Are you starting testosterone (T) but having a hard time figuring out the right syringe/ needle combination to use? Trying to buy needles online but confused by all the terminology? You're not alone. It's a complicated and confusing world out there. And more and more, we've been talking with folks whose doctors aren't giving them clear information. Well, fret not. You've come to the right place. This article will tell you everything you need to know about selecting the correct setup for your shot day.
For those only looking for quick answers to frequently asked questions, jump down to the bottom of this article.
Needle vs. Syringe
First off, some basic terminology. When talking about shots, words can be confusing. Colloquially, people often use the terms "needle" and "syringe" interchangeably. This is fine when you're chatting with friends. But when you're looking for medical products, you'll need to know that needles and syringes are not the same things. They are two separate parts that attach together. Once assembled, you can use them to administer a shot.
In the diagram below, you can see the part called the syringe. The syringe includes the barrel that will hold your T and the plunger you'll use to push testosterone into your body. It will also contain a tip where you will attach the needle. The needle refers only to the sharp metal piece that attaches to the syringe.
Why is this important? Well, for starters, most folks who give themselves T shots will use 2 separate needles but only 1 syringe each time they give themselves a shot.
If you are taking T shots, the testosterone your doctor prescribes is suspended in oil. This allows the hormones to release slowly into your system. However, this also makes the testosterone thick and difficult to draw into the barrel of the syringe through a thin needle. Therefore, folks often use a wider needle to draw testosterone into the syringe.
When it comes time to put that needle into your body, however, you WANT a thinner needle. The thinner the needle, the less painful the shot. And pushing T out of the barrel of a syringe is much easier than drawing it in. For this reason, most folks use one needle for drawing T into the syringe and another for injecting T into their bodies.
Swapping out needles has another vital benefit. When you insert the first needle into your vial of T, your needle will dull a bit. A dull needle will create more friction when you are using it to pierce your skin. And more friction means more pain. Swapping out your needles keeps things sharp and thus less painful. After using the larger needle to draw up the testosterone, re-cap it, remove it from the syringe, and replace it with a thinner one.
Needle Gauge and Needle Length
Now that you know the difference between a needle and a syringe, let's discuss how to find the right needles. Firstly, needles are sold by gauge and length. The gauge of a needle measures the diameter of the needle. Counterintuitively, the lower the number, the wider the diameter of the needle. This means that an 18g (gauge) needle will be wider than a 24g needle.
On the other hand, the length of the needle is a straightforward measurement. A needle that is 5/8" is indeed shorter than a needle that is 1."
The kind of shots you are doing will determine the length and gauge of the needles you need.
If you are doing intramuscular (IM) shots, you will be injecting into a muscle. If you are doing subcutaneous (subQ) shots, you will be injecting into fatty tissue below the skin. With an IM shot, you will need a wider and longer needle. This is because muscle tissue is deeper and thicker than subcutaneous tissue.
The standard recommendation for intramuscular (IM) T shots is between 22-23 gauge and 1-1.5" (inches) in length.
The standard recommendation for subcutaneous (subQ) shots is 25-26 gauge and 5/8” (inch) in length. If you are unable to find 5/8" needles, you can also use needles that are between .5-.75" (inches) in length.
It should be noted that with IM shots, the longer needles can put you at risk of developing hardened scar tissue at your injection sites. And trying to give yourself a shot through scar tissue is exceedingly painful. No matter what, you'll want to rotate your injection sites. However, with IM shots, it's even more important to give your body time to heal. You will need to give your injection site at least a month-long break between doses. You can give yourself a shot in your left thigh one week, your right thigh 2 weeks later, and then 2 weeks after that, you can finally return to your left thigh.
For drawing testosterone into the barrel of your syringe, we recommend using 19-21g needles. This is the same for both IM and subQ injections. The length of these needles is mostly irrelevant. The needle just needs to be long enough to draw T out of the vial.
Luer Lock Vs. Luer Slip Tip
Sounds simple enough, right? Well, there are actually many different types of needles and syringes. You'll want to ensure that the needles you buy work with the rest of your gear.
Firstly, there are several different types of syringe tips. The two most common tips for testosterone shots are Luer lock and Luer slip tip. This is true whether you are doing IM shots or subQ shots.
Luer slip tip syringes connect to needles through simple push-pull mechanics. That is to say, if you want to attach a needle to a slip tip syringe, simply push it on. Friction holds the needle in place on the syringe tip. There is no locking function.
Luer lock tip syringes, on the other hand, must be twisted on. The twisting motion locks the needle into place, making for a more secure connection. It's a bit like the difference between a nail and a screw. All other things being equal, a screw is generally more secure than a nail.
However, just like screws and nails, Luer lock syringes are typically more expensive than slip tip syringes. We all know that transitioning can be expensive, and trans folks are often less resourced than cis folks. If this is the boat you're in, slip tip syringes will absolutely work for giving yourself shots. I've used them for almost two decades now.
It's also important to mention here that if you want to use an Inject-Ease to administer your shots, you will need to purchase slip tip syringes. Luer lock syringes are slightly wider than slip tips. It's not a huge difference, BUT it's just enough so that Luer locks will not fit inside the device.
Testosterone Syringe Sizes
Ok, so you know what type of connecting mechanism you want in your syringes and needles. What's next? Well, there is a wide range of syringe sizes. When folks are talking about syringe size, they generally mean the size of the barrel of the syringe. In other words, how much medicine the syringe can hold. What kind of shot you are giving yourself and the size of your dose will determine what size you need.
If you are taking weekly subcutaneous shots, you will want to purchase 1 mL syringes. Everyone's dose will vary based on what your individual body needs to achieve the desired T level. Some folks need a little more T, and others need a little less. Your doctor will help you determine what dose is right for you by monitoring your T levels and adjusting accordingly. That said, the average dose for a weekly injection is approximately .5 ccs of testosterone. A 1 mL syringe will hold up to 1 full cc - giving you plenty of space in that barrel to hold the T you need.
If you are giving yourself intramuscular shots on the other hand, you have likely been instructed to administer your T every other week. In certain parts of the world, IM T shots are given even less frequently. However, these slow-release shots are generally administered by health care professionals. Personally, for many years, my dose was 1 cc of testosterone every other Friday.
Because you are giving yourself a bigger dose of T, you'll need a syringe that can hold more medicine. Technically, you can fit a full cc in a 1 mL syringe. However, that will make for one very full syringe. It will be much easier to have a syringe with a larger barrel instead. The standard recommendation for IM shots is 3mL syringes.
A quick note about IM vs. subQ shots. We've seen a lot of folks spreading false information about IM shots being more effective than subQ. The idea is that with a larger dose in your body, you'll see changes much more quickly. We can understand the appeal of this type of thinking. When you start taking T - especially in the beginning - it's normal to feel impatient. One of the most frequently asked questions we get is: How long will it take for my body to change on T? So... the more T, the faster the changes, the happier you'll be, right? Wrong.
The idea that subcutaneous shots work more slowly than IM shots is just not true. An IM injection of testosterone peaks your T levels around day 4 or 5 of your cycle and then gradually reduces until you return to your baseline. By the end of your 2-week cycle, your T levels may actually be lower than if you were on a 1-week cycle of subQ shots.
Moreover, think of it this way - teenage cis boys have more testosterone in their bodies than middle-aged guys. And yet, teenage cis boys don't often have deeper voices or more facial hair. Changes with testosterone take time. And thinking that giving yourself more T will speed up those changes is untrue and potentially dangerous.
All other things being equal, .5ccs of T administered weekly is just as effective as 1cc of T administered every other week. The only difference is that your T levels will be more stable because you're giving yourself more frequent doses with weekly shots. In other words, weekly subcutaneous shots will create fewer peaks and valleys in your hormone levels. And studies show that stable T levels mean less hormone-related mood changes, and more consistent energy levels and sex drive.
Ok, back to syringe size. Folks may be wondering if they can use 3 mL syringes if they are doing subQ shots. The short answer is yes. There's no harm in having a larger barrel on your syringe, even if you're only using .5 ccs of T every week. That said, if you are hoping to use the Inject-Ease to give yourself shots, you will have to use 1 mL syringes. We HIGHLY recommend picking one up for a pain-free, anxiety-free shot day experience. However, the Inject-Ease is designed ONLY for subcutaneous shots, and a 3 mL syringe will NOT fit inside it.
TB Syringe vs. Insulin Syringe
Now that we've covered the basics, there's another piece of terminology you might come across in your search for syringes. It's important to mention because one of these types of syringes is not really suitable for HRT. In your search, you may see companies advertise their syringes as either "insulin syringes" or "tuberculin (TB) syringes."
To be clear, the only difference between a 1 mL TB syringe and a 1 mL insulin syringe is the way they are marked on the sides. Insulin syringes are marked in insulin units. TB syringes are marked with cc units. As you take testosterone by the cc, the insulin units may be confusing. You generally won't have to search for syringes that are explicitly marketed as TB syringes. As long as it's not marked "insulin," it should have cc units.
What size needle and syringe do I need for Intramuscular (IM) testosterone injections?
The standard recommendation for intramuscular (IM) T shots is between 22-23 gauge and 1-1.5" (inches) in length.
What size needle and syringe do I need for Subcutaneous (subQ) testosterone injections?
The standard recommendation for subcutaneous (subQ) shots is 25-26 Gauge and 5/8” (inch) in length. If you are unable to find 5/8" needles, you can also use needles that are between .5-.75" (inches) in length.
What size needle do I need to draw testosterone into the syringe barrel?
For drawing testosterone into the barrel of your syringe - whether you are doing IM shots or subQ shots - we recommend using 21g needles.
Can I buy insulin syringes for testosterone injections?
No. Insulin syringes are marked in insulin units, not ccs. To dose yourself appropriately, you will need cc measurements.
What size syringes and needles do I need with the Inject-Ease?
The Inject-Ease can only accommodate 1mL syringes. We recommend 25-26 gauge Luer slip tip needles that are 5/8" in length. However, the Inject-Ease can be adjusted to work with needles between .5" and 1" (inch) in length.
For use with the Inject-Ease, does it matter what brand I buy?
No. The Inject-Ease was created to be flexible. It works with all quality manufacturers of syringes and needles as long as the syringe and needles are the correct sizes. The Inject-Ease can only accommodate 1 mL syringes but can be adjusted to work with needles between .5" and 1" (inch) in length. Please note it is only compatible with slip tip syringes.
We hope we've answered your questions about needles and syringes. Our aim is for you to feel confident about being able to find the proper setup for your shot day. If there is anything that we haven't answered related to selecting the right needles and syringes, drop a comment below. We will do our best to find the answer for you and update this page.
Meanwhile, check out these other articles on testosterone and giving yourself shots:
Also, check out this resource guide at Transgendermap.com.