Intramuscular (IM) v. Subcutaneous (SQ) Injections

Most clinics prescribe once-weekly intramuscular (IM) injections. The problem with this approach is that a once-weekly dosing schedule creates peaks and troughs in symptom management. Men who inject once weekly often feel great for the few days after the injection and then worse again for the few days before they are due to inject. More so, intramuscular injections are painful and difficult to do on yourself. Because of that IM dosing typically requires weekly visits to the clinic to have the injection done for you. But it does not need to be that way. Research supports that subcutaneous (SQ) injections of testosterone are just as, if not more, effective than IM. SQ injections are given in the fatty tissue rather than the muscle. Because of this, they are dosed in smaller, more frequent increments (generally 2-3x/week). This dosing helps maintain more steady levels of testosterone in the body resulting in better symptom management. But wait more injections? Yes, but the needles used for SQ injections are much smaller (less painful) and easier to do on yourself. This means you can skip the visits to the clinic for injections. Additional benefits include a potential decreased risk of elevation in blood counts as the SQ dosing likely better mimics the natural physiologic secretion the body is used to.  Additionally, for similar reasons, SQ dosing may increase testosterone levels more than the traditional once-weekly IM dosing. IM dosing remains an option and can be more convenient for those who feel strongly about keeping the dosing to once a week. If that is the case, having someone who can regularly help administer injections is key. Overall SQ injections have many benefits but like any decision needs to be based on the individual needs of the patient.