Subcutaneous T Injections

[combee]

Hey, folks! So, I've been on T for about five months now, and I've come to discover that there isn't a whole lot of documentation on Sub-Q injections, so I thought I'd give you guys a full write-up of my experiences so far. All the pros and cons and what-have-yous.

To begin with, I live in the States. My parents promised me they would support my hormone therapy if I would wait until I was eighteen. I realized I was trans waaay back when I was fourteen. That was a heck of a long wait, so when the day finally came around, I wanted to get a hold of my hormones as quickly (and as cheaply) as I could. I decided Planned Parenthood was the way to go. The nearest clinic that specialized in LGBT services was a state away, but any inconveniences I experienced getting there were totally made up for by the check-up. For anybody who's curious, the estimated cost was around 200 dollars (without insurance) but we only ended up paying 120 (I think?) because of my age and my "low risk" status (I didn't need to have any STI tests done).

Anyhow, I came in that day fulling expecting to be put on intramuscular injections, but my doctor told me about something I had never even heard of before. Subcutaneous Testosterone Cypionate shots. If you don't know the difference between sub-Q and IM, sub-Q injections only penetrate as far as the topmost layer of fat underneath the epidermis. Right off the bat, you're probably thinking-- less far to go, smaller needle. Thank god, right? The needle I use to inject is a 25 gauge. Whooosh.

Another fantastic thing is the price. I was fulling expecting to have to shell out $70 a month or more for the rest of my life, but at the dosage I'm at right now, I'm only paying 26, and my doctor expects me to stay there. Not entirely sure yet, but I'm hoping I do, because I love sitting under that $30 mark. And oh, yeah, the dosage-- According to my doctor, sub-q requires a lesser dosage because your body absorbs the T more evenly over the course of the week (I have to do shots every week. Are IM shots every week? I can't remember). I started my first three months at .25 and have spent each month since standing at .50.

But how is my transition? As far as I can tell, it's coming along just as well as any other guy's. I'm still pretty early on and I was not a naturally masculine guy pre-t, so I'm still sort of toeing the line of androgyny here, but there have been some very obvious changes. My voice is REALLY deep. I've got that highschool boy shadowstache. I'm boxier, my body hair is darker and more numerous, I've had... growth... And my menstrual cycle has been halted since month 2 (where before I was unfortunately very regular).

The few complaints I have are pretty minor. The biggest one is that ever since I've had my dosage upped, I've been developing nodules EVERY time I inject. They're just these big nasty hard bumps and they itch like crazy. Another thing is that the testosterone can burn pretty bad sometimes, but that's only during and an hour or so after injecting, and I think that's a normal thing with cypionate. Lastly... I've gotta go through a whole rigamarole with my pharmacists. I had to explain the procedure to my last pharmacist twice, and then when the store brought in a new guy, I had to do it again. Neither of them had heard of T being taken subcutaneously. And honestly, they're never impolite about it, and it's really kind of funny, but I've got a bad memory, man. I can never get the syringes straight.

So... I think that's it. Feel free to ask me any questions. I would really, really love for this to become common practice. The benefits are just... tremendous. Especially for the financially challenged (such as myself). Is there anybody here that does it too?

[Magnus]

I'd wanted SubQ from the beginning. It took me until four months ago to finally land an Endo familiar with it and willing to 'oversee' that method. So, I've been doing that since July. I am still on a weekly administration, as I have been for the last three-odd years (biweekly did not agree with me... ran near nothing by the second week). Though I am considering a switch to every '3.5' days now... I don't mind the shots at all anymore; utterly painless.

To my surprise, the induced Polycythemia I'd been subject to for the past... oh, ~two years on IM, ceased (within a week). That was the biggest benefit for me of SubQ and due to that I am not willing to go back to IM (never mind being out of the woods with muscle scarring and nerve damage that is part and parcel of long-term IM). I'm gonna go out on a limb and theorize that the rather close proximity to the hip and/or femur (where most RBC's are made, other than the sternum) is why that happens so much more often with IM than any other TRT delivery method. I can think of no other explanation for that.

On the other hand, I did notice that my TT level dropped roughly 50 ng/dL. However, it had slowly fallen from 800 down to 500's despite the same dosage and administration over a year (then, still IM). No idea why, just one of those funny things (certainly due for an adjustment. Bit too low for not even being 30 yet). Point is, the derived levels between IM and SubQ are comparable.

Ah, yes... that Benzyl alcohol can smart pretty damn good. But, I vastly prefer that to jabbing through a large nerve in the thigh... holy **** does THAT hurt!!! I hated—no, I loathed injecting there. For me, that was never once painless... vaguely nauseating to be honest (I only shot there when I absolutely couldn't avoid it). And after a few years of weekly, my glutes had begun to ache pretty much all the time too. Very glad indeed to be off IM.

SubQ is definitely the way to go. There is no valid clinical reason to elect for IM over SubQ.


And yeah, dealing with the pharmacy can be a nightmare. On that I could write a book, but I'll refrain. Though, to be fair, it's really the FDA and CDC that are the root of the problem there. Too controlled, too many erroneous rules (no less that are differing by locality, even) that keep shifting around and causing confusion and hassles (e.g. the CDC's new cockamamie '30 days after puncture, toss the vial' nonsense—so no more 10mL vials dispensed; and 1mL vials are a PAIN to draw, can barely see the damn needle bevel in the neck. Oh, and of course, the 1mL vials are inexplicably three times the cost of the 10mL vial! But they don't care about that). I never don't hit a snag with my script. It is every single time I have to argue about it and play several rounds of phone-tag to sort it out. It's exhausting.


P.S. Try injecting very slowly. It'll help with the nodules ('sterile abscesses' actually)... slower you plunge, the better your tissues can absorb and kind of disperse it (true of IM too). I also like to pull the needle back slowly (I've noticed that better prevents the T welling back up).

Uh... itching isn't normal. You're likely sensitive to the Benzyl or the oil. As long as it doesn't get worse (e.g. shift to breathing issues), antihistamines would help manage that effect.

P.P.S. 25g 5/8" (ideally luer lock/non-fixed needle type) is typical. However, you lucky rail-thin types ought to stick to 25g 3/8". Note, 23g or thicker is TOO thick for the denser skin of the stomach. And smaller than 25g would be too difficult to draw with. It is also highly inadvisable to attempt SubQ in the belly with a needle in excess of 1/2".

[combee]

Hey, congrats on switching to SubQ! I'm sorry it was such a hard search to find the right Endo. It seems like our doctors are of a rarer kind, but hopefully that changes soon. It really sucks that you've still got residual issues from doing IM. Nerve and muscle damage was probably what concerned me the most when I still thought I'd be using that method, but Polycythemia is another side-effect that I hadn't thought about. Your theory on what causes it sounds pretty good. I'm still fairly uneducated on the medical side of stuff, but I feel like I've heard other guys who've been on long-term IM mention their levels getting a little wacky for no apparent reason. Hopefully you can find a stable range with your new Endo!

Yeeaah, nicking a nerve is definitely not something I'd wanna experience. I can't imagine having to do any sort of activity with an achy backside like that. My buddy who's still on IM has given me a couple of horror stories about hitting veins, too. I've always been really clumsy, so... I just can't imagine the kinda damage I would've done on myself. I'll take the little bit of burn over muscle spasms any day. I wish you wouldn't have had to go through that kind of pain, but your testimony on both methods is really valuable, so thank you for sharing it.

Oh, yeah, there's definitely a whole lot of red tape binding that wasp's nest together. My only solace is that if I have to go through it, maybe someone else doesn't have to. But then again, the first pharmacist totally forgot everything I explained to him, so maybe not. I'm glad it's not just me that has such a hard time drawing out of those 1mL containers, though! When you get right down to the neck of the vial you can't even tell if the tip of the needle is above or below the oil, and you usually end up drawing more air than you do liquid.

Aw, sweet! Thanks for the tips. It would be so nice not to have to deal with that anymore. Thank you for the specification, by the way. "Nodule" is a term I picked up from someone on the internet, and after looking up the definition for it (with probably the most unpalatable description language) I am very glad to have sterile abscesses instead. I wondered if the itching I had was from a mild allergy. It's never escalated further than a localized itchiness and redness, but I'll definitely keep and eye on it from now on and see if I can't remedy the symptoms a little bit.

An interesting thing to note, my pharmacist gives me two needles for one syringe. I use the 25g syringe, remove the needle and replace it with an 18g to draw up with, then remove that and screw the original 25g on again. I was under the assumption that drawing with a 25g would be nearly impossible, but maybe that's not necessary.