Patients should be instructed to always use proper hand hygiene and a clean surface when preparing their intramuscular testosterone injection . The patient should also clean the top of the medication vial with an alcohol swab prior to every injection. After making sure the needle is firmly attached to the syringe, the patient should remove the cap from the needle and draw up a small volume air, which should then be injected into the medication vial. With the needle still in the vial, turn the syringe and vial upside down for medication withdrawal. Once the desired amount of medication has been removed for the injection, the patient may remove the needle from the medication vial, remove the 18 gauge needle and replacement with either a 22 gauge needle or 25 gauge needle for the injection itself. The needle should remain capped during preparation of the injection site. If the two-needle technique is being used, a small amount of (0.03 mL) medication should be aspirated into the syringe to flush out the air in the second needle.

Prior to performing the injection, the site should be identified and cleaned with a second alcohol swab, in an outward motion, 2 in. surrounding the injection site. The patient should then relax the muscle, uncap the needle, and insert the needle at a 90° angle into the muscle (Figs. 13.2 and 13.3). Once the needle is in the muscle, the patient should pull back the plunger and check the syringe for any blood. If there is no blood present in the syringe, the patient should inject the medication into the muscle. If blood is aspirated during needle insertion, the needle has likely entered a blood vessel . If this occurs, the needle should be withdrawn and the injection aborted. The patient will need to repeat the procedure by preparing a new injection. Once all of the medication has been injected, the patient should carefully remove the needle and hold pressure at the injection site.

The injection may be performed in several areas: the deltoid, gluteus, or quadriceps. Due to ease of self-administration, we prefer teaching patients to inject their quadriceps. However, the other areas may be useful if the patient will not be giving themselves the injection.