hone health testosterone injection bottle + needles

How To Self-Administer Testosterone Injections

Need some help with self-injections? Our comprehensive guide will take you through every step.

Ready to self-inject your testosterone or hormones, but not sure where to start? Don’t know whether self-injection is safe, or where’s the best place to inject yourself? Worse, do you have a crippling fear of needles? Dry your palms and relax; we’ve got you and you’ve got this. Here, the definitive guide to all you’ll need to know about injecting hormones, testosterone, including tips and tricks for self-injecting.

First, Talk With Your Doctor

All doctors can show you how to give a self injection; if you need some help, email us and we’ll arrange for a live tutorial. Either will be able to help you troubleshoot issues or point out common errors and, with telehealth on the rise, a video chat with a medical professional to observe your first shot is increasingly common. That can help ease your mind through the ginormous mental jitters surrounding your first shot.

And it truly gets easier after the first shot. Nearly all my patients finish the first self-injection saying, “That’s it?! That was nothing.”

Ready Your Mind and Equipment

Let’s run through a few common questions you may be having to help dispel some common misconceptions about self-injections.

First, is self-injection safe?

Self-injection, done properly—meaning with a prescribed substance, under the direction of a physician—is completely safe. Blackmarket needles, self-sourced substances, and using your own needles; these are things that make self-injection unsafe. As long as your course of treatment is guided by a physician, you’re good.

Is it hard to inject yourself?

It’s not difficult. The initial shot will be the hardest, but the rest will be smooth sailing. The biggest fear here is the pain associated with the needle and a phobia of needles themselves. When I’ve got a patient struggling with self-injections, I advise them to:

How do you get over a fear of injecting yourself?

It’s really about getting through the first shot. Before any patient who needs to self-inject tries on his or her own, we do a test run together with me in the room. That helps them see how easy this is and that they can definitely do it on their own.

New Needles Only

Never, ever reuse needles. Reusing needles is problematic because they are unsanitary but also because after the first use, the needle is blunted immediately, meaning the next time you use it will be more painful. Always keep a fresh supply of new needles in your home and use one for each injection.

Vial with syringe leaning on it on countertop

Understanding Syringes

A needle is one part of a syringe. Let’s quickly talk about the other parts. The tip is the area of the syringe where the needle attaches. The barrel is the tube area that’s open at one and narrows into the hollow tip at the other end. There are lines on the barrel to help you see the volume of solution within it. The plunger is the rod that sits within the barrel and operates like a piston; you can pull or push it to help get solutions into and out of the barrel.

Know Your Needles and Gauge Sizes

You can connect multiple needles to a syringe, depending on the action required. Needle diameter is measured by gauge numbers, which indicates the bore of a needle’s lumen (a fancy word for the hole at the tip of the needle). The higher the gauge number, the smaller or thinner the hole; the lower the gauge number, the bigger or thicker the hole. Higher gauge needles can reduce pain when injecting, but larger needles are required for injecting larger volumes of oil-based substances (like testosterone) into the muscle.

The last thing you’ll need to know about needles is the length of the needle itself. This number is listed after the gauge number. For example, a 25G ½ indicates that this is a 25 gauge needle that is a half-inch long.

Injection Location Dictates Your Needle

The location of the injection will help you determine the needle size, but your weight could play a factor too; slightly larger individuals may require a slightly larger needle as there is more tissue for the needle to penetrate.

At Hone, we recommend three sizes of needles, one for injections that are under the skin—subcutaneous (or SubQ)—and two for injections that are going into the muscle—intramuscular (or IM). More on those two types of injections in a second, but the subcutaneous needle is a 27-30 gauge and either a half-inch to ⅝ of an inch long.

For intramuscular injections, we send two needles: a 20 gauge to use to draw in the medicine, and a 23 gauge for the injection itself (some individuals may use this for a subcutaneous injection, after a little experience). Intramuscular needles are longer, between one to one and a half inches, because it needs to penetrate into the muscle.

The Rest of Your Gear

It’s important to have everything prepped and ready before you start your self-injection. You don’t want to be mid-shot and realize you need something handy. You’ll want to have the following things within arm’s reach.

A hand swabs the skin with an alcohol wipe

Clean Everything

First, you’ll want to wash your hands with soap for at least 20 seconds. Next, you’ll clean the top of your medication vial with an alcohol swab and let it dry completely (you don’t want to push any residual alcohol into the testosterone or medicine). Next you’ll want to scrub your injection site with a fresh alcohol swab, letting that dry completely as well. Lastly, if you need an injection aid, like the Buzzy or ice or a numbing agent, you should have those ready.

What Are You Injecting?

If you’re doing testosterone replacement therapy (TRT), you’re injecting testosterone. Again, provided you’re working under the guidance of a medical professional, injecting testosterone is perfectly safe. There are several ways to introduce testosterone to your body, but the benefits of injecting testosterone is that injections are highly effective and the dosage is consistent, studies have shown. Testosterone in the bloodstream is quickly eliminated, so injections slowly release the hormone into the bloodstream over a longer period of time.

Further, studies also show more muscle strengthening in injections, bolstering that injections of testosterone are the best method for testosterone replacement therapy.

Hone’s at-home testosterone assessment is the simplest way to uncover whether your levels are low. If you qualify for treatment, TRT can be sent right to your door.  

Common Questions

1. What’s the best time of day to inject testosterone?

Traditionally, it’s the morning. It’s not scientifically necessary to inject testosterone in the morning, though our testosterone is at the highest levels in the morning. The reason for the morning push is more about creating a routine to ensure you’re not missing doses.

However, there’s no difference in the time of day you’re injecting; I’ve not seen a study that indicates there’s any change in efficacy between the morning and the afternoon or the evening. Whatever time you select, keep to that time. Consistency is key to building a routine.

2. Is it better to inject testosterone once or twice a week?

The answer here varies, depending on your doctor’s preference but also your dosage. Typically, once or twice per week is the norm. Some guys don’t want to self-inject twice per week, so they want to get the whole week’s dose delivered at once.

If your treatment course calls for, say, a 200 mg dose, with one shot of all 200 mg, your testosterone levels would peak about four days after, then drop off. If you injected 100 mg on at the beginning of the week and another 100 mg towards the end of the week, your peak isn’t as high and your low isn’t as low. Twice per week is preferred for the balance of testosterone delivery.

3. What’s the best place to inject testosterone?

This is really about personal preference; where it’s the least painful and easiest for you to inject. If you have help in the form of a loved one or friend, you can do an intramuscular injection in the upper outer glute or the deltoid. If you’re self-injecting, you can do a subcutaneous injection and use the abdomen or the upper outer thigh (never the inner thigh; there are too many veins you have the potential of hitting).

Man sitting and injecting into hip

4. What is the optimal testosterone injection dosage?

The answer here varies based on your individual plan. Your doctor’s goal is to get your testosterone level as high as possible, within the right range, without seeing any negative side effects. Because everyone’s body is different, you will metabolize testosterone differently than someone else. I’ve seen some guys require 400 mg per week while others only need 100 mg for the same results. Listen to your clinician’s advice and don’t increase your own dosage.

5. How long before testosterone injections work?

It’s important to define “work” here. The goal of testosterone replacement therapy differs; maybe you’re trying to combat fatigue or increase your endurance or libido; others may be trying to correct other issues. The quality of life benefits typically arrive within three or four weeks after the start of treatment.

You should start to notice that you’ll have more energy and vitality around that time. Brain fog should start to clear up, and your motivation and drive should improve. Hot flashes should abate, and your sleeping should improve.

With TRT, some things can take longer before you notice effects, however. If you’re grumpy, sad, moody, or depressed, or experiencing weight gain or a loss of muscle; it can take three or four months before you notice a change in those areas.

6. What are the side effects of testosterone injections?

Many times, side effects occur when there’s an imbalance. When the doses are wrong, or supraphysiologic—very strong—doses. (Side effects also are far more common in self-procured testosterone.) Testosterone injection side effects include increased body hair, a loss of hair on your head, breast enlargement, oily skin, acne (commonly, on the back of head, on the shoulders, or on the chest), a deeper voice because vocal chords thicken, and fatigue.

The testosterone stimulates the kidneys to produce a hormone within the kidney, so your red blood cell count increases, causing fatigue. Other side effects include a decrease in sperm and trauma or bruising at the injection site.

If your dose is supraphysiologic (between 1100 and 1500 mg), you may experience mood swings, high blood pressure, headaches, and an enlarged prostate. If your dose is in the 800 – 1000 mg range, you usually don’t have any of these issues.

Why Testosterone Can Be Trickier to Inject

Testosterone can be tougher to inject than, say, insulin, because the hormone is held within an oil, either sesame or grapeseed. Because it’s thicker, you may need two needles: a low gauge for the vial of medicine and a higher gauge for your body. If you use a high gauge needle to extract the testosterone from the vial, it’s going to be a laborious process to get the medicine through that smaller bore.

How to Choose Between Intramuscular or Subcutaneous

I’m often asked what’s the best way to inject testosterone: intramuscular or subcutaneous? Both are equally effective and you can choose whichever you prefer or find less painful. Old school doctors may disagree, but several studies have shown that subcutaneous testosterone injections have as much efficacy as intramuscular—long believed to be the superior method. Still, there are advantages and disadvantages to IM and SubQ. Let’s spin through those.

person injects shot into waist
Getty Images

Subcutaneous injections

Subcutaneous shots—shots that go right under the skin—are far easier to self-administer. SubQ shots go directly into fatty tissue beneath the dermal and epidermal layers of the skin; generally into the subcutaneous tissue of the abdomen or outer upper thigh.

The absorption of your testosterone is slower as there are fewer blood vessels in the fatty tissue; this is actually an advantage, however, if you’re looking for a prolonged effect. SubQ shots are less painful since you’re using smaller gauge needles and injecting into fatty tissue beneath the skin versus into your muscle.

Accordingly, there’s no risk of damaging muscle since you’re injecting it into fatty tissue. There’s also no risk of accidentally hitting your sciatic nerve. At Hone, many of our staff are clients as well and most prefer the subcutaneous route.

On the flip side, with SubQ injections, irritating solutions or more concentrated dosages might cause sloughing off of the skin epithelial tissue. There is less blood flow to quickly absorb the injection of testosterone.

SubQ injections of more than 1mL of testosterone at a time is often discouraged; larger amounts run a higher risk of not being absorbed properly or causing discomfort. Lastly, SubQ injection sites are more susceptible to infection of the injected area than via IM, as the area is less vascularized.

Intramuscular injections

Intramuscular shots—needles that go deep into the muscle tissue—were believed to be superior because the medication can be absorbed into the bloodstream more quickly, due to muscle fibers having a greater blood supply than the tissue under your skin.

As mentioned earlier, SubQ shots are equally as effective as IM shots, but among the reasons to opt for IM is that you can deliver a larger volume of testosterone than with a SubQ shot. There’s also a lower incidence of immediate injection site reactions and also minimal irritation caused by the medication.

The downsides of IM shots include that absorption of the testosterone is determined by the bulk of your muscle and its vascularity. The onset and duration of the drug is not adjustable. IM injections can be slightly more painful overall than SubQ, with more bruising. You run the risk of accidentally hitting important nerves, including your sciatic nerve. Suspensions or oily drugs cannot be administered with IM injections.

Choosing an Injection Site

For intramuscular injections, you’ll want to inject into your gluteal muscle (your butt), your thigh muscle, or your shoulder muscle. With subcutaneous injections, you’ll want to inject into your stomach area or your shoulder.

Your ultimate goal, regardless of whether you’re going with IM or SubQ, is to avoid any arteries or veins with the needle. With IM injections, that means always choosing a spot within the upper outer thigh—your inner thigh is too vascular. As to where to inject within the glute, the answer is the same: the upper outer portion of your glute.

With either IM or SubQ, rotating injection sites helps. With any injection, there’s trauma to the tissue so if you go back into the same area, that pain will increase. If you’re doing IM injections in your thigh, do the right thigh first, then the left thigh. Rotate between your left and right glute.

If you’re doing SubQ injections into your abdomen, draw an imaginary square around your belly button and rotate injections at the corners of that square.

How to Self-Inject

Ready to administer? Take a deep breath and remember that you can do this.

Needle Disposal

All done? Congrats. What now? First, cap your needle and throw it in your sharps container. You can get a sharps container in most pharmacies, but if you can’t locate one, an empty laundry detergent bottle can also work.

When your sharps container is filled, you can return it to the pharmacy for proper disposal. Check your local rules to see if your state allows you to place a filled sharps container in with your trash. Never throw needles into the garbage.

Post-Injection Site Care

If you’d like, you can ice the injection site, to help reduce swelling, inflammation, and redness. If you’re experiencing redness, swelling, bruising, or a little bleeding, that’s not uncommon. Place a cotton ball on the injection site to help stem any bleeding, and you can place a Band Aid over it after. Remember to rotate your injection sites for your next shot.

Hone’s at-home testosterone assessment is the simplest way to uncover whether your levels are low. If you qualify for treatment, TRT can be sent right to your door.