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A Comprehensive Guide to Administering Testosterone Injections: Techniques, Tips, and Best Practices

Understanding Testosterone Injection Therapy

Testosterone injections are a widely used form of Testosterone Replacement Therapy. These injections can be administered via subcutaneous (under the skin) or intramuscular (into the muscle) methods at various sites on the body. Below is a detailed guide on how to properly administer testosterone injections and understand the key differences between these two techniques.There are several types of injectable testosterone commonly used in Testosterone Replacement Therapy (TRT), each varying in its ester (chemical structure) and how it is absorbed by the body. The 3 most common types include:

Testosterone Cypionate

• Long-acting ester.

• Typically injected once weekly.

Testosterone Enanthate

• Similar to cypionate with a slightly shorter half-life.

• Usually injected every week, often 2 times per week.

Testosterone Propionate

• Short-acting ester.

• Requires more frequent injections (every 2-3 days).

• May cause more injection site discomfort.

Needle vs Syringe

Needle:   In medical terminology, a needle is defined as "a slender, solid, usually sharp-pointed instrument used for puncturing tissues," according to MediLexicon. Unlike a sewing needle, a medical needle is hollow, allowing fluids to pass through for injection into the target area. Medical needles are made from stainless steel and consist of four key components.

The primary distinguishing characteristics of a needle are its thickness, measured in gauge (G), and its length, measured in inches. Needle lengths typically range from 1/2" to 3", although shorter lengths are common for insulin and tuberculin syringes. The gauge of a needle indicates its diameter, with smaller diameters corresponding to higher gauge numbers. For instance, a 21G needle is thinner than a 19G needle. Needle gauges generally range from 7G to 33G, with the standard range falling between 18G and 27G.

For patients taking testosterone, you normally draw with the 18g needle so that the testosterone flows into the syringe quickly and smoothly. One would then inject with the 27g needle so that it is not painful when piercing the skin. The type of testosterone and location of the injection may dictate which size needles one should use, so consult with your physician for the best advice.

Syringe: Syringes consist of three main parts:

• Barrel: The cylindrical component where fluid, such as medication or blood, is held.

• Plunger: A snug-fitting device that moves in and out of the barrel to draw in or expel fluid.
• Tip: The point where the needle hub attaches, if the syringe is designed for use with needles.

Syringes come in various sizes, ranging from 0.3 mL to 60 mL. Larger sizes are typically used for tasks like adding medication to intravenous lines or wound irrigation, while smaller sizes, such as 1 mL to 3 mL, are ideal for subcutaneous (under the skin) and intramuscular (into the muscle) injections. A 1mL syringe is usually the best option for testosterone injections under 1cc as it’s difficult for patients to accidentally inject more testosterone.

Insulin Syringes:
Insulin syringes are small, with volumes typically ranging from 0.3 mL to 1 mL. They are usually easily identified by having orange caps on both ends. Unlike standard syringes, their scale is not measured in milliliters but in units, calibrated specifically for up to 100 units of insulin. As their name implies, these syringes are primarily used for subcutaneous insulin injections, which are often self-administered by individuals managing diabetes. These are the best options for medications like hCG or GLP-1 weight loss drugs like semaglutide or tirzepatide.

Step 1: Gather Necessary Materials

Before starting, ensure you have the following items:

• Testosterone prescription vial and know what your precise dose is. It should be written on the bottle but if you are unsure, call our office at 561-277-8260

• Alcohol wipes to sterilize the vial as well as the injection site.

• A new syringe (The syringe is a clear plastic tube with a plunger and markings.)

• A fresh drawing needle. Usually 18-21g and either 1 or 1.5 inches long

• A fresh injection needle. Usually 23-27g and 1 to 1.5 inches long

• A Sharps container for safe disposal of the materials after the injection.

Step 2: Prepare by Cleaning and Sanitizing

• Wash your hands thoroughly with soap and water for at least 20 seconds prior to handling the materials and medication.

• Use an alcohol wipe to clean the top of the testosterone vial before puncturing each time you perform an injection.

• Always use fresh needles, syringes, and alcohol wipes for each injection to maintain sterility. NEVER REUSE NEEDLES or SYRINGES!

Step 3: Draw the Testosterone Dose: Drawing means to pull the testosterone out of the vial.  

Tip. If you are having difficulty drawing the medication into the syringe, you can inject air into the vial to pressurize it. This will cause the testosterone, which is a thicker liquid, to more easily move into the syringe. The smaller the drawing needle, the longer this process takes.

1. Attach the drawing needle to the syringe without contaminating it. They usually are Lure-Lock Tips that screw on but depending on availability you may have a Slip Tip which you push down onto the syringe to make the connection. Do not overtighten the needle as you will have a difficult time removing it to replace it with the injecting needle. Hand tight is fine so that no air or medication can seep out during the drawing process.
2. Pull the syringe plunger to match your prescribed dosage.
3. Insert the drawing needle into the vial’s rubber stopper and press the plunger to inject air into the vial.
4. Turn the vial upside down and pull the prescribed dose into the syringe.
5. Remove the needle from the vial. We recommend drawing a little air into the syringe to clear the drawing needle of any testosterone that will be inside it.

Step 4: Switch to an Injection Needle

1. Recap the drawing needle and replace it with a fresh injection needle.
2. Avoid touching the needle or syringe to maintain sterility.
3. Screw the needle on tightly to ensure no medication escapes during the injection process.

Step 5: Eliminate Air from the Syringe

1. Gently tap the syringe to release any trapped air bubbles.
2. Slowly press the plunger until only the medication remains in the syringe and a droplet escapes the top/tip of the needle while holding the needle straight up in the air. Do this slowly to make sure you don’t accidently squirt too much medication out of the needle.

Step 6: Administer the Injection

1. Clean the injection site with an alcohol wipe using a circular motion.
2. Depending on your prescribed method, the injection may be subcutaneous or intramuscular:

Subcutaneous (SubQ) Injection:

1. Pinch the skin at the chosen site to form a fold.
2. Hold the needle at a 45-degree angle if you can pinch one inch of skin, or at a 90-degree angle for two inches of skin.
3. Inject the medication slowly and remove the needle at the same angle.

Intramuscular (IM) Injection:

1. Identify the injection site (e.g., deltoid, thigh, or ventrogluteal muscle).
2. Stretch the skin taut and insert the needle at a 90-degree angle.
3. Inject the medication steadily before withdrawing the needle.

Step 7: Dispose of Materials Safely

1. Discard the used syringe and needle in a Sharps container.
2. If you don’t have a Sharps container, use a puncture-resistant container with a secure lid. Contact your local pharmacy or healthcare provider for proper disposal instructions.

Subcutaneous vs. Intramuscular Injections

Subcutaneous Injections

• Administered into the fatty layer under the skin.

• Suitable for smaller volumes (up to 2 mL).

• Associated with less pain and ideal for frequent injections.

Intramuscular Injections

• Delivered directly into the muscle for faster absorption.

• Typically used for larger doses or medications requiring rapid delivery.

• May cause more discomfort and require less frequent administration.

Injection Sites and Techniques

Subcutaneous Sites:

• Upper Arm: Pinch the back of the arm midway down.

• Abdomen: Avoid the area around the navel and inject near the natural waistline.

• Thigh: Use the outer middle portion of the thigh.

• Gluteal Region: Inject in the upper quadrant of the buttock.

Intramuscular Sites for Injection: Intramuscular (IM) Injections:

IM injections are a method used to administer vaccines, hormonal treatments, antibiotics, and high-viscosity medications directly into the muscle tissue. When selecting an IM injection site, clinicians must ensure the site:

• Is safely distanced from nerves, major blood vessels, and bones.

• Is free from injuries, abscesses, tenderness, necrosis, abrasions, or other abnormalities.

• Is large enough to accommodate the required medication volume.

Given these criteria, commonly used and safe IM injection sites include the deltoid, ventrogluteal, and thigh muscles.

• Deltoid Muscle: Locate the top of the shoulder and inject two finger-widths below the bony point. The deltoid usually requires a shorter needle due to there being less subcutaneous fat covering the muscle.

• Vastus Lateralis: Use the top outer part of the thigh which is one of the larger muscles. These are easier for some people to inject into as it doesn’t require as much twisting around as the Glute would.

• Ventrogluteal Muscle: Place the thumb on the tailbone and locate the muscle on the side of the hip.  Methods to Locate the Ventrogluteral Injection Site:

V Method:
Use the opposite hand to locate the injection site. If the injection is on the right hip, use your left hand, and vice versa. Point your thumb toward the person’s groin and place your pointer finger on the iliac crest (the prominent part of the hip bone). Spread your middle finger to form a "V" shape. The injection site is at the base of the "V" where the fingers meet. Note that this method may not be reliable for individuals with a BMI over 30.

G Method:

The "G" stands for geometric. In this method, you imagine lines connecting major bone landmarks of the thigh and hip to form a triangle. Then, draw imaginary median lines from each corner of the triangle. The intersection of these lines is the injection site. This method is more reliable for individuals of all BMIs.

Additional Resources and Support

For more detailed instructions on subcutaneous or intramuscular injections, or if you have any questions or concerns, please contact us at info@novagenix.org or call 561-277-8260.

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