This injection guide is for people who are prescribed Sustanon (testosterone esters) as part of their gender affirming medical treatment.

This information will help you learn how to give yourself an intramuscular injection of Sustanon.

An intramuscular injection is an injection that is given into the muscle.

A healthcare professional will show you how to give yourself the injection. You can use the information in this resource to remember how to do it at home.

Important Information

Do not attempt to administer the injection until you have had proper training by a healthcare professional.

• Before commencing, check the expiry date of the Sustanon. Do not use the medication if it has expired.
• Always use a new needle and carefully examine the liquid to make sure it is clear. Do not use it if the liquid is discoloured or contains any lumps or large particles in it. If you suspect that the liquid has been contaminated, do not use it.
• Always use the specific dose that has been prescribed to you.
• Syringes and needles are for single use only and should be handled with care. Store them safely and dispose of them safely in a special sharps bin. Needles and syringes must not be mixed with household rubbish.
• For detailed information on Sustanon please refer to the Patient Information Leaflet available here.

Warnings and precautions

• Sustanon contains arachis oil, and so is not suitable for people with allergies to peanuts or soya.
• Some people can have unexpected allergic reactions to certain medications. Anaphylaxis is a serious allergic reaction that manifests as difficulty breathing, wheezing, swelling around the face, tingling of the lips and throat, and a choking sensation within minutes of administering the medication. This requires immediate medical treatment. If you experience any of these symptoms after administering Sustanon, discontinue the Sustanon and seek medical help immediately by calling the Emergency Services or attending the Emergency Department at your hospital.
• After administering Sustanon, you may experience a reaction at the injection site, such as pain, a nodule, a rash or discolouration during the injection of the medicine or during the hours following the injection. If you observe a severe reaction at the injection site, seek medical attention.

What is Sustanon?

Sustanon is a preparation of testosterone that is prescribed to people as part of their masculinising gender affirming hormone treatment. Sustanon contains several different testosterone compounds dissolved in an oily solvent. After injection, it forms a reservoir of testosterone that is gradually released into the bloodstream. Each millilitre of Sustanon contains:

• testosterone propionate 30 mg.
• testosterone phenylpropionate 60mg
• testosterone isocaproate 60mg
• testosterone decanoate 100mg

How do I get Sustanon?

Sustanon must be prescribed by a qualified healthcare professional.

What dose of Sustanon is used?

You will need to administer Sustanon at the specific dose that is prescribed to you. The usual adult dose of Sustanon is 250mg every 3 weeks, but different people may require different dose frequencies depending on their specific needs. 

How is Sustanon administered?

Sustanonis administered as an intramuscular injection (into the muscle).

There are specific areas of the body that are suitable for giving intramuscular injections. These are:

• Gluteus maximus: the upper outer quarter of the buttock.
• Vastus lateralis: the outer edge of the middle segment of the thigh.

You will need the following for the injection:

• The glass ampoule of Sustanon 250 in 1ml.
• A syringe.
• A needle for drawing the Sustanon into the syringe. 
• A needle for injecting the Sustanon.
• An alcohol wipe for skin preparation.
• Cotton wool or gauze.
• A sharps bin to dispose of the needle after injection.

How to inject Sustanon 

1. Preparation 

1.1 Wash your hands thoroughly with soap and water.

1.2 Gather your supplies, including the Sustanon ampoule, the syringe, the first needle for drawing up the Sustanon, the second needle for injecting the Sustanon, an alcohol wipe, cotton wool or gauze, and a sharps bin.

1.3 Check the medication name, dose, expiry date, and integrity of the packaging.

Do not use if the medication is not estradiol valerate, is of the incorrect dose, has passed the expiry date, or the integrity of the packaging is compromised.

2. Drawing the Sustanon

2.1 Attach the first needle to the syringe, ensuring that the cap stays on the needle at all times. Put the empty syringe and needle down.

2.2 Pick up the ampoule of Sustanon and flick the top firmly to ensure that all the liquid is in the main part of the ampoule. 

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

2.4 Remove the needle cap and place the needle into the ampoule so that the needle tip rests against the bottom of the ampoule.

2.5 Pull the plunger slowly to draw the liquid into the syringe, ensuring that none is left in the ampoule.

2.6 bring the syringe back out of the ampoule and carefully remove the needle.

2.7 Dispose of the needle, the ampoule and the ampoule top in the sharps bin.

2.8 Check for air bubbles in the syringe by holding it upright wit hthe plunger pointing down. Firmly tap the syringe with your finger until the bubbles rise to the top of the syringe.

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

2.10 After the air has been removed, attach the second needle to the syringe. The injection is now ready to be given.

3. Injecting the Sustanon

3.1 Clean the skin of the chosen injection site with an alcohol swab.

3.2 Gently hold the skin around your chosen injection site by forming a V with the fingers of your nondominant hand and placing the heel of this hand on the skin.

3.3 Holding the syringe like a pencil or a dart, completely insert the needle with a quick and firm motion at an angle of 90° to the skin surface.

3.4 Remove your nondominant hand from the skin and use it to hold the barrel of the syringe.

3.5 With your dominant hand, gently pull back the plunger slightly to check for blood. If you see blood, do not proceed with the injection. Remove the needle, discard the syringe and begin again. If you do not see blood, then it is safe to proceed with the injection.

3.6 Push the plunger to inject the entire contents of the syringe slowly and steadily all the way in.

3.7 When the medication is fully injected, withdraw the needle and syringe.

4. After the injection

4.1 Dispose of the syringe and needle in the sharps bin immediately. The syringe and needle must not be placed in the household rubbish.

4.2 Gently place a piece of cotton wool or gauze over the injection site for a few seconds. This will help seal the punctured tissue and prevent any leakage. Do not rub the injection site after injection.

4.3 Record all details of the injection in the injection diary or using other means. It is recommended that you note where you injected, the dose injected, the date and time of injection and any injection reactions.

Storage

Store your Sustanon below 30°C. Do not store Sustanon in the refrigerator or freezer.

Store your Sustanon in the original package in order to protect the medication from light.

Do not throw away medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. This will help to protect the environment.

References

Electronic Medicines Compendium (2019). Package Leaflet: Information for the Patient: Sustanon 250, 250mg/ml, Solution for Injection.
https://www.medicines.org.uk/emc/files/pil.5373.pdf

Leeds and York Partnership NHS Foundation Trust (2022). How to Give a Testosterone Intramuscular (IM) Injection. 
https://www.leedsandyorkpft.nhs.uk/our-services/wp-content/uploads/sites/2/2022/02/Self-injection-of-Testosterone.pdf