Testosterone Replacement Therapy
Demonstration on how to inject Testosterone safely. Any questions, email us at firstname.lastname@example.org
Testosterone was the first ever synthesized anabolic steroid, and testosterone cypionate is a slow-acting, long-ester, oil-based injectable testosterone compound that is commonly prescribed for the treatment of hypogonadism – low testosterone levels and various related symptoms in males.
How to fill the syringe
Remove the safety seal (plastic cap on top) and wipe rubber top with an alcohol pad. Wipe rubber top before every injection to ensure sterility.
Taking a 3cc syringe and attach a 20G x 1” needle for drawing out testosterone; push the needle into the rubber top and turn the vial upside down.
Pull back the plunger and draw out your dose of testosterone. Push plunger back and forth to try and remove as much air bubbles as possible.
Remove needle from the vial and pull plunger back to pull testosterone which might be trapped in needle tip reservoir.
Carefully twist off the needle used to draw the testosterone and replace it with a 23G x 1 ½” needle for injection.
You will inject into one of 3 places: Deltoid (shoulder), Glute (butt cheek), or top of your thigh. Find whichever works best for you, or alternate between them.
How to do an intramuscular injection of Testosterone Cypionate
Use a 23G x 1 ½” needle for injecting your testosterone.
If injecting into the glute, always inject into upper-outer quadrant of the butt cheek that’s close to the hip.
Clean the skin with an alcohol pad.
Make sure plunger is pushed up which removes all the air-bubbles, leaving only the testosterone.
Relax the muscle being injected.
Push the needle all the way straight into the muscle, withdrawing the plunger briefly to confirm that you’re not in a vein (if you are, you’ll get blood return when you pull back on the plunger, and you should withdraw the needle and re-insert).
Press down on the plunger and then remove the needle quickly.
Use an alcohol pad to wipe the injection site and massage the medication into the glute.
Be sure to keep your injections clean. Always wipe your injection site with an alcohol pad and store your medications in a clean location. Always use a new, unopened needle for each injection. Do not reuse your needle and syringe. Discard your needles in a Sharps container.
You will either have a 5mL or a 10mL vial of testosterone cypionate, which is one of the most common forms of injectable testosterone. Testosterone cypionate typically comes in two different concentrations, 200 mg/mL and 100 mg/mL. When you receive your medication, read the label and identify what concentration you have. In most cases, you will have a 200 mg/mL vial of testosterone cypionate. This means that for every mL of testosterone cypionate there is 200 mg of actual testosterone. A milliliter (mL) is the same thing as a cubic centimeter (cc).
Typically, testosterone is injected once per week, although some individuals need different frequency. When you receive your package, check to make sure you have all the supplies you need to inject your testosterone. You will have a 3 mL syringe, which means it can hold up to 3 mL of a solution. Already attached to it is a 23 gauge needle. The gauge is simply the measurement of the thickness of the needle. The larger the number, the smaller the thickness of the needle. The 23 gauge needle is used to inject the testosterone. Unscrew the 23 gauge needle from the syringe and replace it with the 20 gauge needle used to draw the testosterone out of the vial. It's a fairly thick needle, typically we don't use this needle to inject, but because it's thicker it allows us to draw the testosterone out of the vial much easier, because testosterone is in a fairly thick oil base.
To draw the testosterone out of the vial, grab an alcohol wipe (prep pad or swab). Take the pad and rub the top of the vial of testosterone where you'll notice a small round rubber port or rubber stopper. That's where the needle will be inserted to draw the testosterone out of the vial. Always ensure that this rubber stopper is clean and sterile by rubbing it with the alcohol prep pad. Once you've rubbed the top of the vial with the alcohol prep pad, you can discard that prep pad, set the vial down, make sure you do not touch the top again, because you do not want to contaminate it with bacteria that might be on our fingers.
Now you're ready to draw the testosterone using the 3 mL syringe, 20 gauge needle. You've already rubbed the top of the vial so now you're ready to insert the needle into the top. Insert directly into the middle of the round rubber port, at the top of the vial. Turn the vial upside down, so that gravity can allow the testosterone to enter the syringe which will assist the testosterone into drawing into the needle as you pull slowly back on the plunger. Now, the particular dosage for this injection will be 1 mL of testosterone cypionate which equals 200 mg of actual testosterone. If you notice the black rubber plunger that's used to draw the testosterone within the syringe, you want to make sure that the top of that rubber plunger is aligned with a one mL mark on the syringe and this will give you 1 mL or 200 mg of testosterone cypionate.
Now that the testosterone is drawn out of the vial and into syringe, cap the needle as to not set a bare needle down on the table and risk contaminating it. You've successfully drawn testosterone out of the vial using the 3 mL syringe and 20 gauge drawing needle. Before you remove the drawing needle and put on the injection needle, you want to pull back on the plunger a little bit to make sure all the testosterone is pulled out of the tip of the drawing needle reservoir. Unscrew the drawing needle off the top and discard it. Now simply twist on the injection needle, make sure it's nice and tight. Here we have a 23 gauge 1 1/2" needle that's typically used to inject testosterone cypionate. 23 gauge is a fairly narrow gauge needle, very easy to inject and the length is to ensure that it's going to enter the muscle, which is where testosterone cypionate needs to be injected.
Make sure the air bubbles are completely out of the testosterone. Do this by flicking the side of the syringe and pushing on top of the plunger till the testosterone starts to come out of the top of the needle, making sure we still have one mL. Now you're ready to inject.
Now it is time to do the injection. You are going to do an intramuscular injection into the butt cheek or the glute. It is not the only place that testosterone can be injected, but it is the most common and easiest place for most patients to inject testosterone. Remove the drawing needle by unscrewing it off the top of the syringe and discarding it into your hazardous waste container. Open the 23 gauge needle that's going be used to inject. The needle is 1 1/2" long to ensure that it gets into the muscle tissue, which is where testosterone needs to be injected to be absorbed effectively.
Once you take the cap off the needle, you do not want to set the needle down for risk of contaminating it with bacteria that might be found on the table top, counter top or wherever you might be injecting. If you do end up having to set it down after you've put the injection needle on, be sure to be very careful and safely cap the needle prior to setting it back down. For injecting, you want to ensure that the area you're injecting is clean and sterile by using an alcohol prep pad, just like we did when we rubbed the top of the vial testosterone before drawing it out. When injecting in the glute, you want to make sure you're doing it in the proper place.
Watch the video above to know where to do the injection into the glute. When doing an injection in the glute, you want to go into the upper left or the upper right of the butt cheek. This will ensure the best place to inject where the most muscle tissue is and also avoid some of the nerves and vascular that's found in the middle of the butt cheek that can cause some irritation. Ensure that that the upper left quadrant of the butt cheek is nice and clean. Typically, it's right below the belt line, almost underneath where the hip is. Take the weight off the leg, so that the muscle's not tense, this will make it a little easier to inject. At a 90 degree angle insert the needle directly into the area you're injecting. Pull back on the plunger ever so slightly, this is called "aspirating". This ensures that you are not in a vein, you do not want to inject the testosterone into a vein, you want to make sure you're in a muscle tissue.
When you pull back or aspirate on the plunger, if you are in a vein it will fill up with blood and be easy to identify and you simply pull the needle out and re-inject into a different area. Inject the testosterone slowly by pushing down on the plunger until all of the testosterone is out of the syringe. Pull the needle out carefully and grab an alcohol pad that you just used, go ahead and clean a little bit of the blood off and ensure that the injection side is nice and clean and sterile. You can even rub a little bit to make sure that testosterone is nice and absorbed. You've completed your injection.