Needle Size to Use To Protect Testosterone Vial Rubber Stopper Integrity

[James]

This question is obviously open for everyone's thoughts, and I'd particularly like to hear the opinion of Shaun Noorian with Empower Pharmacy. I posted a while back about everyone's thoughts as to why the package insert from the manufacturer in my West-Ward Cypionate clearly says for replacement in hypogonadal males to injection 50 to 400 mg every two to four weeks. Now if a guy were to come on these boards with that type of protocol, we'd all try and educate him about the advantages of, at minimum, once weekly injections, and would tell him to find a better doctor more knowledgeable with TRT. But since the manufacturer is recommending piercing the rubber stopper only once or twice a month, are the rubber stoppers 'ok' with being pierced multiple times every week? I'm wondering if the rubber stopper is made with a once or twice monthly protocol in mind, and if the integrity of the stopper is compromised with far more pokes than maybe it was created for.

 

[PAUL-E]

You could be right, I noticed using an 18ga to draw which is common the stopper would get very beat up and even had a chunk missing once (with 2x a week injection protocol) but it still stayed sealed, I would recommend drawing with a smaller needle I use a 21ga to draw my testosterone then backload my insulin syringe and have had no issue with a 3x a week protocol. My nandrolone I use the 30ga insulin syringe and the stopper is in even better shape hope this helps.

 

[Vince Carter]

This question is obviously open for everyone's thoughts, and I'd particularly like to hear the opinion of Shaun Noorian with Empower Pharmacy. I posted a while back about everyone's thoughts as to why the package insert from the manufacturer in my West-Ward Cypionate clearly says for replacement in hypogonadal males to injection 50 to 400 mg every two to four weeks. Now if a guy were to come on these boards with that type of protocol, we'd all try and educate him about the advantages of, at minimum, once weekly injections, and would tell him to find a better doctor more knowledgeable with TRT. But since the manufacturer is recommending piercing the rubber stopper only once or twice a month, are the rubber stoppers 'ok' with being pierced multiple times every week? I'm wondering if the rubber stopper is made with a once or twice monthly protocol in mind, and if the integrity of the stopper is compromised with far more pokes than maybe it was created for.

You're overthinking things.

 

[Vince]

I would believe they do not make to rubber stopper. I would also believe that it's just a generic stopper, used for many types of meds.

 

[trt4me]

People have been poking the vials with stoppers for years with no issues. I have never used bigger than 23 g ever and still didn't notice anything bad.
Typically the expiration date for test cyp is plenty longer than it will be used so I don't think the manufacturer is concerned.
Also I'm sure the rubber stopper is a commodity item that is the same on most vials.

 

[James]

Paul-E - I've never had a chunk missing like that. Used to draw with 19g and inject with 25g. I now draw and inject with the same 27g.

Vince Carter - you're probably right, just adding to the rich content of this great site!

 

[PAUL-E]

Paul-E - I've never had a chunk missing like that. Used to draw with 19g and inject with 25g. I now draw and inject with the same 27g.

Vince Carter - you're probably right, just adding to the rich content of this great site!

I brought the vile in to my Doctor to make sure it was ok to use there was a piece of the stopper in the testosterone but since it was still sealed and not leaking they said it was ok but be sure not to inject the rubber piece. the brand was Watson test cyp

 

[Tommy Wall]

But when buying vials can´t you just buy extra rubber stoppers and change them sometime before the testo inside the vial is finished?Or the vials shouldn´t be opened at all once the testo is inside? I have inject some ampoules into the vial because here they only avaible in ampoules.

 

[James]

It's not a good idea to pop off the rubber stopper and snap a new one on.

 

[Helboi]

It's not an issue. I inject every other day, way more than most, and I've never had one issue with a rubber stopper (I use a 25g). Also, no, you would never want to replace it...that would open the bottle and the meds to contaminants and you don't want that.

 

[EmpowerPharmacy]

When drawing Testosterone Cypionate a lot of patients ask me whether or not they should draw with a 18G or 21G needle before swapping it with a smaller one (25G 1'') before injecting. Here are the reasons we recommend using a 21G to draw instead of a 18G needle:

1. Fewer Losses of Testosterone. A 18G needle holds more liquid than a 21G so there will be more Testosterone stuck in the bore of the 18G needle. These losses add up and cause patients to run our of their medication before their next refill. Since Testosterone is a controlled substance pharmacies can't refill the medication more than a week or two early and patients can be without their medicine until their next refill is authorized.

2. Draw time is identical. Our Testosterone Cypionate is made in Grapeseed Oil vs the Cottonseed Oil that is found in commercially available Testosterone Cypionate. Grapeseed Oil is much less viscous than Cottonseed Oil, which allows it to flow just as quickly through a 21G needle as it does through a 18G needle. I made a video documenting the draw time of a 18G vs a 21G here: https://youtu.be/q76GOKK6UbA

3. The stopper's life is extended. Using a large bore draw needle causes a large hole in the rubber stopper every time it is punctured. When large holes are present this causes the vial to no longer be a closed system, which increases the possibility of germs being introducing into the vial.

4. Coring is prevented. By not using a large bore needle you also prevent coring the stopper, which is the breaking off of a cylindrical piece of rubber into the vial due to the cutting action of the needle puncturing the stopper. This piece of rubber then gets sucked into the barrel of the syringe during the draw and then gets injected into the patient. This occurs more often as the bore of the needle increases.

5. Sterility is assured. Since there is less of a chance of the stopper becoming damaged with a 21G needle vs a 18G needle there less less of a chance of a patient getting an infection.

Ideally, you'd like to draw with as small of a bore needle as possible. For intramuscular injections I recommend drawing and injecting with a 1cc 25G 1'' syringe. For subcutaneous injections I recommend drawing and injecting with a 1cc 29G 1/2'' insulin syringe.

 

[James]

Sounds like the answer to my question is that the stopper will should be fine even with all those punctures, and best to draw with a smaller bore needle. I draw with a 27g, twice weekly so should be good.

 

[Benning78]

I have had issues with two of my last West-Ward 10 ml test cypionate vials. The hole would appear and stay after very first poke,and the rubber would be destroyed after a few weeks to the point the air is getting inside. I had chunks of rubber in my syringe as well. Contacted the company and sent them all proof. They are doing quality check inspection.
I ques 'know in 45 days what happens. Never had issues with other vials and used same gauge needles...

 

[at15]

draw with a 23, should have no issues doing many draws

 

[Benning78]

Once the vial is depressurized I was not able to get anything out with less than 18 G.
I used 23G to inject air in before drawing and the air just leaked out from one of the holes...
I have transferred it all into a new 10 ml vial for now,which I purchased online, and filtered everything just in case through a syringe filter....

 

[Benning78]

You would not loose any medication in the bore of 18 G since no one uses 18G to inject medication! You draw all the medication out of syringe before attaching the one size syringe you use to inject!

 

[Vince]

I also have wonder about the stopper, when mixing HCG. That big needle on the mixing syringe, luckily we only pierce it once with that big needle.

 

[madman]

Once the vial is depressurized I was not able to get anything out with less than 18 G.
I used 23G to inject air in before drawing and the air just leaked out from one of the holes...
I have transferred it all into a new 10 ml vial for now,which I purchased online, and filtered everything just in case through a syringe filter....

I never inject air into my vial. Poking the neoprene stopper with 28 gauge 1/2 inch and have had absolutely no issues drawing/injecting Depo-Test in cottonseed oil, even when down to the last 1ml of test left!

 

[DocGeezer]

I inject .6mL every 4 days and I've had issues with grey rubber specs in the vial and subsequently winding up in the syringe. Missed one and luckily it stopped up the injection by blocking the 25G needle half way through the injection.

Using 20G needles to draw, remove big needle then pull back into the syringe to clear the needle, swap to a 25G needle then remove bubbles and check syringe for rubber flakes via a lit magnifier against a dark background.

Considering trying the slow 30 second draw with the 25G needle since I didn't realize it was a timing thing, needing to take my time to load up the syringe rather than rushing as I had been which was creating too much of a vacuum creating frothy air bubbles.

Does seem to be caused by the large diameter needles carving out chunks of rubber as you push through and it's not from multiple stabs in the same spot. I've had it happen to a vial taking care to use a virgin area each time. It's the needle diameter.

 

[DocGeezer]

I stand corrected. Just found an article on Science Direct with a study that showed the smaller the diameter the higher the rate of coring. 18G with 10% occurrence, 23G with 33% and higher gauges up to 70%.

"Avoiding unconscious injection of vial-derived rubber particles during intra-articular drug administration" Google it.