Subcutaneous Injection of Testosterone Is an Effective and Preferred Alternative to Intramuscular Injection:
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Demonstration in Female-to-Male Transgender Patients.

Spratt DI1, Stewart II1, Savage C1, Craig W2, Spack NP3, Chandler DW4, Spratt LV1, Eimicke T5, Olshan JS5.
Author information
Abstract
CONTEXT:
Testosterone (T) is commonly administered intramuscularly to treat hypogonadal males and female-to-male (FTM) transgender patients. However, these injections can involve significant discomfort and may require arrangements for administration by others.
OBJECTIVE:
We assessed whether T could be administered effectively and safely subcutaneously as an alternative to intramuscular (IM) injections.
DESIGN:
Retrospective cohort study.
SETTING:
Outpatient reproductive endocrinology clinic at an academic medical center.
PATIENTS:
Sixty-three FTM transgender patients aged >18 years electing to receive subcutaneous (SC) T therapy for sex transition were included. Fifty-three patients were premenopausal.
INTERVENTION:
Patients were administered T cypionate or enanthate weekly at an initial dose of 50 mg. Dose was adjusted if needed to achieve serum total T levels within the normal male range.
MAIN OUTCOME MEASUREMENTS:
Serum concentrations of free and total T and total estradiol (E2), masculinization, and surveillance for reactions at injection sites.
RESULTS:
Serum T levels within the normal male range were achieved in all 63 patients with doses of 50 to 150 mg (median, 75/80 mg). Therapy was effective across a wide range of body mass index (19.0 to 49.9 kg/m2). Minor and transient local reactions were reported in 9 out of 63 patients. Among 53 premenopausal patients, 51 achieved amenorrhea and 35 achieved serum E2 concentrations <50 pg/mL. Twenty-two patients were originally receiving IM and switched to SC therapy. All 22 had a mild (n = 2) or marked (n = 20) preference for SC injections; none preferred IM injections.
CONCLUSIONS:
Our observations indicate that SC T injections are an effective, safe, and well-accepted alternative to IM T injections.