#Shooting Star: An Interactive Testosterone Injection Guide
##For Intramuscular Injections of Testosterone Suspended in Oil
####© [[Marty Hernandez Avedon]], 2016
####The following is presented as an educational service. I'm a writer, not a doctor. Everyone has slightly different medical needs. The best way to address them is by seeing a knowledgeable and respectful medical professional (and by doing plenty of research on your own).
(set: $name = '')
(set: $blood = false)
We're assuming the best case scenario here.
Ok. Picture it.
You're in the bathroom of your home. It's really nice bathroom, too. There's potpourri, and fluffy towels, and soap that looks like it belongs in a hotel.
Open your [medicine cabinet]<click1|.
(click: ?click1)[You see here:
* a box of alcohol swabs,
* a box of bandaids,
* a package of syringes,
* a package of smaller gauge needles,
* a <a href='http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts/Sharps/ucm263236.htm' target="_blank">sharps container</a>,
* ...and, finally, your T.
[[Take all of it out and put it on the counter.]]]
Whew! That's a lot of stuff.
Ok. So...what do you always have to do when you're handling needles?
No, no...we're not going to cry this time. It's going to be all right. Trust me.
What you always have to do is [wash your hands the proper way.]<click2|
(click: ?click2)[You turn on the bathroom faucet, and wet your hands. Then you soap up your hands all over, front and back, lathering up for at least 20 seconds.
You rinse off, then dry your hands with a paper towel, rather than a washcloth or bath towel, because heaven knows what's on them. You also use a paper towel to turn the faucet off.
You think all this protocol is a little much, but it's what the <a href = "http://www.cdc.gov/features/handwashing/" target="_blank">CDC</a> recommends, and you don't want an infection.]
[[Ok, time to shoot up!]]
(if: $blood is false)[Hey there, $name. You're getting way ahead of yourself there. I don't want to write this as an annoying text adventure, but first things first.
You take out your bottle of T. Is it a fresh bottle?
(else-if: $blood is true)[Looks like you have to wipe the top of the vial again.
[[Let's go.->Ok now.]]]
(click: ?click4)[Carefully pop off the top of the vial. The cap kept the top sterile until you needed to use it. But it's not designed to pop back on, so just throw it out.
If you accidentally touch the top while popping the cap off, or you just want to be extra safe, you should wipe the top of the vial with an alcohol swab. Wait a little for it to dry.
Don't try to rush it by fanning the top. That'll just wave germs on to the vial you just cleaned.
(click: ?click5)[Take one of the alcohol swabs and wipe the top of the vial. This makes sure that nothing gross will get into the syringe when you inject.
Wait a few seconds for it to dry...otherwise, you might get alcohol in the syringe. Getting rubbing alcohol into the syringe will make your shot hurt more.
Don't try to rush it by fanning the top. That'll just wave germs on to the vial you just cleaned.
Get your syringe. Check the label. It should be something like an 18 or a 19 or a 20 gauge.
[Am I using the right gauge?]<click6|
(click: ?click6)[Needle gauges can be a little confusing. The smaller numbers are wider, while the bigger numbers are narrower.
You want a wide opening on your needle when you're drawing up T into the syringe. The oil the T is dissolved in is really thick! It's not easy to draw it into the syringe if the needle gauge is too narrow. That's why you should use an 18, 19, or 20 gauge right now.]
[[Open the packaging.]]
Pull out your fresh syringe. It will have a plastic cap over the needle. Just pull the cap straight up to remove it. If you twist it, that might loosen the needle.
Keep the cap on the counter so you can slip the needle back in whenever you need to put the syringe down.
Hold the syringe so the needle points up in the air. Always point it outward, away from your body. It's like handling scissors, basically.
[[Get ready to fill up.]]
You know how much you're injecting, right? If you're not sure, check the prescription on the box your vial came in.
As a reminder, cc's and milliliters are <a href='http://www.convertunits.com/from/cc/to/milliliter' target="_blank">literally the same thing</a>, so don't stress if your syringe uses one kind of unit and your prescription uses another.
Now, check the numbers on your syringe and draw back the plunger until it hits the number for your dose.
[[Stick the needle in the top of the vial.]]
Don't push it all the way into the T just yet!
This is when you press the plunger and let the air in the syringe out. This will make drawing up the T easier.
[[Now push the needle all the way in and turn the vial upside down.]]
Check that the needle is completely submerged in T. It would be silly if you tried to draw up T and the needle was sticking out of the medication.
Pull the plunger on the needle back again, until you hit the mark for your dose. Do it slowly. If you go fast, air can get in, and it's annoying to get the air bubbles out.
(click: ?click3)[If air gets into the syringe, you won't be getting your full dose. You're doing an intramuscular injection, so it's not dangerous if a little air gets in the syringe. The worst thing that would happen is that your shot might hurt a little more. If you were injecting into a blood vessel, however, watch out! Air bubbles in a blood vessel can kill.]
Sometimes air bubbles aren't easy to see. Once you think you have the right amount of T in the syringe, keep the needle in the vial and tilt the syringe a little just to check.
If you have air bubbles, tap the syringe gently. Keep the tip of the needle submerged and press the plunger until the bubble travels up and out. Then, slowly draw in some more T to fill the syringe to your proper dose.
[[I've got my dose!]]
Great job, $name. You're doing fine.
You now want to switch needles, for two reasons.
One, the needle you just stuck in the vial has gotten slightly blunt, so it's going to take more effort to push it into your skin.
Two, if you switch needles now, you can use a thinner needle for your injection, and it will hurt less.
[[Does switching needles mean another syringe?]]
Nope! You just need to switch needle tips.
Slip the needle back into the cap. Don't hold the cap, just aim the needle into the opening while the cap is resting on the counter.
Now, twist the cap and needle off and dump them in your sharps container.
Pick up the package of extra needles. Make sure the packaging says that they're between a 21 and a 25 gauge.
You want the needle to be a bigger number so it'll be thinner and hurt less. However, if the number is too big, it will be very thin, and that will make pushing the plunger much more difficult.
[Ok, but what about length.]<click7|
(click: ?click7)[Not all needles with the same gauge are the same length, though there are some standard sizes. You want to use needles that are in the low to mid 20s and 1.0 inch to 1.5 inches long for intramuscular injections. The needle has to be long enough to reach a muscle. If you're very chubby, you actually might need a longer needle.]
Open the package. Twist the needle on to the syringe, and put the syringe down on the counter. Don't take the cap off the needle just yet.
Now you just need to decide where you're shooting the T.
[[Where am I sticking this thing, anyway?]]
When you go to the doctor's office to get this done, you're usually given a choice. Some people get T injected into their butt cheek, while others get it injected into the outside of their thigh (toward the hip, away from your thigh gap).
These two locations offer different advantages and disadvantages.
Injections to your backside are sometimes said to hurt less. However, if it's not done carefully, the needle can hit the sciatic nerve. That's <a href='http://imr.sagepub.com/content/42/4/887.full' target="_blank">really bad</a>. In fact, the current advice given to doctors and nurses is to perform intramuscular injections into the thigh instead.
Injections into your thigh reduce the risk of injury, and easily allow you to watch the doctor as they inject so you can learn to do it yourself. However, the injection site is more prone to bruising.
People who self-inject T (almost?) always use their thigh. Have you ever tried to look at your own butt? Ok, now try that, with something sharp in your hands.
Actually, please don't.
In either case, you need to alternate from your left thigh/butt to your right every other shot. This keeps the muscle healthy and prevents too much damage to your body.
Every time you inject, you do a tiny bit of damage. It's nothing to be scared of, but it adds up. If you change things up from shot to shot, your body can heal.
[[Pick a spot.]]
Take a fresh alcohol swab and wipe it in a spiraling motion over the area you want to inject into. Start at the center and work your way out.
Don't rub the swab back and forth, that'll push new germs into areas you just cleaned. Understand that the swab isn't going to kill everything. It just will reduce the amount of germs on your skin, lessening the risk of infection.
Wait a few seconds to let the alcohol dry. Don't fan it, that'll push germs on to the cleaned skin.
[[Pick up your needle and get ready to aim.]]
Your needle still has the cap on, right? Pull it straight off, just like you did when you were getting ready to draw T.
Keep the needle pointing up. Turn the syringe so the bevel on the needle is facing the front. The bevel is the slanted part. It might be hard to see, so look closely to check.
[[Ok...here comes the hardest part...]]
Keeping the needle at a strict 90 degree angle to the injection site, stick it right into your body. Try to do it in a smooth, swift motion.
I'm not going to lie: this might hurt! For most people, it feels like a sharp pinch.
If it bothers you a lot more, you could ask your doctor about <a href='https://www.drugs.com/androgel.html' target='_blank'>T cream</a> <a href='https://www.drugs.com/pro/testopel.html' target='_blank'>or</a> <a href='https://www.drugs.com/cdi/androderm-patch.html' target='_blank'>other</a> <a href='https://www.drugs.com/striant.html' target='_blank'>methods</a> that don't involve needles. There's no shame in it. Some folks are just a lot more sensitive to pain, or have a big problem with needle phobia.
[[It's in! Now what?]]
Don't shoot up just yet.
Draw back the plunger. This is called aspirating. Always do this. Make sure there isn't any blood being drawn up.
[[I don't see any red. I think there might be an air bubble now, though?]]
Don't panic! This is just kind of annoying. You've hit a blood vessel, and you unfortunately have to start over.
[[Ok, time to shoot up!<-Ah, dang.]]
[But I want to inject now!]<click9|
(click: ?click9)[Don't try to inject now. Shooting T into a blood vessel hurts a lot. The oil the T is suspended in is so thick that it damages your smaller blood vessels as it circulates. It makes you cough because it gets caught up in your lungs.
It's going to <a href='https://www.youtube.com/watch?v=azrYHLwcHsQ'>suck</a>.
Injecting a lot of T into a blood vessel is dangerous, but if it's just a little, you're not in danger -- just a load of pain.]
(set: $blood = true)
That's good! That means you're in muscle. That's exactly where the needle should be.
You can press the plunger now. Go slow and steady. Make sure it goes all the way down.
You might feel some heaviness or warmth in your leg, but that's normal. You're pushing liquid into tightly-packed muscle, and your body has to make some room.
Now, pull the needle out, being careful to point it outward, away from your body. Drop the needle and syringe in the sharps container.
Some folks like to massage the injection site, but it's not strictly necessary. You don't need to "work the T in".
Now put a bandaid on. You're done! Give yourself a lollipop for the full doctor's office experience.
[[Wait...I want to see some sources!]]
I used these sites as references:
* FDA page on sharps containers and safe disposal of needles: <a href='http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts/Sharps/ucm263236.htm' target="_blank">http://www.fda.gov/MedicalDevices/...Sharps/ucm263236.htm</a>
* CDC guidelines on hand hygeine in healthcare settings: <a href='http://www.cdc.gov/handhygiene/providers/index.html' target="_blank">http://www.cdc.gov/handhygiene/providers/index.html</a>
* Medline Plus guide to drawing medicine from a vial: <a href='https://medlineplus.gov/ency/patientinstructions/000530.htm' target="_blank">https://medlineplus.gov/ency/patientinstructions/000530.htm</a>
* Healthline's guide to intramuscular injections: <a href='http://www.healthline.com/health/intramuscular-injection' target="_blank">http://www.healthline.com/health/intramuscular-injection</a>
* Medical tech company Becton Dickinson's intramuscular injection chart (pdf): <a href='https://www.bd.com/hypodermic/pdf/Intramuscular_Injection_Guidelines.pdf' target="_blank">https://www.bd.com/hypodermic/pdf/Intramuscular_Injection_Guidelines.pdf</a>
* Advice on choosing a proper needle size: <a href='http://nursinglink.monster.com/benefits/articles/8243-how-to-determine-needle-size' target="_blank">http://nursinglink.monster.com/benefits/articles/8243-how-to-determine-needle-size</a>
* A paper on needle gauge and pain: <a href='http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769648/' target="_blank">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769648/</a>
* Allnurses' forum discussion on the importance of swabbing vials: <a href='http://allnurses.com/infectious-disease-nursing/alcohol-pads-and-372366.html' target="_blank">http://allnurses.com/infectious-disease-nursing/alcohol-pads-and-372366.html</a>
* A video discussing what happens if you inject T into your bloodstream: <a href='https://www.youtube.com/watch?v=azrYHLwcHsQ' target="_blank">https://www.youtube.com/watch?v=azrYHLwcHsQ</a>
* The Straight Dope on what happens when you inject air into a vein: <a href='http://www.straightdope.com/columns/read/2866/can-air-injected-into-the-bloodstream-really-kill-you' target="_blank">http://www.straightdope.com/columns/read/2866/can-air-injected-into-the-bloodstream-really-kill-you</a>
* An anatomical video on thigh injection: <a href='https://www.youtube.com/watch?v=O7ZxHodcWAU' target="_blank">https://www.youtube.com/watch?v=O7ZxHodcWAU</a>
* An anatomical video on butt injection: <a href='https://www.youtube.com/watch?v=dYWmLP8OCKE' target="_blank">https://www.youtube.com/watch?v=dYWmLP8OCKE</a>
* A video demonstrating butt injection: <a href='https://www.youtube.com/watch?v=Nin5eqNCo0o' target="_blank">https://www.youtube.com/watch?v=Nin5eqNCo0o</a>
* A case report on nerve injury from messing up a butt injection: <a href='http://www.medscape.com/viewarticle/551320_3' target="_blank">http://www.medscape.com/viewarticle/551320_3</a>
* Drugs.com articles on Androgel, Androderm, Testopel, and Striant, four different ways of taking T without having to inject yourself:
** <a href='https://www.drugs.com/androgel.html' target='_blank'>https://www.drugs.com/androgel.html</a>
** <a href='https://www.drugs.com/cdi/androderm-patch.html' target='_blank'>https://www.drugs.com/cdi/androderm-patch.html</a>
** <a href='https://www.drugs.com/pro/testopel.html' target='_blank'>https://www.drugs.com/pro/testopel.html</a>
** <a href='https://www.drugs.com/striant.html' target='_blank'>https://www.drugs.com/striant.html</a>
* The Drugs.com article on injectable Testosterone: <a href='https://www.drugs.com/testosterone.html' target='_blank'>https://www.drugs.com/testosterone.html</a>
* ...and last, but not least, University of Michigan's guide to injecting T intramuscularly (pdf): <a href='http://www.med.umich.edu/1libr/SpinalCordInjuryProgram/IMselfInjectionTesto.pdf' target="_blank">http://www.med.umich.edu/1libr/SpinalCordInjuryProgram/IMselfInjectionTesto.pdf</a>
[[That was pretty cool. Can I give you money?]]
(if: $name is "")[(set: $name = "Anonymous")]Hi, $name. Let's get [[ready to inject]].
What's your name?
######Note: The name you enter is not stored in your browser. If you don't want to enter anything, it just defaults to "Anonymous."
[<input type="text" name="cName" placeholder="Anonymous">]<cName| <button type="submit" onclick="customScripts.submitName('cName')">That's me.</button>
(live:100ms)[(set: $name = ?cName)]
I'm a writer and trans activist. I've been on testosterone therapy for several years. I started injecting myself this spring after several training sessions at <a href='http://callen-lorde.org/' target="_blank">Callen-Lorde</a>, an LGBT health clinic in Manhattan.
Although this guide is written by a trans person (me), I tried to keep things very general, and not make assumptions about whether you, the reader, are trans, or what reasons you might have for injecting testosterone.
This guide is free to share, but if you can throw me a few bucks, that's great, too. I could use it.
Do you know how much writers make? Answer: not enough.
My Paypal is firstname.lastname@example.org and anything you can offer is appreciated. Don't feel guilty if you don't have anything to spare, though.
[[Take me to the title page.->Title]]
If you're shooting into your thigh (and if you're self-injecting, you probably are), sit down and grab your <a href='https://www.youtube.com/watch?v=O7ZxHodcWAU' target="_blank">*vastus lateralis*</a>.
You know, your vastus lateralis. It's part of your quadricep.
Ok, you most likely have no idea where your vastus lateralis is, unless you're a med student.
In the video in the link above, we see that this muscle is located on the outer edge of your thigh, in between your kneecap and the top of your leg bone.
You can roughly figure out where it is by putting one hand above your knee, and another below your groin. The border formed by your hands is where your vastus lateralis should be. The best place to inject is in the middle of this region, a little off to the side, closer to your hip.
So, yeah. Grab it. Grab your vastus lateralis and lift it away from the bone. This reduces the risk of going in too deep and hitting a nerve.
Avoid injecting into any spot that's bruised, scarred, or otherwise damaged. Pick a nice, healthy-looking, fresh spot.
[[But I want to inject into my butt!]]
[[Clean your skin.]]
If you hit the sciatic nerve, you can <a href='http://imr.sagepub.com/content/early/2014/06/11/0300060514531924.full' target="_blank">really mess yourself up</a>. The <a href='http://imr.sagepub.com/content/42/4/887.full' target="_blank">medical literature</a> recommends you avoid injecting into this area, since injury is so common.
If you are injecting into your butt, you need to take a look and divide your butt cheek into quadrants.
First, note that you are injecting into the gluteus maximus, and that this muscle is roughly located in between the top of your pelvis and the bottom of your groin. So you need to be in between the bottom crease of your butt, and that flattened area near the top where you might (or might not) have butt dimples.
Check out <a href='https://www.youtube.com/watch?v=dYWmLP8OCKE' target="_blank">this video</a> for exactly where you need to go.
Now that you have successfully located your own butt cheek, mentally create a dividing line down the middle going up and down, and another line across the middle, going left and right.
You now have 4 butt quadrants. You want to inject into the middle of the topmost quadrant, on the side closer to your hip.
If you go too low or too close to your crack, you might not hit muscle. You'll wind up hitting the sciatic nerve, or other important butt structures.
You'll have to see a doctor.
<a href='https://www.youtube.com/watch?v=ODVJ_y-ZIec' target="_blank">It will suck</a>.
[[Clean your skin.]]