Dr Stevens has taken you through your first injection, demonstrating preparation of the testosterone vial, storage, dosing, preparation for injection and injection technique. You have been provided with a 6-week TRT starter box for initiation of therapy, this includes 3 x ampoules of Testosterone Enanthate 250mg/ml, a 10ml sterile vial, a selection of needles for drawing up the testosterone, 23g (blue) needles for deep IM glute, 25g (orange) for quads and 27g (grey) for shallow IM (or subcutaneous) injections. It also includes syringes, alcohol wipes, plasters and a high quality klip-lock box for long-term reusable storage.
Your First Solo Injection
Do not be daunted by the process. It’s quite simple, just follow the step-by step guide below. After a few weeks you will be an expert.
- Wash hands, prepare clean area, open your 6-week TRT starter box.
- Lay out equipment needed:-
- 10ml sterile vial with Testosterone Enanthate
- 1 x 1ml syringe
- 1 x 23g (blue) needle
- 1 x 25g (orange) or 27g (grey) needle
- 1 x alcohol wipe
- 1 x spot plaster
- 1 x sharps bin
- Open blue needle packaging from the top, leave in package, place on side. Remove the 1ml syringe from the top of the packaging. Pick up the blue needle and place it firmly onto the syringe.
- Open alcohol wipe and swab the top of the 10ml vial, do not discard.
- Remove the needle from its cover, ensuring it is still attached to the syringe.
- Puncture the 10 ml vial with the needle/syringe. There is a central rubber ring on the bung, place the needle perpendicularly into this.
- Turn the vial upside down and manoeuvre the tip of the needle so that it is fully immersed the liquid in order to draw the testosterone into the syringe for injecting.
- Slowly pull back on the plunger, the testosterone is quite viscous so be patient. Keep firm pressure on the plunger and the liquid will slowly fill the syringe. Some guys find that placing the vial on the radiator for a few minutes or popping it onto a hot wheat bag helps to make it more fluid.
- You will be injecting 0.25ml. Be aware there is some dead space at the end of the syringe and surface tension will make it appear that there is more liquid in the barrel of the syringe than there actually is, I would recommend drawing out 0.3ml.
- When the syringe is loaded, remove the needle from the vial and place the vial down. Draw back gently on the plunger to remove any testosterone from the needle and into the barrel.
- Remove the blue needle from the syringe, they advise never re-sheathing needles due to the risk of a needle stick injury. Open the 25g (orange) needle for deep IM injection, or 27g (grey) needle for shallow IM injection. This purely comes down to personal choice, both are an effective delivery method, obviously the higher the gauge the less pain but, conversely, more time injecting.
- Attach the needle to the syringe with the testosterone in the barrel. Remove the cover.
- Hold the syringe with the needle pointing upwards. It is likely that you have drawn some air in with the testosterone which should now be at the top. Gently push the plunger upwards to remove the air so that the liquid is at the top. There should be no bubbles in the syringe, if there are, gently tap on the syringe and hold it with a warm hand to coax it to the surface where it can be expelled as described above.
- If you’re a pro, you’ll have exactly 0.25ml in the syringe when a small oil bubble appears at the tip of the needle. If you have excess oil or not enough, you simply place the needle into the vial and expel or draw whatever small amount is necessary for accurate dosing. Any potential blunting to the needle is so minimal, it’s not of any concern.
The principle is always the same. Wipe the area with an alcohol wipe, insert the needle at 90 degrees to the skin and inject the testosterone. You need to be applying firm pressure to the plunger, especially with the higher gauge needle, however there shouldn’t be any resistance.
For shallow IM injections, use the 27g (grey) needle. This can be used for all injections sites, including deltoids, quadriceps and gluteal region.
For deep IM injections, use the 25g (orange) needle for the upper outer quadriceps / ventro-gluteal region. The 23g (blue) or the 25g (orange) needle can be used for upper outer glutes (rarely used but still a viable site).
I always recommend rotating injection sites to minimise potential scar tissue build up from repeated injections. In theory, once the needle is inserted you should aspirate to make ensure you are not in a blood vessel, so as not to cause an oil embolus. In practice, this is extremely unlikely with use of the 25 and 27-gauge needles. These injection sites should not be near any major vessels and nerves, however, if you do hit a vessel (blood) or nerve (shooting pain), simply remove the needle, exchange it for a fresh one and try a different site.
Once the plunger has been fully depressed, simply remove the needle and place a spot plaster on the injection site with a small amount of pressure to aid clotting.
It is important to safely dispose of your sharps in an approved sharps bin. Always remember to keep your medication and equipment in a safe place, out of the reach of small children.
HUMAN CHORIONIC GONADOTROPHIN
Dr Stevens will have demonstrated preparation of your first vial of HCG using Gonasi HP and bacteriostatic saline. He will have also taken you through dosing and administration of the prescribed dose. The process of preparation is quite simple as long as you take a methodical approach.
Your First Solo HCG Injection
- Wash your hands, prepare a clean work area, open your 6-week HCG starter pack and remove HCG vial from refrigerator.
- Lay out equipment needed:
- HCG vial
- 1 x 1ml 29g needle with attached syringe
- 1 x alcohol wipe
- Wipe the top of the HCG vial with the alcohol wipe to ensure that the rubber stopper is clean.
- Remove the cap from the plunger and needle cover from the syringe.
- Insert the needle into the central rubber ring on the stopper at a 90-degree angle, pushing down on the plunger as there is some dead space.
- Turn the vial upside down, ensuring the tip of the needle is fully immersed in the liquid. Slowly pull back the plunger to the prescribed dose. If you see air in the syringe, simply push the liquid back in and repeat the process.
- Remove the needle and insert it into the subcutaneous tissue of the abdomen at a 45-degree angle. A very gentle pinch should identify the correct area to insert your needle.
- Push down on the plunger until all of the liquid has been injected. Remove the needle.
- Return the HCG vial to the fridge and dispose of the needle/syringe into a sharps bin.
MILLIGRAMS (MG) PER MILLILITRE (ML
Testosterone Enanthate 250mg/1ml
Human Chorionic Gonadotropin
5000iu HCG in 5ml Bacteriostatic Saline = 100iu / 0.1ml
5000iu HCG in 2.5ml Bacteriostatic Saline = 200iu / 0.1ml
5000iu HCG in 1.0ml Bacteriostatic Saline = 500iu / 0.1ml
Dr Robert Stevens MBChB MRCGP Dip.FIPT