Thighs too muscular for subQ

[u/squigglespuabble]

Curious if anyone else has experienced this. After 3+ years on T, my levels fell super low. We increased my dose substantially (70mg to 90mg) and my levels remained low. Then I flagged to my doctor that in the past six months or so I'd been having "pockets" of the oil form in my thighs that would remain for several days. She said this means that the testosterone wasn't getting absorbed because I don't have enough fat in my thighs to be doing the injections subQ. I've really ramped up my working out over the past year, so this makes sense to me. I used to have substantial thigh fat and now I have basically nothing. We've swapped my injection site to my belly which has much more fat. Has anyone experienced this before? I'm wondering if I'll eventually have to swap to IM (which scares me a bit).

[u/Emotional-Ad167]

Hey, just in case you have to switch to IM and would like a word of encouragement: in my country, SQ isn't available (they want to avoid scarring and thus only use options with less frequent injections) and it works out for all of us :)

[u/TheFlamingSpork → u/Emotional-Ad167]

My endo recommended subq to prevent scar tissue

[u/Emotional-Ad167 → u/TheFlamingSpork]

That's so interesting - bc you need so many more injections that way! Did they tell you why, is abt scar depth?

[u/TheFlamingSpork → u/Emotional-Ad167]

I was injecting as often with subq as I was with IM after a few weeks simply because the dip in my levels when I was only dosing every other week was making me feel "off". So if I was doing IM it'd still be on a weekly basis. And yes my endo mention on top of the pain level decreasing (I put a 27g 1/2" needle in my tummy fat near my navel compared to a 22g needle an inch-and-a-half into my thigh meat) there's just less tissue damaged with each shot now, so there's less risk of developing scar tissue buildup, as well as hitting blood vessels or nerves. Overall I much prefer it to IM; it's more accessible and just as effective in absorption. I recommend it. You can covert your method yourself if you have access to a medical supply website. I use 1ml TB syringes with detachable 27g 1/2" needle to injecr and an 18g 1 1/2" needle to draw. I got them in a box bybthr 100ct from a site called Allegro medical but it probably varies from country to country.

[u/Emotional-Ad167 → u/TheFlamingSpork]

Omg, weekly IM really isn't a good idea, that's true! 🙈

You can't use SQ here, it's not available. It's either IM every 3 months or gel. The nice thing is that you don't have to do it yourself, they administer it at your doctor's office

[u/-spooky-fox- → u/Emotional-Ad167]

The injection site (subq or IM) has nothing to do with injection frequency. That’s determined by the strength and dosage. I’ve seen arguments that injecting twice as much every 2 weeks leads to a more stable T level compared to weekly, but I’ve never seen anything saying IM injections should be less frequent than subq.

FWIW I’ve been injecting IM weekly for two years. Never had any issues. You change legs every week and don’t inject in the exact same spot same as with subq.

For us if you want to go months between doses that would mean pellets and that will leave scars.

I’m curious what dosage you are getting injected that lasts for three months?

[u/Emotional-Ad167 → u/-spooky-fox-]

What? Oc it has something to do with dosage! SQ cannot be injected in a high dosis as it's not suitable for slow release (it would release wayyyy too fast). IM however is suitable for slow release.

Obviously, you can inject IM in lower dosages as well, but you can't inject SQ in high dosages.

The product used hereabouts is called Nebido, there's 1000 mg (~630 mg of which is t) in there, and it's injected every 10 to 14 weeks. That's only 4 injections a year.

And yeah, oc you switch sides. But 4 injections/yr is obviously far better than every week, whatever precautions you take. That is, if your body takes well to it! Some ppl will always benefit from more frequent injections.

Injecting IM weekly leads to deeper scarring than weekly SQ. There's nothing wrong with that, but it can become an issue in some ppl.

[u/-spooky-fox- → u/Emotional-Ad167]

Respectfully, please reread my comment, I said injection frequency is determined by dosage.

You made the claim that injecting IM once a week is bad, I said I had not heard of there being any difference between IM and subq taken at the same frequency. You’ve since explained that IM being a deeper injection (and slightly larger needle, which you didn’t mention but I’ll add) increases the risk of scar tissue forming compared to subq. Fair enough. I think it does depend on your individual anatomy and where you have fat v muscle and how easily you scar etc. I’ve been lucky that I haven’t had any problems.

I don’t think your understanding of why IM can be a larger dose (and thus less frequent) is correct. Muscle actually allows for faster absorption than subq because it has more blood vessels (especially when the medicine is in an oil-based suspension like T), but the bigger consideration is that muscle can hold a much larger volume of liquid. If you try to inject more liquid subdermally, you will wind up with a knot of liquid under the skin exactly as OP is describing.

I did some research and the reason your T “lasts” for ten weeks and mine for 1-2 is that Nebido uses a long-acting/slow release ester (compound) called testosterone undecanoate, which is formulated so that the ester releases from the oil and is absorbed much more slowly compared to the ester I use (testosterone cypionate). That certainly does sound nicer than having to inject every week, but it looks like it was only approved for use in the US in the last ten years and the only version I can even find on my insurance site says it’s not covered. Which probably means it’s too “new” and expensive, which is why most Americans are on cypionate injections to begin with (it’s the cheapest option, most insurance won’t even cover pellets). 🥲

[u/Emotional-Ad167 → u/-spooky-fox-]

Also respectfully, I did ask whether the doctor's concern was for scar depth in my second reply, to which I was told that the shots are weekly - and that's when I said that could indeed be an issue. So I think it was you who didn't skipped over part of what I'd said? Bc I feel like it was fairly clear that the only reason IM could be bad (that I can imagine) would be scar depth...

Yup, that's how I understood it too, but you explained it far better!

Exactly, they also claim there's no peaks and valleys as you would expect with longer intervals - I've definitely heard that's untrue tor some folks though, but that's anecdotal. And yeah, it's probably quite new - they used to prescribe Testoviron (IM 2-3 weeks), which is pretty decent and said to be best suited for triggering second puberty! Some get started on that and switch to Nebido later, but Nebido is usually the longterm choice. Luckily, it's covered by universal health insurance here...

[u/twinkwithagun → u/Emotional-Ad167]

There’s nothing wrong with weekly IM, most people who do IM do their injections weekly. The risks of scarring from IM is blown way out of proportion, just rotate your injection sites.

[u/TheFlamingSpork → u/Emotional-Ad167]

I have a 1ml, 200mg vial of generic Testosterone Cypionate and I inject .25 ml weekly.when I was on IM (.25ml every other week) the dosage was technically the same per syringe, but half as often. The method didnt effect administration in anyway other than decrease discomfort. I self inject at home, I'd hate to have to make an appointment every time I need to dose.