The information below is for educational and entertainment purposes only and should not be used as medical advice. It does not replace or represent the advice of a medical professional.
The physical FTM (female-to-male) transition nearly always starts with the injection of testosterone into the body. Testosterone is the primary male sex hormone, mainly made in men’s testicles and also in small amounts in women’s ovaries. It’s the chemical that causes masculinization of the body. Since trans guys can’t produce it in the quantities as cis guys, it has to come from outside of the body. This usually happens in the form of regular self-administered injections.
In that sense, it’s very natural to ask and wonder how to inject testosterone into one's body. Particularly in a way that minimizes the pain and discomfort associated with injections. The idea of doing it yourself might seem scary for some, especially since it’s self-administered. However, transguys are not alone, various fertility drugs, vitamin B12, insulin, epinephrine, and cancer medications are also often self-administered. There are several ways to make the experience as pleasant as possible, and in this article, we’ll discuss step by step how to inject testosterone.
What needle to use? Length and gauge
First, you need to know what gear you should use. There are basically three types of injections: subcutaneous injections, intravenous injections, and intramuscular (IM) injections. Subcutaneous means under the skin and these injections are quite shallow. When injecting intravenous, you inject directly into the vain. Testosterone, however, has to be injected intramuscular, meaning directly into the muscle.
Therefore the syringe needle you have to use will be longer and thicker compared to those used for subcutaneous injections. This is also the reason why these injections are experienced as more painful (Güneş, 2013). Fortunately, injection needles have gotten much sharper over time, reducing the pressure needed to insert them and therefore reducing the pain. The needle thickness, or gauge, for testosterone, should be 22 to 25 Gauge. The needle length depends on your weight but is usually between 1-1.5 inches/ 2.5-3.8 cm.
“Be aware of blunt needles! This obviously will significantly increase the pain of the injection. Make sure to switch up your needles after each use to avoid this!
Preparation before injection
Before the injection, have a hot shower to relax your muscles and your mind. Also, warm up your “T” to room temperature or a bit above that. This will significantly reduce the discomfort when the fluid spreads in the muscle. Find a comfortable place in a well-lit room where you know you won’t be interrupted. Make sure you have the vail with the T, a syringe, the needle, alcohol swabs, and a puncture-proof disposal container. If you didn’t take a shower before, make sure you have washed your hands properly!
Where to inject the testosterone?
Several IM injection sites lend themselves very well for testosterone injections. You need to find a vascular site, meaning it has vessels that run through your body. That way, when the testosterone is injected, it can travel where it needs to be in the body and work its masculinization magic. Additionally, areas with less subcutaneous fat are usually less painful. Several sites fit those criteria above very well; arm, thigh, and hip/butt. However, if you choose to inject the testosterone all by yourself, the hip can sometimes be challenging to reach and is not advised!
The important thing is to keep rotating the injection site between each injection. A study found that cell injury occurs at injection sites, regardless of the substance injected (Treadwell, 2003). Therefore, it’s essential to leave the site to recover for a minimum of a week. This will further reduce the unpleasant sensations linked to injections.
By Ruud de Jong
The injection technique
Now, to the act itself. Place the needle carefully on the syringe and subsequently put the needle into the vail by puncturing the rubber in the middle. Fill the syringe with the prescribed dosage of testosterone and remove any air bubbles that might be in the syringe by ticking on the syringe with your finger. Meanwhile, make sure the needle doesn’t touch anything else.
There are basically two injection techniques that are known to be the least painful for IM injections; the Air-lock injection technique (ALT) or the Z-track (ZT-) method. In some studies, the ALT is found to be less painful (Najafidolatabad et al. 2010), while in other studies, it was vice versa (Ehsani et al. 2011), or even equally divided (Tambunan & Wulandari, 2015). We suggest you try which one you prefer best and research it further yourself.
With the Air-lock injection technique, a small amount of air is drawn into the syringe, the skin is held flat, and the needle should be put in at an angle of 45 degrees. The testosterone is injected, followed by the small amount of air that was put in before. The needle is taken out, and the skin is let loose. The idea is that the air is keeping the T locked in the muscle, preventing it from flowing back into the subcutaneous layer where there are more pain receptors.
The Z-track technique has the same outcome with a different method; firmly hold the skin tight with your free hand, insert the needle directly at a 90-degree angle, inject the testosterone, pull the needle out again at the exact same angle, and release the skin to its original position. This movement should form a Z which prevents the fluid from surfacing again.
Retrieved from: mavcure.com
Regardless of what exact technique you’ll use, always disinfect the injection site with alcohol beforehand. Let the skin dry again before injecting to avoid unnecessary stinging from the alcohol. If it’s your first time, it can be uneasy or even scary, but we’ll promise you’ll get used to it and also become good at it.
However, the most direct way to reduce any pain is to reduce the amount of movement the needle makes; make sure the needle goes straight in, without any detours! Before you inject, pull the plunger a little bit to see if any blood comes out. If there is no blood, you may inject the T.
By: Iwan Beijes
How much to inject?
How much testosterone to inject is also subject to each person. The more you inject each time, the less often you have to do it. On the other hand, the bigger the volume of the injection, the more pain it will cause. It also much depends on the type of testosterone you administer, as it could be long-acting T, which doesn't need to be taken as often. Keep in mind; testosterone therapy is individually tailored, and therefore you should always discuss the volume of your injections with your physician.
After the injection, first, safely dispose of the needle. From there, there are a couple of things you can do to minimize discomfort. First, apply a gel with arnica as the ingredient. Arnica is a herb that is known to reduce swelling. Subsequently, put some ice on the injection site. Make sure not to put the ice directly on your skin, but put a towel or a cloth around the ice. Additionally, you can massage the injection site, but this also comes down to personal preference. Try what works best for you.
Some pain or discomfort after injection can happen, but we hope that a combination of the above tips and tricks will help you (or someone you love) to reduce or even eliminate any soreness. Find out what works best for you and be patient; it will get better over time, and the results are more than worth it!
By Joao Santos
Check also the video below from Sam Collins to see how to inject your T shot
- Agaç E, Günes UY. Effect on pain of changing the needle prior to administering medicine intramuscularly: a randomized controlled trial. J Adv Nurs. 2011 Mar;67(3):563-8.
- Ehsani, Maryam, et al. "A comparative study on pain severity caused by Z-track and air lock methods for intramuscular injection." Journal of Ardabil University of Medical Sciences 11.4 (2011): 309-315.
- Terry Treadwell, Terry. “Diagnostic Dilemma: Intramuscular Injection Site Injuries Masquerading As Pressure Ulcers. WOUNDS. 2003;15(9):302-312.
- Najafidolatabad SH, Malekzadeh J, Mohebbinovbandegani Z. Comparison of the pain severity, drug leakage and ecchymosis rates caused by the application on tramadol intramuscular injection in Z-track and Air-lock Techniques. Invest Educ Enferm. 2010; 28(2):171-175
- Tambunan, Evelyn Hemme, and Imanuel Sri Wulandari. "Utilizing Z-track Air Lock Technique to Reduce Pain in Intramuscular Injections." Jurnal Ners 10.1 (2015): 112-117.