For individuals on testosterone replacement therapy (TRT), self-injection is a common practice that, when performed correctly, is safe and effective. However, the procedure requires careful attention to detail to avoid a variety of potential pitfalls. Knowing what happens if you mess up a testosterone injection is crucial for patient safety, as errors can range from minor discomfort to serious medical emergencies. This article breaks down the different ways an injection can go wrong, the signs to look for, and the appropriate course of action.
The Consequences of Specific Injection Errors
Accidental Intravenous Injection
Injecting testosterone directly into a blood vessel is one of the most serious errors that can occur during an intramuscular (IM) or subcutaneous (SubQ) injection. Since many testosterone formulations are oil-based, this can lead to a pulmonary oil embolism (POE), where the oil obstructs blood flow in the lungs. The absorption is also uncontrolled, causing a sudden and severe spike in hormone levels.
Symptoms of a POE or accidental intravenous injection include:
- Sudden coughing or shortness of breath
- Chest pain or tightness
- Heart palpitations or anxiety
- Dizziness or fainting
If you experience any of these symptoms during or after an injection, seek immediate medical attention.
Incorrect Injection Location
Testosterone is prescribed for either intramuscular or subcutaneous injection, and using the wrong location can impact absorption rates and effectiveness. For example, accidentally injecting an IM-specific formulation into the fatty subcutaneous layer can lead to inconsistent hormone levels and a less predictable treatment response. Conversely, injecting a SubQ formula deep into the muscle may cause unnecessary pain. Moreover, injecting into an inappropriate area, especially in the gluteus, could risk damaging the sciatic nerve.
Hitting a Nerve
Contacting a nerve with the needle can cause significant, albeit often temporary, pain. Hitting a sensory nerve may result in a sharp, shooting, or electric shock-like pain. Hitting a major motor nerve, such as the sciatic nerve, can be far more serious and lead to muscle jerks, weakness, or even partial paralysis in severe cases. Safe injection practices, like using the upper-outer quadrant of the glute, are designed to avoid major nerves. If you feel an intense, shooting pain, withdraw the needle immediately.
Improper Sterile Technique
Infections are a risk of any injection, but improper hygiene significantly increases this risk. Using non-sterile equipment, reusing needles, or failing to properly clean the injection site can introduce bacteria into the tissue.
Signs of infection or abscess include:
- Redness, warmth, or swelling at the injection site
- Pus formation or a tender lump
- Fever, chills, or worsening pain
Incorrect Needle Size and Site Rotation
Using a needle that is too short for an intramuscular injection or too long for a subcutaneous one can lead to poor absorption, increased pain, and bruising. Additionally, repeatedly injecting in the same exact spot can cause muscle hardening and scar tissue, making future injections more difficult and painful. Proper site rotation is essential to allow tissues to heal.
A Comparison of Common Injection Errors
| Injection Error | Potential Consequences | Severity | Action Required |
|---|---|---|---|
| Accidental Intravenous Injection | Sudden hormone spike, pulmonary embolism, cardiovascular symptoms | High | Immediate emergency medical care |
| Incorrect Location (IM vs SubQ) | Inconsistent absorption, hormonal fluctuations, reduced effectiveness | Medium | Consult your healthcare provider |
| Hitting a Nerve | Sharp, shooting pain; potential for temporary or long-term nerve damage | Medium to High | Withdraw needle, assess pain, and consult doctor if pain persists |
| Infection due to Improper Hygiene | Abscess, fever, sepsis | High | Seek medical attention for potential antibiotics or abscess drainage |
| Hitting a Small Blood Vessel | Localized bleeding, bruising | Low | Apply pressure, and a new needle/injection site if bleeding into the syringe |
| Repeating Same Injection Site | Scar tissue formation, muscle hardening, increased pain | Low | Rotate injection sites |
| Not Aspirating (for IM) | Risk of intravenous injection (though controversial), anxiety | Medium | Follow your provider's instructions; if not aspirating, be aware of increased risk |
What to Do If You Make a Mistake
If you realize you have made an error during or after an injection, your response depends on the severity of the mistake:
- Visible Blood During Aspiration: If you pull back on the plunger during aspiration for an IM injection and see blood, do not inject. Withdraw the needle, discard the syringe and needle, and restart the process with a new, sterile needle and syringe at a different site.
- Intense Pain or Electric Shock Sensation: Immediately withdraw the needle. You likely hit a nerve. While often temporary, persistent pain or numbness requires medical evaluation.
- Mild Bruising or Bleeding: If you hit a small capillary, some minor bleeding or bruising is normal. Apply pressure with gauze or a cotton ball. Do not rub the area.
- Developing an Infection: If you notice signs of infection (redness, warmth, swelling, pus), contact your doctor. Antibiotics may be necessary.
- Severe Symptoms: For symptoms suggesting an intravenous injection, pulmonary embolism, or a severe allergic reaction (tight throat, breathing difficulty), seek emergency medical care immediately by calling 911.
Preventing Future Errors
Prevention is always the best strategy when it comes to injections. Following proper technique is paramount:
- Receive Proper Training: Before self-injecting, ensure your healthcare provider demonstrates the correct procedure for your specific type of injection (IM or SubQ).
- Follow Sterile Procedure: Always wash your hands, use a new, sterile needle and syringe for each injection, and clean the injection site thoroughly with an alcohol swab.
- Rotate Injection Sites: Alternate between approved injection sites (e.g., thighs, glutes, or abdomen for SubQ) to prevent tissue damage and discomfort.
- Use Correct Equipment: Ensure you are using the correct needle length and gauge as prescribed by your doctor.
- Aspirate (If Instructed): Follow your doctor's instructions on whether to aspirate before an IM injection to check for blood vessels.
- Dispose of Needles Properly: Use a designated sharps container for all used needles to prevent injury and contamination.
Conclusion
While a minor error during a testosterone injection may result in nothing more than a small bruise, more significant mistakes carry serious health risks. Understanding what constitutes an error, recognizing the symptoms, and knowing how to respond safely are critical for anyone performing self-injections. Always follow the instructions provided by your healthcare provider, and when in doubt, never hesitate to seek professional medical advice. Consistent, proper technique not only ensures the efficacy of your treatment but also protects your health and safety.
For more information on safe injection practices, consider consulting resources like NewYork-Presbyterian's guide on intramuscular injections.
