This injection guide is for people who are prescribed testosterone enantate as part of their gender affirming medical treatment.

This information will help you learn how to give yourself a subcutaneous injection or an intramuscular injection of testosterone enantate. 

A subcutaneous injection is an injection that is given under the skin, whereas 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 testosterone enantate. Do not use 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 ampoules 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 ampoules must not be mixed with household rubbish.
• For detailed information on testosterone enantate 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, tingly of thel ips 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 testosterone enantate, discontinue the testosterone enantate and seek medical help immediately by calling the Emergency Services or attending the Emergency Department at your hospital.

After administering testosterone enantate, 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 testosterone enantate?

Testosterone enantate is an injectable preparation of testosterone that is prescribed to people as part of their masculinising gender affirming hormone treatment.

How do I get testosterone enantate?

Testosterone enantate must be prescribed by a qualified healthcare professional.

What dose of testosterone enantate is used?

The dose of testosterone enantate will depend on factors such as your serum testosterone level, your serum oestrogen level, your stage of pubertal development, and your general health. Doses can range from 25mg every 2 weeks to 400mg every 2 weeks. You will need to administer testosterone enantate at the specific dose that is prescribed to you.

How is testosterone enantate administered?

Testosterone enantate can be administered as a subcutaneous injection (under the skin) or as an intramuscular injection (into the muscle). You will need t the following for the injection:

The glass ampoule of testosterone enantate 250mg in 1ml.

• A syringe.
• A needle for drawing the testosterone enantate into the syringe.
• A needle for injecting the testosterone enantate.
• An alcohol wipe for skin preparation.
• Cotton wool or gauze.
• A sharps bin to dispose of the needle after injection.

There are specific areas that are suitable for giving subcutaneous and intramuscular injections. These are as follows.

Sites for subcutaneous injections:

• As a general rule, these areas are those with a substantial amount of fat below the skin.
• These include the abdomen, thighs, and buttocks.
• When injecting regularly, it is important to change injection sites regularly to limit the risks of pain, irritation, and lipodystrophy (clumping or loss of fat under the skin).

Sites for intramuscular injections:

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

How to inject testosterone enantate

1. Preparation

1.1 Wash your hands thoroughly with soap and water.

1.2 Gather your supplies, including the testosterone enantate ampoule, the syringe, the first needle for drawing up the testosterone enantate, the second needle for injecting the testosterone enantate, 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 testosterone enantate, is of the incorrect dose, has passed the expiry date, or the integrity of the packaging is compromised.

2. Drawing up the testosterone enantate

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 testosterone enantate 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 ampoule.

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

2.5 Pull back 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 upright with the 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 testosterone enantate

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 testosterone enantate at room temperature. Do not store testosterone enantate in the refrigerator or freezer.
• Store your testosterone enantate 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 (2022). Patient Information Leaflet: testosterone enantate 250mg/ml for Injection.
https://www.medicines.org.uk/emc/files/pil.3733.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