How to Inject Testosterone in the Glute

Injecting testosterone into the gluteal muscle is one of the most common ways people receive testosterone replacement therapy, whether for hypogonadism or gender-affirming care. The procedure itself is straightforward once you understand the anatomy, but the difference between a smooth injection and a painful one often comes down to site selection, needle length, and a handful of technique details that are easy to get right with practice. The gluteal region actually contains two widely used injection sites, and research over the past decade has shifted which one clinicians recommend.

Two Gluteal Sites, Not One

When people say “inject in the glute,” they usually picture the upper-outer quadrant of the buttock. That traditional location is called the dorsogluteal site, and it sits in the gluteus maximus muscle toward the back. But there is a second gluteal site, the ventrogluteal, which sits on the side of the hip in the gluteus medius muscle. The distinction matters because the two sites do not carry the same risks.

The dorsogluteal site is close to the sciatic nerve, the largest nerve in the body. Misplaced injections there have caused nerve injuries ranging from temporary numbness to lasting weakness, and case reports describe it as a persistent problem worldwide regardless of a country’s healthcare resources.¹ The ventrogluteal site, by contrast, is farther from any major nerves or blood vessels, has a thicker layer of muscle, and carries less subcutaneous fat in most people.

A systematic review and meta-analysis comparing the two sites found that ventrogluteal injections produced significantly less pain, less bleeding, and smaller hematomas than dorsogluteal injections.² A separate study focusing on older adults found that while both sites met the tissue-thickness thresholds for safe intramuscular injection, the ventrogluteal site had greater muscle thickness and a lower risk of the needle hitting bone or depositing medication into subcutaneous fat.³

Despite this evidence, many people still default to the dorsogluteal site out of habit. One training study found that roughly a third of nurses frequently used the dorsogluteal site before receiving updated education on ventrogluteal technique.⁴ If your provider or instruction sheet tells you to inject in the “upper outer quadrant of the buttock,” you are being directed to the dorsogluteal site. It is worth asking about the ventrogluteal site instead, or learning to locate it yourself if you self-inject.

How to Find the Ventrogluteal Site

Locating the ventrogluteal site feels awkward at first but becomes automatic with repetition. You are looking for the meaty area on the side of your hip, roughly between the hip bone and the top of the thigh. One common method is to place the heel of your opposite hand on the bony prominence at the front of the hip (the greater trochanter), point your index finger toward the front of the hip crest, and spread your middle finger toward the back. The triangle formed between your two fingers is the injection zone. The thickest part of that triangle, usually just below the hip crest, is the target.

If you are injecting yourself, it helps to stand with your weight on the opposite leg so the target-side hip is relaxed. Some people prefer to lie on their side with the top leg slightly bent. Either position works as long as the muscle is not tensed, because a contracted muscle hurts more and makes it harder for the needle to slide in.

Choosing the Right Needle

Testosterone in oil is viscous, so the injection typically requires two needles: a thicker drawing needle (often 18-gauge) to pull the testosterone out of the vial, and a thinner injecting needle (usually 21- to 23-gauge) to deliver it into the muscle. Using the same needle for both steps dulls the tip, which increases pain on entry.

Needle length is where body composition enters the picture. The goal is a needle long enough to pass through the skin and subcutaneous fat and deposit the oil into muscle tissue, but not so long that it risks hitting bone. Research on the ventrogluteal site found that a 32-mm (roughly 1.25-inch) needle works for all males and normal-weight females, while a 38-mm (1.5-inch) needle is needed for all females and covers at least 98 percent of females at the dorsogluteal site.⁵

Those recommendations assume a BMI under a certain threshold. A study measuring subcutaneous fat thickness at the ventrogluteal site found a strong correlation between BMI and fat depth. At higher BMIs, even a standard 1.5-inch needle may not reach muscle. The expected failure rate for intramuscular delivery with a 1.5-inch needle was about 71 percent in women with a BMI over 30 and about 60 percent in men with a BMI over 35.⁶ If your BMI is in that range and you are injecting in the glute, talk to your prescriber about whether a longer needle or a different injection site makes sense.

Step-by-Step Technique

Before you start, wash your hands thoroughly and lay out your supplies on a clean surface: alcohol swabs, the vial of testosterone, the drawing needle and syringe, and the injecting needle. If the testosterone is refrigerated, let it warm to room temperature first; cold oil is thicker and harder to inject.

Draw up: Attach the drawing needle to the syringe. Wipe the vial’s rubber stopper with an alcohol swab, insert the needle, invert the vial, and pull back on the plunger to your prescribed dose. Tap out any large air bubbles and push the plunger slightly to expel them.
Swap needles: Remove the drawing needle and attach the injecting needle. Do not touch the new needle tip.
Prepare the site: Clean the injection area with an alcohol swab in a circular motion and let it dry completely. Injecting through wet alcohol stings.
Insert the needle: Hold the syringe like a dart. Spread the skin taut with your free hand (some providers teach the Z-track method, where you pull the skin to one side before inserting and release it after withdrawing, to help seal the oil in the muscle). Insert the needle at a 90-degree angle in one smooth, quick motion.
Inject slowly: Push the plunger steadily. A pace of roughly ten seconds per milliliter is a reasonable baseline for comfort. Research on injection speed has produced mixed results, with one study finding slower injection reduced pain and another finding no significant difference, so a moderate, consistent pace is a safe middle ground.⁷
Withdraw and apply pressure: Pull the needle out smoothly, then press an alcohol swab or gauze over the site for a few seconds. Do not rub the area, as this can push oil into subcutaneous tissue and increase soreness.

Dispose of both needles immediately in a sharps container. Never recap a used needle with both hands; if you must recap, use the one-handed scoop technique to avoid needlestick injuries.

Do You Need to Aspirate?

Aspiration means pulling back on the plunger after inserting the needle and before injecting, to check whether blood enters the syringe (which would suggest the needle is in a blood vessel). For decades, this was standard practice. The current guidance from both the World Health Organization and the Centers for Disease Control and Prevention is that aspiration is no longer necessary for most intramuscular injection sites.⁸

A randomized controlled trial specifically testing aspiration at the ventrogluteal site found no blood return in any of the injections, whether aspiration was performed for one to two seconds or five to ten seconds, and pain levels did not differ between groups that aspirated and those that did not.⁹ The ventrogluteal site simply does not sit near large blood vessels, so the aspiration step adds time and discomfort without meaningful safety benefit.

There is a caveat, though. Some clinicians still advise aspirating when injecting oil-based testosterone, specifically because accidental intravenous delivery of an oil suspension can cause a reaction called pulmonary oil microembolism (more on that below). The conservative position is that if you are injecting into the ventrogluteal site and you have correctly identified the landmark, aspiration is unnecessary. If you are injecting into the dorsogluteal site, where the anatomy is more variable, aspirating for five to ten seconds is a reasonable precaution.

What Common Side Effects to Expect

Most gluteal testosterone injections are uneventful. A study tracking 551 weekly injections in 26 men found that about 70 percent caused no complaints at all. The remaining 30 percent involved minor local side effects, mostly pain and bleeding at the injection site. No serious side effects were observed. Of the three sites tested in that study (gluteal, deltoid, and thigh), the gluteal site had fewer overall complaints and less bleeding, though it was more likely to cause post-injection pain than the other two.¹⁰

Post-injection soreness at the gluteal site usually peaks within a day or two and fades within a few days. It tends to be worse with higher-volume injections and with cold oil. Rotating between left and right glutes on alternating injection days gives each side time to recover and helps prevent the formation of scar tissue over months of regular use.

Rare but Serious Complications

Two complications deserve mention because they can be alarming even though they are uncommon.

Pulmonary oil microembolism, or POME, happens when a small amount of oil enters the bloodstream and travels to the lungs. Symptoms include coughing, shortness of breath, chest tightness, and sometimes dizziness. It can feel frightening but almost always resolves quickly. A postmarketing safety analysis of over 90,000 doses of injectable testosterone undecanoate found only 28 spontaneously reported POME events across more than four years, which comes out to less than 0.1 percent per injection. Most of those events resolved on their own, the majority within 30 minutes, and more than 60 percent required no medical intervention at all.¹¹ The risk appears to be highest with large-volume, long-acting formulations like testosterone undecanoate (which is injected in a 3-mL or 4-mL dose). Shorter-acting esters like testosterone cypionate or enanthate use smaller volumes, typically 0.5 to 1 mL per injection, and POME reports with these are rarer.

Infection at the injection site is the other concern. Proper aseptic technique prevents the vast majority of infections, but when they do occur they can progress beyond simple cellulitis. Case reports describe pyomyositis, a deep infection within the muscle itself, developing after intramuscular testosterone injection. In the reported cases, initial examination suggested surface-level cellulitis, but imaging revealed deeper involvement.¹² If redness, swelling, and warmth at an injection site are worsening rather than improving after a few days, or if you develop a fever, get it evaluated rather than assuming it will resolve on its own.

Oleomas and Long-Term Site Rotation

Over years of injections in the same area, the oil vehicle can accumulate in tissue and form oleomas, which are firm, sometimes painful nodules made of oil-filled granulomas. One case report described a man who developed disfiguring submuscular nodules in both deltoids and one gluteal region nine years after injecting testosterone in oil at those sites. Pathology confirmed granulomas containing viscous fluid and areas of calcification.¹³ This is an extreme case, and oleomas are uncommon with standard injection volumes and proper technique, but it illustrates why consistent site rotation matters. If you inject weekly, alternating between left and right ventrogluteal sites gives you at minimum two weeks between injections at the same spot. Some people add the deltoid or the vastus lateralis (outer thigh) to their rotation for even more recovery time.

When the Glute Is Not the Best Choice

The gluteal muscles are a reliable option for most people, but they are not the only option, and in some situations they are not the best one. People with higher BMIs face the needle-length problem described earlier: if the subcutaneous fat layer is thick enough that a standard needle cannot reach muscle, the injection ends up depositing testosterone in fat rather than muscle. This does not mean the testosterone goes to waste, but absorption is less predictable.

Subcutaneous injection, which deliberately delivers testosterone into the fat layer using a shorter needle, has gained traction as an alternative. A pilot study comparing subcutaneous and intramuscular testosterone injections found that the subcutaneous route was well tolerated and appeared to deliver equivalent testosterone levels, though there was wide variability between and within patients.¹⁴ Subcutaneous injection uses a much smaller needle (typically 25- to 27-gauge, half an inch long), which many people find significantly less intimidating and less painful. The abdomen and thigh are common subcutaneous sites.

If self-injecting in the glute is physically difficult for you because of limited shoulder or arm mobility, the thigh (vastus lateralis muscle) is usually easier to reach while seated. Some people find the thigh more painful post-injection than the glute, but the trade-off in accessibility can be worth it. Your prescriber can help you decide which site and route matches your body and your comfort level.

Testosterone Formulations and How They Affect the Injection

Not all injectable testosterone is the same, and the formulation you are prescribed changes the logistics of the gluteal injection. Testosterone cypionate and testosterone enanthate are the most commonly prescribed esters for intramuscular use. Both are suspended in an oil carrier (cottonseed oil or sesame oil, depending on the brand) and are typically injected every one to two weeks in volumes of around 0.5 to 1 mL. These are the formulations most people self-inject at home.

Testosterone undecanoate is a longer-acting ester marketed under brand names like Aveed in the United States. It is injected in a much larger volume (3 mL) at less frequent intervals, usually every ten weeks after an initial loading period. Because of the POME risk associated with larger oil volumes, testosterone undecanoate is administered only in a clinical setting under observation, not at home. You will not be self-injecting this one in your glute.

The oil carrier itself can matter. Sesame oil tends to be slightly thinner than cottonseed oil, which can make drawing and injecting marginally easier. Some people have allergies to one carrier but not the other. If injections are consistently more painful or produce more local reactions than you would expect, the carrier oil is worth discussing with your provider as a potential factor. All approved testosterone replacement methods, when dosed according to guidelines, restore normal serum testosterone levels and relieve symptoms in most men with hypogonadism.¹⁵

Practical Tips That Make a Real Difference

People who self-inject regularly develop small habits that collectively make the experience better. Warming the vial before drawing helps the most. Hold it in your closed fist for a few minutes, or run warm water over it. The oil flows through the needle much faster when warm, which shortens both the draw and the injection and reduces pressure at the injection site.

Ice can numb the skin before injection, but some providers discourage it because cold tightens the muscle. A better approach for most people is to relax the muscle by shifting weight to the opposite leg if standing, or lying on their side with the top knee bent. Tensing up is the single most common cause of self-inflicted injection pain.

If you notice a small drop of oil or blood at the puncture site after withdrawing the needle, that is normal. The Z-track method, where you stretch the skin to one side before inserting the needle and release it afterward, creates a zigzag path through the tissue that helps seal the depot inside the muscle. It is worth learning if you find that oil leaks back out frequently.

Finally, keep a simple log of which side you injected, the date, and any unusual soreness or reactions. Over months, patterns emerge. You might discover that one side is consistently more comfortable, or that a particular lot of testosterone causes more soreness than another. That kind of information is useful both for your own comfort and for conversations with your prescriber if problems arise.