When I first started testosterone gel a year and a half ago, I swore I’d never switch to injections. They seemed too scary, too involved, and too painful to be worth it… until gel wasn’t giving me results fast enough, and suddenly, my fear of not transitioning quickly enough outweighed my fear of needles. Don’t let my multiple tattoos fool you — needles still scare the shit out of me. Yet suddenly, here I was, facing the possibility of doing an injection once a week every week for the rest of my life. What was a scaredy cat like me to do?

The answer? Research.

If you Google “how much do testosterone injections hurt,” the first results (once you scroll past ads for T) are general info pages about uses and side effects of testosterone. Useful medical information, sure, but not what my anxiety needed to be quelled. Besides random Reddit threads, nowhere on the internet satisfyingly answered my questions: How much does self-injecting T hurt? What exactly does it feel like? And most importantly, how is anyone with any level of fear of needles regularly doing this???

I needed answers. Even better for my obsessive brain, I needed data. So, I did what any normal man would do: I created a survey to send out to trans men/trans mascs on injectable testosterone so I could get hard crowdsourced data on how bad T shots hurt. My brain is normal and my needle anxiety is healthy, thank you very much.

The following data is based on responses from 48 people. This number is not enough to be very statistically significant, so I can’t say this data is going to scientifically contribute to the study of transmasculinity. What I can say is it helped me be less nervous about shots before switching over, and if you’re in the same boat as me, maybe it’ll help you, too.

Types of Testosterone Injections

As a little background, there are two types of injections: subcutaneous, often referred to as sub Q, and intramuscular, often referred to as IM. In my survey, the split between types of injections was surprisingly even — 60.4% sub Q, 39.6% IM.

The difference between the shots is in the name. Sub Q only goes into the fat, while IM goes into the muscle. I’m on sub Q, since the smaller needle seemed less intimidating for a beginner like me. If you’re looking for needle specs, Folx Health says that “[sub Q] needles are relatively thin and short, typically a 25G needle, and ⅝ inches in length,” while IM injections “can be a more painful method for folks since you are injecting directly into the muscle, and the needle is longer, 22G or 23G and 1 to 1.5 inches in length.”

That hypothesis about IM hurting more makes sense given the size and depth of the needle. But that’s not what the data backed up when I asked survey takers…

How Much Do Testosterone Injections Hurt?

I asked how much injections hurt on a scale of 1-10. I was expecting around a 5. The average answer instead? A measly 2.85.

Even more fascinatingly, if I broke it down by type of injection, IM injectors typically rated their injections as less painful than sub Q injectors. The average IM pain was 2.53, while the average sub Q pain was 3.07. This doesn’t mean IM is less painful than sub Q. This just means one guy’s survey found an interesting result that, in an ideal world, would be studied more by real scientists.

As the answers for the survey started to come in and point to such a low pain number, I didn’t believe it at first. I thought I had coincidentally found responders with high pain tolerances, or somehow every trans man on the internet was playing a trick on me. But with 48 people telling me it’s not that bad, the voice in my head saying shots were too painful to even consider started to quiet down. Only two respondents rated the pain above a 5 —  for nearly 96% of respondents, the pain was 5 out of 10 or below.

I was even more pleasantly surprised by the lack of pain when I switched to injections myself. The worst it’s ever been is a 3 out of 10, and some weeks, it’s a 0. I think you could inject me in my sleep, and it probably wouldn’t wake me up.

What Do Testosterone Injections Feel Like?

What I was most curious about was also the least quantitative measure; other than ranking the pain, how did injecting the testosterone actually feel? Common answers included a bee sting, a pin prick, or (understandably, if uncreatively) a vaccine. Basically, small, sharp, over quickly, with maybe a little soreness after.

As one subcutaneous testosterone user, Rose (they/them), described it, “the initial pain of the needle piercing skin is short and sharp, and is usually alleviated as soon as the length of the needle is completely inside. It hurts like a bee sting, or someone pulling out a few hairs at once.”

Mikolaj (he/they), an intramuscular testosterone user, was similarly descriptive. “The stab itself is like a little pinch, a zit probably hurts more than this… [Approximately] one in five times, the muscle is slightly sore after the shot for a couple of hours… the sensation is similar to sore muscles after medium-intensity exercising.”

Can You Make Testosterone Injections Hurt Less?

I also asked survey respondents if there was anything they’d done to help make their injections easier or less painful. All of this is anecdotal, but some answers came up over and over again.

Common responses included pushing the needle in straight like a dart instead of at an angle, pinching and rubbing the spot before you inject, switching up your injection site (for example, if you do thighs, swapping off right and left), and making sure your muscles are relaxed.

Many people mentioned tactics related to injection in their glutes to reduce pain, so I looked into it for myself. It turns out you should avoid injecting in the glutes, or at least do it very carefully. According to Folx Health, “The gluteal site (buttocks) is no longer recommended as an injection site. Over time, with repeated injections into the incorrect area, inferior gluteal nerve injury can occur. If gluteal location is truly desired, proper placement of injection is key to prevent nerve damage.” If you’re a die-hard butt injector and want to make sure you’re doing it safely, your best bet is to check in with a medical professional.

How Much Needle Anxiety Did/Do Other People on Testosterone Have?

The physical aspect of injections was one thing, but the mental aspect was my real challenge. Before switching to shots, I thought I was the only t-boy on earth who was so dramatic about needles. The survey revealed that I’m not alone: 53.2% of respondents said that needles had “generally been a problem/anxiety” for them before starting injectable T. It was comforting to know that over half of these people had gotten over a fear similar to mine.

I asked respondents to rank their anxiety about self-injecting on a scale of 1-10; first, how anxious they were before starting T and then how anxious they are about self-injecting now.

Of all the data I collected, this was the most comforting for me. Average injection anxiety before starting T: 6.68 out of 10. Average injection anxiety after: 3.81.

Not everyone’s anxiety level decreased. Six respondents (12.5% of the sample) had increased anxiety by an average of +2.5. If we frame it the other way, though, 42 respondents experienced a reduction in anxiety (87.5%) by an average of -3.75. My own anxiety went from a 9 to a 3, which I would have never thought was possible.

Do People Inject Themselves or Have Help?

This whole idea of “self”-injection comes with a huge caveat for me: I went into this too afraid to self-inject, and technically, I am still too afraid to self-inject. My girlfriend got trained on how to inject (for her own estrogen shots) and injects me, and as of a few weeks ago, I inject her, too. I can withdraw the medicine just fine. I just can’t stab myself. I can either stab or be stabbed, but not both.

I was expecting more people to be in my boat of needing others to inject for them. Turns out, I’m in the minority: 79.2% of respondents do their own injections, 6.3% have others inject them, and 14.6% do a combination of both. To that 79.2%, I salute your bravery, and I hope to join your ranks one day.

For over a year, I swore shots were too scary for me. Now, three months into them, I only wish I’d started sooner. Changes are coming faster, I feel physically better, and all I had to do was get over my fear of a pain so small and fast it barely registers. Actually injecting myself is the next barrier, but for now, I’m proud I can do it at all. What I’ve learned from trying shots myself is what the data made me suspect: It’s worth it.

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