Specifically, the odds ratio for developing ED in men with total testosterone 6 used a single question to define ED and also showed an increase in ED risk as total testosterone levels decreased. In a small study of young men with acute respiratory infections, mean total testosterone levels declined by 10%, with some cohorts experiencing reductions of up to 30%.25 Where possible, clinicians should use LCMS to measure total testosterone levels to maximize accuracy and limit CV between tests in men undergoing testing, particularly in men with very low total testosterone levels. It was decided that a cut-off value was critical to define testosterone deficiency and that this cut-off be based on at least two total testosterone levels drawn in an early morning fashion at the same laboratory using the same assay. Prior to initiating treatment, clinicians should counsel patients that, at this time, it cannot be stated definitively whether testosterone therapy increases or decreases the risk of cardiovascular events (e.g., myocardial infarction, stroke, cardiovascular-related death, all-cause mortality). The care of testosterone deficient patients should focus on accurate assessment of testosterone levels, symptoms and signs as well as proper on-treatment monitoring to ensure therapeutic testosterone levels are reached and symptoms are ameliorated.
For trough total testosterone values 300 ng/dL are achieved at the end of an injection period. One study reported comparative pharmacokinetics between IM testosterone enanthate (250 mg every 3 weeks) and IM testosterone undenaconate (1,000 mg every 9 weeks, a dosage that is only available outside the United States).440 Results demonstrated that IM testosterone enanthate achieved trough levels of 239 ng/dL compared to 470 ng/dL with IM testosterone undecanoate at the end of the 10-week cycle. While mid-cycle testing is convenient for patients, there may be value in assessing peak level (18-36 hours after injection) as the adverse events (e.g., polycythemia, hyperestrogenism) are likely at least partially related to the peak level.
Once you are comfortable in correctly knowing how to give yourself testosterone injections, and start taking them, you will be on your way to achieving some remarkable benefits. You may have to have your testosterone injection dosage adjusted, or be retrained on how to take your testosterone injections, or perhaps switch to another brand of injectable testosterone. Most users of testosterone injections find that the heavy muscle of the outer part of the upper thigh is the easiest injection site to access, and to administer the IM. Taking additional injections, or more than your prescribed dose of testosterone, will not improve your results, and in fact, can be dangerous. They can be easy to self-administer, and relatively safe and pain-free, once you know all of the steps and procedures to properly administer testosterone injections. This is because the thick muscles of your forearm, buttocks, or outer thigh, are very vascular, and also can accommodate the relatively thick needles of testosterone injections with little discomfort. The first step in learning how to administer testosterone injections correctly, is to choose your injections site.
Although the study was not powered to detect cardiovascular events as a primary endpoint, the authors did not detect increased risk in the testosterone group. Included in these events were 33 deaths, 22 of which were in men who were on testosterone therapy, and 11 in the placebo groups. Vigen et al. (2013)363 conducted a retrospective analysis of patients who received a prescription for testosterone therapy after coronary angiography. Men with total testosterone level 315 ng/dL declined from 100% at 4 weeks to 86%, 75%, and 14% by 12, 20, and 24 weeks, respectively.
To minimize the risk of complications, it’s recommended to rotate injection sites and avoid injecting into the same area repeatedly. With practice and the proper preparation, self-injections can become a quick and simple part of your routine. Allow medication to reach room temperature, use a quick insertion technique, rotate injection sites, and apply gentle pressure (not rubbing) after withdrawal. Your doctor’s office will train you on proper technique including drawing the medication, selecting injection sites, sanitizing the area, and safely disposing of needles. It takes time for your body to get used to the impact of increased testosterone in the blood. If you are experiencing pain on a regular basis, try alternating your injection sites. In a steady push, trying to keep the needle at a 90 degree angle, inject the testosterone into the muscle.

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