If you have a phobia of needles starting testosterone sounds incredibly daunting, but this post will outline how to prepare for getting injections with a focus on Sub-Q injections.
you donât have to take testosterone in injection form- there are alternatives like gel and patches
if you decide to get injections then try to develop coping skills to help you deal with the anxiety. Then expose yourself to the phobia in a controlled way by watching videos of people getting injections while you use your coping skills to prepare yourself.
Iâll be honest- my internal thoughts when I considered starting shots went something like this: (you gotta read this in a semi-hysterical panicked rush) âOh no no no no I canât do that ahhh nope, time to try to think of something elseâ. But I needed to start testosterone to help me pass better, reduce my dysphoria, make me more comfy in my body, and improve my mental health.
I did not want to do biweekly injections- and I didnât have to. I took testosterone in gel form for the first 9 months I was on testosterone. And hereâs more info on the gel.
The positives of the gel for me:
Donât have to deal with needles which is good since Iâm scared of injections
No bruises or any pain. Itâs completely painless, and the closest thing itâs like is putting hand sanitizer on your shoulders/upper back every morning.
No mood swings since thereâs a constant level of T in my body
Quicker to do, takes only a minute
The disposal of the empty bottles is easy- just throw them in the trash
Donât have to measure a dose, itâs just a certain number of pumps like how you pump a hand soap.
Thereâs also pellets you can get implanted that release T over time, and you get them replaced every few months. The implantation process does involve needles. Youâd be numbed with a lidocaine injection first (the only pain youâd feel). Then the doctor inserts a small hollow tube (a few millimeters wide). The pellets are fed into the tube and under the skin, which feels weird but not painful. The whole process takes a few minutes and youâre done for a while.
Another method of taking T is via a nasal gel like this and discussed here. This is a pretty new method so there isnât a whole lot of info and personal experiences out there yet.
Thereâs also a patch you can use that you place on your skin and it releases testosterone that way, although it can cause skin irritations like itching sometimes. Thereâs an informational post about it here, and a video with someone starting the patch here. Using the patch means you donât have to worry about transference to someone else like with the gel.
If you have a needle phobia going on the gel or another form of T is a good alternative to getting shots and itâs defs worth researching and then discussing with your endo. Remember that youâll still have to do blood work no matter what form of T youâre on though.
However, testosterone gel just wasnât working out for me. I struggle with hygiene as a result of disability and mental illness, so I often shower only once a week or even once every other week. I know, thatâs gross, but shaming me about it isnât going to help me so please donât send me any asks about it because Iâm doing my best. As a result, the testosterone gel was layering up on me instead of getting absorbed. I also had issues with consistently applying the gel every day so Iâd often miss a day every week. So I didnât end up getting the full benefits of the gel, but that is just my personal experience.
I decided that I wanted to try injections, but I was still Terrified of them. I had to work to overcome that reaction, but the advice people gave me was all a variation on âjust man up and do it, itâs easy!â which doesnât actually help much. I have not yet started injections so I will edit this post to add on more when I do, but I have started working to desensitize myself to seeing needles which is what this post is about. You donât need to actually be on injections to do this- in fact, itâs best if you start working to overcome your fear before you have the prescription. If you plan to start T with injections at some point itâs best to start getting ready now- the process of developing coping mechanisms doesnât happen in a day and you have to keep practicing them over time.
This is is working for me but of course your mileage may vary and Iâm not a professional- Getting a therapist and being in therapy (especially one that specializes in phobias, exposure therapy or CBT) might be helpful if you have a severe phobia. If your phobia of needles is a âhyperalgesicâ fear (youâre scared of needles because injections hurt you a lot) then you should talk to your endo about pain management options.
First I did some reading on coping with phobias which provided some concrete strategies on what I should try doing, like how to avoid fainting and worksheets to print and use to try to use CBT to change your thinking about the topic. These three links should be required reading to anyone who has a fear of needles but want to start T injections:
Phobias: A self help guide
Phobias are an extension of anxiety, so I looked at anxiety resources next:
How to calm yourself during an anxiety attack
Coping statements for anxiety
Cognitive restructuring for anxiety
Decatastrophizing: The âWhat Ifâ Technique (Worksheet)
Anxiety and intrusive thoughts
Challenging anxious thoughts
How to Combat Your Anxiety, One Step at a Time
Understanding Intrusive Thoughts & Feelings with High Anxiety
How to prevent depersonalization from anxiety
I noticed that I had issues remembering to breathe when I was confronted with needles so focusing on deep breathing helped give me something to think about that wasnât my fear and helped keep me calm:
Color breathing (on pg 2)
How breathing affects feelings
If you tend to faint when you see needles or get shots, you shouldnât use deep breathing. You should focus on applied tension because youâre having a vasovagal reflex reaction which lowers your blood pressure.
For some people, phobias cause panic attacks. The info below is about how to cope with a panic attack:
How to cope with panic attacks
Information on panic attacks and coping
How to calm yourself during a panic attack
7 steps to managing panic attacks
7 steps to cope with panic attacks
How to cope with triggers you canât avoid
Part of overcoming a phobia is changing how you think about it. You want to consciously attempt to change your internal monologue. This doesnât mean that someone mentions needles and you immediately think âoh thatâs interestingâ with no fear, it means you think about getting T shots and your first thought is âOh help thatâs so scary I canât do thatâ and then you correct yourself and you think âIâm scared of it but Iâm capable of coping and I will do it and survive and itâll be okayâ. It can feel kind of fake to do that when itâs forced but over time it really does make a difference.
Make your own affirmations
Positive coping statements
Unhelpful thinking habits
Awareness of unhealthy thinking styles
When I spent 6 months in intensive outpatient, we had a DBT group that taught me about distress tolerance and emotion:
Distress tolerance skills
Distress tolerance activities
Panic list for distress tolerance
Improving distress (takes a min to load)
Emotion regulation skills
Emotion regulation worksheet
Letting go of painful emotions
Mindfulness of your current emotion
Healthy perspectives on emotion
Coping with intense emotions
Opposite action (mini chart)
Managing extreme emotions
What does being emotionally healthy look like?
How to keep ourselves from drowning in emotion
Now that Iâve done some research on coping methods I tried to consciously choose which ones seemed like theyâd be helpful for me to use. I made a binder that had the printouts of worksheets that would help and I wrote down strategies in it. You may want to use different strategies depending on what the root of your phobia is, if you know. If you have a therapist then this is something you should discuss with them if you think itâll be helpful.
What will I do when I start to feel anxious?
Will I try to focus on my breathing, will I use mindfulness, will I use positive self-talk, etc
What will I do when I feel Iâm close to a panic attack?
One idea is stop working on this and do something else like going on a walk, watching a TV show, and come up with an Activity list that I will choose from since forcing myself to the point of a panic attack isnât productive.
If having a list of activities wouldnât work because the choice would overwhelm you since youâre close to a panic attack choose one activity in advance and make sure youâre prepared for it, like if you choose watch TV then make sure you choose which show youâll watch and if you choose painting make sure your art supplies are on hand.
If you set your expectations too high and think that youâll completely beat the anxiety then youâll feel like you failed when you end up feeling anxious anyway. Remember that the goal isnât to completely eliminate anxiety at this point- if you feel anxious, donât think âLook this is proof I canât do it!â and think âYeah I felt anxious but I still managed to cope with it and get throughâ. No matter what happens donât beat yourself up over it. Maybe you panicked and didnât use any coping skills. Okay, next time youâll be more prepared and itâll go better. You donât have to be perfect!
Once youâve got some coping skills in your arsenal itâs time to put them to the test. If youâve got a phobia of needles like me, you probably have avoided all info about them and injections so now itâs time to educate yourself on what is involved in getting a shot.
There are two types of testosterone injections:
Intramuscular (IM) injections. These have larger needles that go all the way into the muscle, and the injection site is usually the thigh.
Subcutaneous (Sub-Q) injections. These injections have smaller needles that only go into the fat, and the injection site is usually the stomach.
If youâve got a needle phobia you may want to do sub-q injections since the needle is less intimidating. Since Iâll be doing sub-q shots thatâs what I know about, so the following is information about sub-q and injections in general. While subq injections for T are newer and some endocrinologists still prefer IM injections, subq injections are a safe and effective alternative to IM injections.
A needle looks like this simple diagram (tw: also has drawing diagram of needle going into skin)
Each needle has a Birmingham gauge which is the term used to refer to the diameter of the needle. A larger gauge = smaller needle. A needle with a 16 gauge is actually larger than a needle with a 22 gauge. The needle size you use is determined by the amount of subcutaneous tissue present, which is based on patient build.
The needles are usually 27, 28, or 29 gauge which is often smaller than the IM needles and theyâre often half an inch long or .625 inch. If you can grab 2 inches of skin between your thumb and index finger then you will probably be able to use a shorter needle, and if you can only grab 1 inch of skin then you might have to use a longer needle. You should discuss needle size with the person prescribing your T.
A syringe is the tube with a plunger in it that you attach your needles to, and they probably have a luer lock so you twist the needle on. Lance fit syringes arenât as good for T since the T is oil and makes things slippy so you donât want to risk it popping off. You measure how much T youâll inject by the measurement markings on the side, which are usually in milliliters
Subcutaneous injections are inserted at 45 to 90 degree angles, depending on amount of subcutaneous tissue present and length of needle- a shorter needle is usually inserted 90 degrees and a longer needle is usually inserted at 45 degrees.
Most people do their shots in the abdomen basically on your tummy chub, avoiding a 2-inch circle around the belly button. The abdomen site has the fastest rate of absorption among the sites, but some people use their thighs.
You need a sharps container which is a box you use to dispose your used needles in. You could also use a thick empty detergent bottle. Make sure that both the syringe and needle fit into the container easily and cannot break through the sides. Ask your healthcare provider or a pharmacist what your state or local requirements are for getting rid of used syringes and needles.
You canât reuse a needle, they have to be new and straight from the sterilized packaging each time. Even after just one or two uses, syringe and pen needles can become dull. Sharp needles cause the least amount of trauma to the skin. Additionally, used needles are no longer sterile.
Your little testosterone bottle is also called a vial. The vial is made of glass and has a plastic or metal top covering a rubber stopper. When you draw out the testosterone you donât unscrew the cap, you put the needle in through the rubber stopper.
Supplies youâll need: 2 alcohol swabs/pads, your testosterone bottle, two needles (one big one to take the testosterone out of the bottle and one small one to inject with), a syringe to attach your needles to, and a sharps container
Always check the expiration date on the bottle. If itâs expired, donât use it. It can help to write the date you opened the bottle on it or in a notebook. Also make sure there are no crystals or lumps in the bottle.
You want to warm your T up to room temperature before you inject so the injection doesnât feel weird or sting.
If you are concerned about the swelling and redness around an injection site, outline the swelling with a pen or marker. This will help you to determine if it is increasing in size and monitor if and how the injection site is changing. If the swelling or redness increases in size or does not decrease in size, contact your physician. You should contact your physician immediately if you have any questions or concerns about abnormal or unusual redness, swelling or side effects.
Try rubbing ice on your skin for a few minutes before injecting if you experience pain, but donât leave the ice cube in place too long as it can freeze cells damaging the tissues and decrease the absorption of the medication.
Other people say they choose to inject after a warm shower when the skin is soft and supple or apply a warm compress to the injection site for 5 minutes before injecting.
You may notice a little bead of medication or a drop of blood on your skin after the injection. This is normal.
Do not aspirate (pull back on the plunger) after youâve inserted the needle. It is not necessary to aspirate because the dermis is relatively without vessels so the likelihood of injecting into a blood vessel is small.
Hereâs the gist of how getting an injection works. It may vary depending on what type of needle you have and you should follow the instructions of your doctor, this is just an example of what the process may be like.
Get your stuff out. You have to store your needles, testosterone bottle, and sharps container somewhere that animals and children arenât going to get into.
Start some music playing if you want to! Music can help keep you calm or determined- play whatever you want to. I like to listen to upbeat pop for this.
Wash your hands using soap and then dry them
Open an alcohol swab/pad and clean the top of testosterone bottle
Open syringe package, take the syringe out
Take the larger needle out of the packaging and attach it to the syringe and take the cap/top off. Remove needle from cap by pulling it off in a straight motion.
Draw back the syringe plunger to the number of your testosterone dosage so it has air in that part. If too little or no air is injected, withdrawing the medication may be difficult. If too much air is injected, the plunger may be forced out of the barrel causing the medication to spill. So put as much air in as your dose will be.
Insert the needle into the testosterone bottle rubber stopper push the air into the bottle then carefully flip it over
Pull the syringe back to the amount of testosterone is in your dose then draw just a bit more than needed and push out extra so there are no bubbles
Flick the vial to remove remaining bubbles if there are any. You donât want any bubbles!
Pull the syringe back to take all the testosterone out of the big needle. Be careful not to contaminate the needle by touching it- everything should be as sterile as possible.
Put the cap back on the big needle and unscrew it from the syringe body that has your testosterone. Donât put the cap back on the needle if you have shaky hands- wait a bit and use your breathing and coping skills until youâve calmed down so you donât accidentally poke yourself.
Put the big needle into the sharps container
Take the little needle out of the packaging and attach it to the syringe and put it down.Â
Take off your shirt or pull it up. If you wear a binder then tuck your shirt into that.
Choose your injection site. It should be two inches from your belly button (if thatâs where your doc told you to inject). You donât want to inject in the same place you did last time or within an inch of that area, so do it to the left or right of your belly button depending on that. Donât inject in an area where the skin is burned, scarred, hardened, inflamed, swollen, or damaged by a previous injection. Avoid spots on your skin that have scar tissue, moles, inflammation, or unusual changes in appearance or texture.
Open another new alcohol pad/swab and clean the injection site going in circles expanding outward so you donât draw germs into the area. Wait until it has dried completely before you inject.
Pick up your syringe and needle. Uncap the needle and push the air back out of the needle until you can see a tiny bead of T at the end.Â
Take a big pinch of skin between your thumb and index finger and hold it. Your thumb and forefinger should be about an inch and a half apart as you squeeze the fat. Hold the syringe in the dominant hand between the thumb and forefinger, with the bevel of the needle up so the point will be inserted into the skin first. Insert the needle at a 90 or 45 degree angle, whichever you were instructed to do.Â
After the needle is completely inserted into the skin push down on the plunger at a moderate to slow speed until thereâs no testosterone left while you hold the fat.
Wait 15-30 seconds to reduce possibility of a leak then pull the needle out. Withdrawing at the same angle as insertion minimizes discomfort and damage to the tissue.
Dispose of the needle in the sharps container, donât bother to put the cap back on the needle.
Put mild pressure on the injection site with a clean finger, gauze pad, or cotton ball for 5-8 seconds.
Put your bandaid on and youâre done until next time in two weeks.Â
Some people have needle issues because of resistive fear which stems from being scared of being forced or controlled, so for them self-injecting is better than having someone else do it. But some people donât self-inject and they have someone else do that process, whether itâs a parent, a partner, or a nurse. If you donât think youâll be able to do it yourself, enlist someone else who can learn how to do it and is willing to help. Talk to your endo about who can do injections for you when you go to meet them for your prescription and see if they have any recommendations.
Once I understood whatâs involved in getting an injection I watched videos where people actually did it. This is an opportunity to practice using your new coping skills before the real deal happens.
This is the least graphic visual I could find if you arenât ready to see it actually happen yet. Itâs super short and shows a computer model self-injecting and you canât actually see the needle go in. If you want to see a picture before you watch the videos of people doing the injections so you know what to expect, this is a diagram but it does show the needle going into the skin.
YouTube videos of people doing their injections: (note that you should follow what your doctor tells you to do and not copy them exactly)
How I do my Sub-Q Testosterone shot
How I do my testosterone injection- SubQ
Subcutaneous Injection (Testosterone)
FTM Transgender - Subcutaneous testosterone Injection
How to Give Yourself A Subcutaneous Injection
Doing a SubQ Testosterone Shot | Andrew
E1: FtM SubQ Testosterone Injection Tutorial
Subcutaneous Testosterone Injection in the Tum
Sub Q testosterone shot âtutorialâ
How to do a subcutaneous (SubQ) testosterone injection
How to do a SubQ shot with Testosterone
Subcutaneous Testosterone Cypionate Injection
How to Give a Subq Subcutaneous Injection Shot
Shot Prep - Testosterone (HRT) Subcutaneous
Made a timelapse of my weekly subcutaneous shot
Watching videos of injections can be draining, so itâs best to take a break in between videos and stop if youâre starting to feel exhausted or panicked.Â
I also tried reading random things that have the word injection in them to help prepare for that too since the anxiety also happens when I see the word and not just when I actually see a needle. If you also want to try that, here are some random forum posts about T injections:
SubQ vs IM Injections for Testosterone
Subcutaneous vs Intramuscular Testosterone
Needle Gauge and Availability
Intramuscular or Subcutaneous?
Itchy swelling at injection site
Mild tingling/burning after subcutaneous injection?
Tips for Lessening the Pain of Injections?
Allergic reaction to sesame oil / other subcutaneous injection sites?
For those of you injecting T..
I dread needles. Tips on self injecting please!
Are SubCu T Shot supposed to sting?
Where to get injection stuff?
First Time Injection Questions
For anyone curious about switching to subQ: a comparison photo of my IM and subQ needles
T leaking out after sub-q shot?
Questions for guys who do SubQ
Those who have tried both IM and SubQ, which do you prefer and why?
Needle size for T. Enanthate, sub q injections?
How deep should a SubQ shot be?
A helpful reminder about Sub-Q, inflammation, and allergy meds
What do you feel when you inject subq?
Things to expect while injecting vs. Things not to do while injecting?
Why some men run out of their injectable testosterone before their next refill
Common T Injection Site No Longer Recommended for IM injections
TRANSGENDER HEALTH Injection Guide (Lists how to do IM injections then SubQ injections)
Hormones: A Guide for FTMs
Sometimes you just arenât ready for injections even if you try your hardest. That isnât your fault and you shouldnât feel bad about it, and it doesnât mean youâre weak or not masculine- about 10% of adults have a fear of needles so youâre in good company.
I know that if I had tried to start injections initially I wouldnât have been able to do it since I wasnât in a good enough mental state to be able to cope. I had to work on improving my overall mental health with meds and therapy before I was able to get to a point where I was able to try to work on the phobia without getting completely overwhelmed. Please reach out for help if you need it.
If you find that you arenât ready yet, thatâs okay! Also remember that there are alternative forms of testosterone and not being able to do injections doesnât mean you canât start testosterone.