From the Guidelines
Testosterone shots can hurt due to the pain of injection, which is a well-documented disadvantage of this form of therapy. The injection itself involves a needle piercing through skin and muscle tissue, which naturally causes some discomfort, as noted in a study published in the New England Journal of Medicine 1. The oil-based solution used in most testosterone preparations is thick and viscous, requiring larger gauge needles and causing more tissue displacement during administration. Additionally, the oil can create pressure and inflammation in the muscle tissue as it's absorbed, leading to post-injection pain that may last for days.
Factors Contributing to Pain
- The injection technique, including the use of a new, sharp needle and slow injection over 30-60 seconds, can help minimize discomfort.
- The location of the injection, with common sites including the gluteal muscles, thigh muscles (vastus lateralis), and sometimes the deltoid, each having different pain sensitivity.
- The temperature of the testosterone preparation, with room temperature injections potentially being less painful than cold injections.
- Post-injection care, such as massaging the area and rotating injection sites regularly, can also help reduce pain and discomfort.
Minimizing Discomfort
To minimize discomfort, it is essential to follow proper injection technique, use a new, sharp needle, and inject slowly. Massaging the area afterward and rotating injection sites regularly can also help reduce pain. Some patients find that warming the area before injection or applying ice afterward can help reduce pain. If pain is severe or accompanied by significant swelling, redness, or fever, medical attention should be sought as these could indicate infection or other complications, as highlighted in the study 1.
From the FDA Drug Label
Miscellaneous: Inflammation and pain at the site of intramuscular injection. The most likely reason testosterone shots hurt is due to inflammation and pain at the site of intramuscular injection.
- Pain is a known adverse reaction to intramuscular testosterone injections.
- The exact cause of this pain is not specified, but it is likely related to the injection process or the body's reaction to the medication. 2
From the Research
Testosterone Shots and Pain
- Testosterone shots can be painful, but the level of discomfort varies depending on the administration route and individual tolerance 3, 4, 5, 6, 7.
- Intramuscular (IM) injections are known to cause significant discomfort and may require arrangements for administration by others 3.
- Subcutaneous (SC) injections, on the other hand, are considered to be less painful and can be self-administered with relative ease 4, 5, 6.
- A study found that 95% of patients reported no injection-related pain with SC testosterone enanthate auto-injector 5.
- Another study reported that only 1 patient out of 965 injections experienced mild pain with SC testosterone enanthate auto-injector 6.
Comparison of Administration Routes
- IM testosterone cypionate (IM-TC) and SC testosterone enanthate auto-injector (SCTE-AI) are two common administration routes for testosterone replacement therapy (TRT) 7.
- A comparison study found that both IM-TC and SCTE-AI provide a significant increase in total testosterone (TT) levels, but SCTE-AI is associated with lower levels of post-therapy estradiol (E2) and hematocrit (HCT) compared to IM-TC 7.
- The study suggests that SCTE-AI may have a preferable safety profile over IM-TC due to its lower peak-to-trough ratio and reduced risk of supraphysiological testosterone peaks 7.
Factors Influencing Pain Perception
- Individual tolerance and pain perception can influence the level of discomfort experienced with testosterone shots 3, 4, 5, 6, 7.
- The administration route, dose, and frequency of injections can also impact pain perception 3, 4, 5, 6, 7.
- Proper training and technique for self-administration can help minimize discomfort and improve overall experience with SC injections 4, 5, 6.