Testosterone Injection Pain and Swelling | Am I Okay?

Self-administering your testosterone shot can be an intimidating experience in the best of times. So when something goes wrong - say you have more blood than usual, or you get a lump afterward - it can be difficult to keep calm. 

Perhaps you've found this article because one of these things just happened to you. You might be asking: Is this normal? Did I inject the wrong spot? How do I know when to go to the doctor?

Or maybe you're reading this because you're new to self-administering. With the threat of coronavirus, most folks are trying to eliminate unnecessary trips to the doctor's office. For those who normally have their shots administered by health care professionals, this might mean having to give yourself shots at home instead. Even when something doesn't go wrong, the questions above are good ones to ask. The more that you know about the challenges you may face, the more prepared you'll be when they arise.

The short answer is yes. While not every shot will hurt, most people will experience some injection pain some of the time. Pain and soreness are completely normal after injections and are generally not cause for alarm. In one study, pain was reported by 80% of participants, "peaking immediately after injection, reaching only moderate severity, lasting 1–2 days and returning to baseline by day 4." This means that about 4 days after giving yourself a shot, any resulting pain should be gone.

For my first 16 years on hormones, I gave myself bi-weekly intramuscular (IM) shots using 1.5" needles. When I did IM shots, I experienced some amount of shot pain nearly 50% of the time. The pain was never severe, but sometimes made squats and lunges a bit uncomfortable the next day.

When I finally switched to weekly subcutaneous (sub-q) shots, the pain frequency dropped to about 1 out of every 5-6 shots. The shorter needles that are used with sub-q made for a drastic reduction in pain frequency. What's more, the severity of my pain dropped from moderate to mild. 

More recently, my shot pain has disappeared altogether. What happened? For starters, I started using an auto-injector called the Inject-Ease (more on that below). I also starting implementing many of the tips in this article. Hopefully this info will alleviate your shot pain too and bring you some peace of mind.  

Quick note here: if you experience anything beyond moderate pain, you should absolutely contact your doctor. The same goes if you develop a high fever, experience other unforeseen health problems, or if the pain persists longer than 4 days. 

Tips for Avoiding Pain

1. Swap Out Your Needles

One way to avoid having painful injections is to use one syringe for drawing and another for injecting. Any time a needle passes through any medium, the needle will be slightly dulled. The sharper the needle, the easier it will travel inside your body and the less pain you will feel. Most doctors teach their patients to swap needles after drawing. However, if yours did not, don't fret. You can find extra syringes online or request them from your healthcare provider. We recommend using a 20-gauge syringe for drawing. The wider needle pulls T into the barrel quickly and with minimal air bubbles.

2. Try an Inject-Ease

I started using the Inject-Ease auto-injector in October of 2022 and it has absolutely changed my life. Since using it, I've experienced zero shot pain. It's also done wonders for my shot anxiety. It's so much easier to press a button than it is to stab myself once a week. My boyfriend also has serious shot anxiety. It's so bad that they actually can't give themselves shots and have always had a partner do it. For months now, I've been giving them their weekly shot and when I asked them to describe what the Inject-Ease felt like, they said, "It's like you're waiting for the shot, but it already happened." 

2. Allow the Shot Site to Dry Completely

Another smart tip is to allow your skin to dry completely after using alcohol swabs. Alcohol can cause a stinging sensation when pushed into the skin. Allowing the area to dry can prevent this from happening. As an aside, if you are having trouble finding alcohol pads due to COVID-19, you can prep your shot site with soap and warm water. Just be sure to wash the soap off completely and to let the area dry before administering your shot. 

3. Use Temperature to Aid You

We've also heard folks report that warming up your testosterone and icing your injection site can help reduce shot pain. To warm up your T, hold it in your hand for a minute or so and let your body heat do the job. This will also work to un-crystalize your T if you've been storing it in lower temperatures.

As for icing, a cold pack applied to the area before and after injecting can numb the shot site and reduce your pain. Icing your skin will also shrink your blood vessels. This makes it less likely that you will accidentally hit one while injecting. 

4. Hydrate

This tip comes from Transguy Supply Creative Director, Auston Bjorkman. After years of giving himself shots and experiencing periodic pain, he noticed that his shots hurt quite a bit less if he made sure to drink plenty of water the day before. While I couldn't find any medical sources to back up this claim, it does make sense. Dry skin is less supple and has less elasticity. My best guess is that hydrating decreases needle friction, which should also decrease pain. Either way, it's worth a shot (pun intended), and staying properly hydrated is important for so many other health reasons. 

About 2 years into hormone therapy, I had a very alarming shot experience. I was giving myself a shot in my leg when I pulled out the syringe and blood geysered from the shot site. My first thought was that I'd hit an artery, and I was terrified. I quickly grabbed some paper towels and applied pressure to the site.

Once I calmed down a bit and realized that I wasn't going to die, my second thought was that all the T had gushed out with the blood. Would I need to give myself another shot?

The answer to the latter is no. It's possible that a small amount of T escaped, but not enough to require re-injecting.

When I asked other trans-masculine folks on HRT if this had ever happened to them, many of them said yes. Almost 100% of them asked if I aspirated before injecting. Truthfully, I did not. My doctor had not taught me to do this.

In case you are wondering, here's how to aspirate: Once you have completely submerged the needle into your skin, pull back on the plunger a bit to see if any blood appears in the barrel. If not, you can proceed with your shot. If you do see blood, pull the syringe out, change the needle, and try again in a different spot.

Aspirating doesn't mean you won't ever bleed from your shot - nicking a vein is relatively common - but the idea is that aspirating can prevent you from injecting directly into a vein. I say "idea" here because whether or not aspirating is necessary or even helpful is a topic of debate in the medical community. As far as I am aware, there have been no studies specifically assessing the need for aspiration prior to IM injections. Personally, I recommend talking with your doctor and following the protocol they suggest. 

If you do IM shots and are a frequent bleeder, you might also want to talk with your doctor about Z Tracking. Z Tracking is a method of injection in which you pull the skin of the site to the side. While your skin is pulled, you inject the needle and empty the syringe. Hold the needle in place for 10 seconds before removing it. Once you have fully withdrawn the needle, release the skin. This will reduce the amount of T and blood that is allowed to escape.  

Here is a helpful video tutorial on the Z Tracking method:

Testosterone Injection Pain and Swelling

Some pain and soreness are normal after injecting your shot, but there are reactions to keep an eye out for. Injections aren't as simple as taking other prescription medications and I strongly recommend that you learn with a medical professional. Also, be sure you're getting your hormones through your doctor and only taking your specific prescription dosage.

If you have more shot tips for your fellow trans and non-binary travelers, please comment them below! Together, I hope we can make shot day as painless and worry-free as possible.

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