, met its primary goal in the ongoing late-stage study. The study involves 150 patients with less than 300 nanograms of testosterone per deciliter of blood. QuickShot is the only self-administered, subcutaneous treatment currently in late-stage

What is the largest dose of Sub-Q testosterone someone can inject before running into issues ie-nodules, injection site pain, etc?​

​

​

The rule of thumb unofficially followed by most doctors is never inject more than 1mL total of a water-based injectable subcutaneously.​

​

When it comes to oil-based injectables usually not more than 0.5mL is a low risk of site injections. Going over 0.5ml of an oil-based often leads to discomfort and swelling at the site of injection. 0.5mL or less yields no site issues especially when using grapeseed oil.

​

 

[Nelson Vergel]

Subcutaneous Testosterone Injection Studies

 

[Nelson Vergel]

 

[Nelson Vergel]

Subcutaneous Testosterone Injections Are Effective for TRT - ExcelMale

 

[calm--]

I saw the video about combining the testosterone and hcg in one syringe, which is great. 1 syringe and 1 injection instead of 2.

So first I draw the testosterone into the syringe. Should I pull and press some air into the hcg vial as well? Are we not worried about accidentally pushing some of the testosterone into the hcg vial?

 

[Nelson Vergel]

I saw the video about combining the testosterone and hcg in one syringe, which is great. 1 syringe and 1 injection instead of 2.

So first I draw the testosterone into the syringe. Should I pull and press some air into the hcg vial as well? Are we not worried about accidentally pushing some of the testosterone into the hcg vial?

You could draw HCG first since it will serve as a water-based "push" for testosterone. No need to push air into the T vial after you draw the HCG.

 

[Jayyy]

Hi Nelson,
I think in your video, you mentioned that you use 11,000 IU and add 5.5 ml of water to it to make a HCG Solution, which is about 2000IU for a 1ml but you said that you will take only 250IU twice a week and draw 0.25ml of HCG. I guess, it means your taking 500IU twice a week because 1ml equals 2000, so 0.25ml equals 500IU.

 

[Nelson Vergel]

IM versus Sub-q T Injections: Effect on TT, hematocrit, E2, and PSA

Comparison of Outcomes for Hypogonadal Men Treated with Intramuscular Testosterone Cypionate Versus Subcutaneous Testosterone Enanthate (2020) Introduction Intramuscular testosterone cypionate (IM-TC) is the conventional treatment option for hypogonadal men with baseline serum total...

www.excelmale.com

 

[ivankonst2017]

For guys that like to inject IM like me, this is my experience.
Best and most painless sites for me - delt(27g 3/4 inch), gluteus max(25/26g 1 inch), gluteus medius(again 1 inch, if you are lean I guess 3/4 is ok as well.
Pectoral - painless, but I know very dangerous for infection. Also upper outer tight is painless for me, 1 inch or 3/4 inch. Middle tigh, calf are painful, in calf also a lot of possibility to hit a vain.
Ive seen people injecting in biceps, but should be very lean to see the veins there, havent tried that.
Unfortunately injection sites are not so much.

 

[Nelson Vergel]

Subcutaneous Testosterone Injections Are A Good Alternative to Intramuscular Ones

Abstract Context: Testosterone (T) is commonly administered intramuscularly to treat hypogonadal males and female-to-male (FTM) transgender patients. However, these injections can involve significant discomfort and may require arrangements for administration by others. Objective: We assessed...

www.excelmale.com

 

[Nelson Vergel]

SUB-Q TESTOSTERONE INJECTIONS IN HYPOGONADAL MEN

SUBCUTANEOUS TESTOSTERONE INJECTIONS IN HYPOGONADAL MEN (2022) Rodney L Dennis MD Testosterone Therapy may be administered in various ways. But, one delivery route not often considered is a subcutaneous injection. Some reasons for this may include a lack of familiarity with the technique, a...

www.excelmale.com

 

[Nelson Vergel]

Principles of Testosterone and hCG Injection Technique

Selecting the Devices There are many different syringes and needles, suiting many different procedures. It is important to choose the needles and syringes carefully according to the type of injection to be administered. For example, the length and gauge of the needle and type of syringe must...

www.excelmale.com

 

[BigTex]

Interesting, I cannot load my syringe with 25G x 5/8 test cyp in grapeseed oil, far too viscous. Maybe need to warm significantly above room temperature?

I always put the vial in the microwave for 15 seconds. Warms it up just enough to make it easier to dal with. I have used GSO, Cottonseed and even Castor oil. I use 30g-5/16"

 

[1Dani]

I am getting some blood gushing out last 2times doing sub q injections in stomach and no matter where I try to inject it hurts 2-3times more then any blood test Ive done.
Very strange.

 

[madman]

I am getting some blood gushing out last 2times doing sub q injections in stomach and no matter where I try to inject it hurts 2-3times more then any blood test Ive done.
Very strange.

You most likely nicked a surface blood vessel.

What size needle (gauge/length)?

Are you rotating injection sites frequently?

*It is extremely important to rotate sites to keep the skin healthy. Repeated injections in the same spot can cause scarring and hardening of fatty tissue that can interfere with the absorption of the medication. Each injection should be about 1 inch apart


Whether one is injecting strictly sub-q or shallow IM most are using LDS insulin syringes 27-31G with various needle lengths 1/4"(6MM), 5/16"(8MM), 1/2"(12.7MM).

One of the main advantages of using an LDS insulin syringe for trt is that there will be minimal waste of medication due to low-dead space let alone you draw/inject using the same needle (fixed).

Numerous benefits of using an LDS insulin syringe (fixed needle) as injections are virtually pain-free, minimal trauma to the tissue, minimizing any waste of medication, easier for many to measure accurate doses when injecting lower volumes and you can draw/inject using the same needle to boot.

“Fixed insulin type syringes have no void space at the point where the needle joins the syringe, and so are known as Low Dead Space Syringes, which is sometimes abbreviated in the literature to LDSS. They are made like this so that the full accurate dose is delivered, and there is no waste”




post #2

Nodule from SubQ Injections

Requisite Background: TRT patient for 5 years - current protocol is Test 80mg 2x/week, HCG 500iu 2x/week - and, I'm also currently taking HMG 75iu 3x/week in my quest to regain my fertility. Through the years, I experimented with multiple different protocols, from the standard 100mg injection...

www.excelmale.com

post #2

Best injection technique for low dose daily SubQ?

I switched this year from E3.5 injections to low dose daily injections thanks to @Cataceous. I'm currently injecting 8mg each morning of Propionate-only after trying a blend of Cypionate and Prop. Like many on here, I started with harpoon needles from my general physician and than graduated...

www.excelmale.com

 

[1Dani]

You most likely nicked a surface blood vessel.

What size needle (gauge/length)?

Are you rotating injection sites frequently?

*It is extremely important to rotate sites to keep the skin healthy. Repeated injections in the same spot can cause scarring and hardening of fatty tissue that can interfere with the absorption of the medication. Each injection should be about 1 inch apart


Whether one is injecting strictly sub-q or shallow IM most are using LDS insulin syringes 27-31G with various needle lengths 1/4"(6MM), 5/16"(8MM), 1/2"(12.7MM).

One of the main advantages of using an LDS insulin syringe for trt is that there will be minimal waste of medication due to low-dead space let alone you draw/inject using the same needle (fixed).

Numerous benefits of using an LDS insulin syringe (fixed needle) as injections are virtually pain-free, minimal trauma to the tissue, minimizing any waste of medication, easier for many to measure accurate doses when injecting lower volumes and you can draw/inject using the same needle to boot.

“Fixed insulin type syringes have no void space at the point where the needle joins the syringe, and so are known as Low Dead Space Syringes, which is sometimes abbreviated in the literature to LDSS. They are made like this so that the full accurate dose is delivered, and there is no waste”




post #2

Nodule from SubQ Injections

Requisite Background: TRT patient for 5 years - current protocol is Test 80mg 2x/week, HCG 500iu 2x/week - and, I'm also currently taking HMG 75iu 3x/week in my quest to regain my fertility. Through the years, I experimented with multiple different protocols, from the standard 100mg injection...

www.excelmale.com

post #2

Best injection technique for low dose daily SubQ?

I switched this year from E3.5 injections to low dose daily injections thanks to @Cataceous. I'm currently injecting 8mg each morning of Propionate-only after trying a blend of Cypionate and Prop. Like many on here, I started with harpoon needles from my general physician and than graduated...

www.excelmale.com

Hi Madman tnx for taking the time to answer me.
Ive done sub q for about 2months with 26G X 3/8"0,45x10mm,
but only this past few weeks has the pain no matter where I put the needle around my stomach fat come , I get very small bump under the skin but no redness no itching its just the pain when injecting and blood rush that comes with the pull out of the needle.
I only do E3D right now and rotate between each side.
Its very strange that it hurts no matter where I try to pin, very annoying because I get almost scared to pin again, its like doing a blood test x4 on myself each time.
Since this started to happen my libido+ erections has gone down the toilet also, maybe not related but.

 

[Nelson Vergel]

Dr. Crisler, SQ, and studies?

I was watching one of the late Dr. Crisler’s videos….i believe he mentioned there or in a blog that SQ injections end up raising T levels about 20% higher than same dose on IM i.e. 80mg total weekly SQ would get results like 100mg total weekly IM please someone correct me, as i think im not...

www.excelmale.com