How to give a Testosterone Intramuscular (IM) Injection

Once you are established on hormones, it may be appropriate for you to self administer hormones with the support and training of the health care provider who normally undertakes your injection. Your GP surgery may be able to provide the equipment required. This guidance is suitable for Enantate or Sustanon but NOT for Nebido.

What is an intramuscular injection?

An intramuscular injection delivers medication directly into the muscle. This allows the medication to be quickly absorbed into the bloodstream

Before you start you will need the following:

1.    Box containing one vial of testosterone

2.    Disposable syringe, two green (21G) needles

3.    Alcohol swabs

4.    A yellow sharps bin (you can get this on prescription from your doctor, nurse or pharmacist)

Step 1: Getting ready

1.    a well lit area in which to work, clean the area and wash your hands

2.    Find Remove the testosterone vial from the box and check:

·      The writing to ensure it is the correct medication

·      The expiry date written as MM/YY (do not use if out of date)

·      The fluid inside the vial (do not use if discoloured, cloudy or has bits in)

Step 2: Preparing the injection

1. Attach the green needle to the syringe ensuring that the cap stays on the needle at all times, put the empty syringe and needle down

2. Pick up the vial and firmly flick the top to ensure all the liquid is in the main part of the vial

3. Snap the top off the vial by firmly grasping between finger and thumb and pushing away from the dot on the neck of the vial

4. Pull the needle cover straight off the syringe and place the needle into the vial so that the needle tip rests against the bottom of the vial

5. Pull back the barrel slowly to draw the liquid into the syringe, ensuring none is left in the vial

6. Bring the syringe out of the vial and carefully remove the needle, disposing of it in the sharps bin

7. Dispose of the vial and the top in the sharps bin

8. Check for air bubbles in the syringe by holding it upright with the plunger pointing towards the floor, firmly tap the syringe with your finger until the bubbles rise to the top of the syringe

9. Slowly push the plunger up to force the air bubbles out of the syringe

10. After the air has been removed, attach the second green needle and the injection is now ready to be given

Step 3: Selecting the injection site

There are two common sites for injection; the buttock or the thigh:

• Vastus lateralis muscle in the thigh:

  • Can be used for self injection or if someone else is giving the injection

  • Look at the thigh and divide it horizontally into 3 equal parts

  • The injection is given into the middle third on the outer edge of the thigh

• Gluteus maximus in the buttock

  • Can be used if someone else is giving you the injection

  • Expose the bottom and mentally divide one of the buttocks into four quarters, aiming the injection into the upper, outer quarter

Step 4: Giving the injection

1.    Clean the skin of the injection site with an alcohol swab; let it air dry

2.    Hold the skin around the injection site by forming a V with the fingers of your non-dominant hand and placing the heel of this hand on the skin, aiming the injection in between the arms of the V

3.    Completely insert the needle at a 90 degree angle with a quick, firm motion

4.    Remove your hand from the skin and use it to grip the barrel of the syringe

5.    With the other hand, gently pull back on the plunger to check for blood

o   If you see blood in the needle, do not inject, remove the needle immediately and discard the syringe, starting the process of preparing the injection again

o   If you do not see any blood, complete the injection by slowly pushing the plunger down

6.    When the full dose of the medication is given, remove the needle and syringe

7.    Gently press a wipe on the injection site until there is no further bleeding

8.    Dispose of the whole needle and syringe in the sharps bin

Tips for reducing injection discomfort

·      Inject medicine that is at room temperature

·      Remove all air bubbles from the syringe before injection

·      Let the skin dry before injecting, after using alcohol wipes

·      Keep the muscles in the injection area relaxed

·      Break through the skin quickly with the needle

·      Rotate the site of injection

·      Try not to change the direction of the needle as it goes in or comes out