Injection technique is another consideration when evaluating post-injection pain, but research in this area is also conflicting. preparations like Nebido.) Injection Technique Smaller, more frequent injections are likely to cause less pain than larger injections administered bi-weekly (or every few months in the case of long acting T. The volume of injection can contribute to post-injection pain. It’s not hard to imagine that the duller tip of the needle would cause more pain, but again, studies have not unanimously concluded that this is the case (Rock, 2000 and Ağaç, 2011.) Volume of Injection
Just Say No to Blunts! Trans men are commonly advised to use one needle for drawing up, discard it, and then “switch up” to a higher gauge needle for injection. It would stand to reason that using a smaller gauge needle would reduce injection pain, but researchers have disagreed on this on this point. (Güneş, 2013.) The typical needle gauge used to inject testosterone is between 22 and 25. The needle used to inject should be long enough to penetrate through the subcutaneous tissue into the muscle mass, or the patient will have more pain. (Treadwell, 2003) Needle Length, Gauge and “Switching Up” The toxicity of the medication, the volume injected, and even the speed at which the injection is given also will influence the size of the necrotic lesion. In other words, the surrounding muscle and tissues in the immediate area of the needle tip are subjected to the pressure of the mass of fluid that has been instilled into the area, which causes pressure necrosis.
Forceful placement of a volume of fluid into a closed space will cause damage. The only variable is the size of the necrotic lesion and the severity of it. It has been found that necrosis of the muscle will occur after any IM injection no matter what medication is injected. This helps to limit injection site reactions and the formation of scar tissue. Rotating injection sites is a must! Give an injection site a week or two off before injecting there again. Pain receptors are found within the subcutaneous layer, not in muscle tissues and so injections administered into subcutaneous tissue may be more painful. In various studies it was found that most injections given to the dorsogluteal site delivered medication into the fatty tissue. Therefore, the needle has a better chance of reaching the muscular tissue in the ventrogluteal area than in the dorsogluteal area.
The ventrogluteal site has less subcutaneous tissue and a thicker muscle mass than the dorsogluteal site.
Areas of the body with less subcutaneous fat are generally less painful injection sites. Some injection sites are more prone to pain than others. The deltoid (arm), vastus lateralis (thigh), and gluteal muscles (hip/buttocks) are the most common sites for IM injections. With IM injections, Testosterone is deposited deeply into vascular muscle tissue.