This injection guide is for farers of people who are prescribed Nebido (testosterone undecanoate) as part of their gender affirming medical treatment.
This information will help you learn how to administer an intramuscular injection of Nebido to the person for whom Nebido is prescribed.
An intramuscular injection is an injection that is given into the muscle.
A healthcare professional will show you how to give the injection. You can use the information in this resource to remember how to do it at the person's 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 Nebido. 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, needles, and vials 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, syringes and vials must not be mixed with household rubbish.
- For detailed information Nebido please refer to the Patient Information Leaflet available here.
Warnings and Precautions
- 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 Nebido, discontinue the Nebido and seek medical help immediately by calling the Emergency Services or attending the Emergency Department at your hospital.
- After administering Nebido, you may experience a reaction at the injection site, such as a 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 Nebido?
Nebido is a preparation of testosterone that is prescribed to people as part of their masculinising gender affirming hormone treatment.
Nebido 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 over several weeks.
How do I get Neboido?
Nebido must be prescribed by a qualified healthcare professional.
What dose of Nebido is used?
You will need to administer Nebido at the specific dose that is prescribed to you. The usual adult dose of Nebido is 1000mg every 12 weeks, but different people may require different dose frequencies depending on their specific needs.
How is Nebido administered?
Nebido is administered as an intramuscular injection (into the muscle) by a trained person.
Given the volume of liquid required, Nebido must be administered into the gluteus maximus muscle as follows:
- Measure the site carefully, because an injection given in the wrong place could hit a nerve or blood vessel.
- Uncover one buttock. Imagine a line from the bottom of the buttock to the top of the hip bone. Imagine another line from the top of the crack of the buttock to the side of the hip. These two lines forma box divided into four quarters.
- The needle should be placed in the upper outer quarter of the buttock, below the curved bone.
You will need the following for the injection:
- The glass vial of Nebido 1000mg in 4ml.
- A syringe.
- A needle for drawing the Nebido into the syringe.
- A needle for injecting the Nebido.
- Gloves for personal safety.
- An alcohol wipe for skin preparation.
- Cotton wool or gauze.
- A sharps bin to dispose of the needle after injection.
Injecting Nebido
1. Preparation
1.1 Wash your hands thoroughly with soap and water.
1.2 Put on gloves for personal safety.
1.3 Gather your supplies, including the Nebido vial, the syringe, the first needle for drawing up the Nebido, the second needle for injecting the Nebido, an alcohol wipe, cotton wool or gauze, and a sharps bin.
1.4 Check the medication name, dose, expiry date, and integrity of the packaging.
Do not use if the medication is not Nebido, is of the incorrect dose, has passed the expiry date, or the integrity of the packaging is compromised.
2. Drawing up the Nebido
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 Remove the plastic cap from the top of the vial of Nebido.
2.3 With the needle cap still on, hold the syringe upright with the needle facing up and pull back hte plunger to the line on your syringe for your dose. This fills the syringe with air. For example, if you need 4ml of medicine, pull back the plunger to the line marked 4ml on the syringe.
2.4 Remove the needle cap and insert the needle into the rubber top of the vial. Do not touch or bend the needle.
2.5 Depress the plunger all the way in to push the air into the vial. This keeps a vacuum from forming so that the medicine will flow easily into the syringe.
2.6 With the needle still in, turn the vial upside down and hold it up. Make sure that the medicine covers the tip of the needle the entire time.
2.7 As before, pull back the plunger to the line on your syringe for your dose. For example, if you need 4ml of medicine, pull back the plunger to the line marked 4ml on the syringe.
2.8 Bring the syringe back out of the vial and carefully remove the needle.
2.9 Dispose of the needle and the vial in the sharps bin.
2.10 Check for air bubbles in the syringe by holding upright with the plunger pointing down. Firmly tap the syringe with your finger until the bubbles rise to the top of the syringe.
2.11 Slowly push the plunger up to force the air bubbles out of the syringe.
2.12 After the air has been removed, attach the second needle to the syringe. The injection is now ready to be given.
3. Injecting the Nebido
3.1 Clean the skin of the injection site with an alcohol swab. The injection site is the upper outer quarter of the buttock.
3.2 Gently hold the skin around your chosen injection site by forming a V with the fingers on 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 dominant 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.
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 Nebido below 30°C. Do not store Nebido in the refrigerator or freezer.
- Store your Nebido in the original package in order to protect the medication from light.
- Do not throw away any 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 (2023). Patient Leaflet: Information for the User: Nebido 1000mg/4ml Solution for Injection: Testosterone Undecanoate.