How to Inject Testosterone: A Step-by-Step Guide

Subcutaneous Injections and Intramuscular Injections

Subcutaneous injections, sometimes called subq injections or SQ injections, are injected into the fatty layer between the muscle and the skin. This type of injection is typically used for a smaller volume of medication, usually up to 2 mL.

With subq injections, the medication is absorbed by the body over a period of time. The injection is often more comfortable with less injection site pain, making it preferable for some testosterone replacement therapy patients.

Subcutaneous injections also allow for more frequent injections if necessary, which can help patients maintain testosterone levels effectively.

Intramuscular injections, or IM injections, are injected into the muscle at various points throughout the body. IM injections deliver medicine to the bloodstream quickly, which is why they are typically used for vaccines and life-saving medications like epinephrine in the case of severe allergic reactions.

Intramuscular injections can be uncomfortable and require a larger needle than SQ injections, and these injections are typically done once to twice a week.

Learn more about testosterone injection methods from Dr. Justin Saya, Defy’s medical director and lead practicing physician.

Subcutaneous Injection Instructions

With subq injections, you’ll need to pinch the skin between your thumb and forefinger in the area where you inject. If you can pinch about two inches of skin, you can inject by holding the needle at a 90-degree angle. If you can only pinch one inch of skin, you can inject by holding the needle at a 45-degree angle.

Subcutaneous injections can be injected into the following areas:

• The upper arm – Stand with your arm down and your hand at your hip, and gently pinch the skin midway down and at the back of the upper arm.
• The abdomen – Injection sites in the abdomen can be found at the natural line of the waist, where there is typically 1-2 inches of skin to pinch. The area around the belly button is typically a good spot for subq injections.
• The thigh – The middle of the thigh toward the outer side of the thigh is often an appropriate spot to inject.
• The glute – divide the buttock into four quarters, and inject into the upper right (right cheek) or upper left (left cheek) quarter.

How to do a Subcutaneous Injection

When you’re ready to begin, follow Steps One Through Five in the How to Inject Testosterone section to prepare your testosterone injection. Then choose your injection site. Many patients rotate through injection sites to avoid fatigue and over-injection in one area of the body.

Pinch the skin at your injection site between your thumb and forefinger. If you can pinch at least two inches of skin, hold the needle at a 45-degree angle; if you can only pinch one inch, then hold the needle at a 90-degree angle.

You should hold the needle with your dominant hand to ensure greater mobility. To grip the needle, hold the syringe with your thumb and first finger the way you would hold a pen.

Use your wrist to press the needle into the skin. Depending on how thick your skin is, it may require a little pressure. Do not forcefully shove the needle in, since this could cause bruising and potentially push the needle too deep.

Slowly depress the plunger of the syringe to inject the medication, then remove the needle at the same angle you used to push it into your skin. Dispose of the needle and syringe safely as listed above in Step Seven.

For more in-depth subq injection instructions, check out our downloadable subcutaneous injection instructions handout.

Intramuscular Injection Instructions

For IM injections, follow the preliminary steps from the How to Inject Testosterone section above. Once you reach Step Six, you will likely need to inject in one of the following IM injection sites:

• Vastus Lateralis Muscle – the top of the thigh. If you place your thumb at the top of your thigh and wrap your fingers around the side, you will feel this muscle.
• Deltoid Muscle – the shoulder. This injection site can be useful because injections can be performed standing or sitting down. Feel for the top of the shoulder, where the bone is, and imagine an upside-down triangle from that spot. Inject at the top of the triangle, about two fingers down from the shoulder point.
• Ventrogluteal muscle – the muscle of the hip. This muscle is a good injection site because it’s unlikely that you will hit blood vessels or nerves. However, it may require some help, since it’s on the backside of the body. To find this muscle, place your thumb on the base of your tailbone and move straight across either to the left or right. Then place your index finger two inches below your hip bone.

Once you have cleaned the area as instructed in Step Six from the How to Inject Testosterone section, you’ll want to let the area dry completely. Then pull the skin taut and hold it like that with your free hand.

Use your wrist to push the needle into the skin at a 90-degree angle. You don’t want to be too forceful, which can cause bruising, but you also don’t want to move too slowly. It should be quick but gentle. The needle is sharp enough to slide easily into your skin.

If you experience bleeding, you have likely hit a blood vessel and should dispose of the needle and medication and start over.

If you don’t experience any bleeding, depress the plunger steadily. Do not force the medication in too hard; this can cause discomfort. You may experience some stinging as you inject.

Once the medication has been injected, remove the needle quickly and dispose of appropriately as outlined in Step Seven above.

For more in-dept instructions on IM injections, view our downloadable intramuscular Injection instructions handout.

This step-by-step guide should have helped you understand how to inject testosterone, and the differences between intramuscular and subcutaneous injections. If you’re a patient and you have questions about injection instructions, you can contact us at [email protected]