Subcutaneous Testosterone Therapy: A Comprehensive Guide

Subcutaneous Testosterone Therapy: A Smaller-Needle Option for Hormone Therapy, Muscle Health, and Integrative Care

Abstract

Subcutaneous testosterone injections, often called SubQ or SC testosterone injections, deliver testosterone into the fatty tissue just under the skin instead of deep into a muscle. Research in men shows that properly prescribed subcutaneous testosterone can produce testosterone levels comparable to intramuscular injections while often making self-administration easier and more comfortable (Figueiredo et al., 2022).

SubQ testosterone may be an option for people who do not want testosterone pellets or who dislike deep intramuscular injections. It is important to be clear that SubQ testosterone is still an injection; it simply uses a different tissue layer and usually a shorter, finer needle. Testosterone therapy may support sexual health, muscle mass, strength, and bone health when a true hormone deficiency or other accepted indication is present. Integrative chiropractic care can complement medical hormone management by addressing mobility, biomechanics, rehabilitation, muscle function, and musculoskeletal health. Testosterone does not replace exercise, rehabilitation, nutrition, or chiropractic treatment.

At Injury Medical Clinic PA in El Paso, Texas, this whole-person approach brings chiropractic and rehabilitation care together with medical oversight, functional medicine, personal injury care, and related services.

What Is a Subcutaneous Testosterone Injection?

A subcutaneous injection places medication into the fatty layer underneath the skin. An intramuscular, or IM, injection places medication deeper into muscle tissue.

For many decades, intramuscular testosterone was considered the normal injectable route. However, research has increasingly examined whether testosterone esters such as testosterone enanthate and testosterone cypionate can also be delivered under the skin.

A major review published in the Journal of Clinical Endocrinology & Metabolism concluded that available evidence supports subcutaneous testosterone as a practical option. Studies have found comparable average testosterone concentrations and pharmacokinetics between SubQ and IM administration in appropriately selected patients (Figueiredo et al., 2022).

Dr. Thomas A. Hatzilabrou’s white paper, The Quiet Case for the Subcutaneous Needle, makes a similar argument. The paper states that decades of routine IM use were based partly on tradition and reviews of evidence suggesting that subcutaneous administration can provide comparable exposure with easier self-administration.

The white paper also emphasizes an important point: changing the route does not remove the need for individualized dosing and monitoring.

Why Some Patients Prefer SubQ Over Intramuscular Testosterone

The main difference is not simply where the medication goes. It can also change the injection experience.

Subcutaneous injections generally use a shorter needle and are easier for many patients to reach and administer themselves. A comparative study found that patients receiving testosterone subcutaneously achieved effective testosterone concentrations and generally preferred SubQ injections over IM administration (Spratt et al., 2017).

Potential advantages may include:

• A shorter and finer needle
• Less discomfort for some patients
• Easier self-administration
• Less need to reach deep muscle tissue
• More flexibility for long-term treatment
• Potentially smoother testosterone concentrations with some dosing schedules
• An alternative for patients who do not want implanted pellets
• No risk of transferring topical testosterone to another person through skin contact

The Worldborne Medical white paper compares the two routes and describes SubQ administration as easier to self-administer, with generally less injection discomfort and smaller concentration swings in the studies it reviews.

Cleveland Clinic also explains that subcutaneous testosterone is injected beneath the skin and that patients can be taught how to administer it safely. Mayo Clinic describes prescription subcutaneous testosterone enanthate as a weekly treatment for appropriately diagnosed low testosterone and stresses that the dose should be adjusted by the treating clinician.

Why Injection Comfort Matters

Comfort may sound like a small detail, but hormone therapy can continue for months or years. A treatment that causes anxiety, soreness, or difficulty with self-injection may become harder to follow consistently.

Needle fear can contribute to avoiding medical care and missing procedures. Patient-education literature has highlighted how fear of needles may cause people to postpone injections, laboratory testing, or other needed care.

This is one reason a smaller SubQ needle may be meaningful. The goal is not simply to make an injection “easier.” The goal is to make a medically necessary treatment easier to follow correctly.

Does SubQ Testosterone Produce Steadier Levels?

A biologic reason makes this possible.

Muscle has a rich blood supply. Fatty tissue underneath the skin has different blood flow and lymphatic characteristics. Testosterone placed in SubQ tissue may therefore leave the injection site differently from medication deposited deep inside a muscle.

The systematic review by Figueiredo and colleagues explains that subcutaneous tissue has less vascular variation during physical activity, which may contribute to more stable absorption of testosterone esters (Figueiredo et al., 2022).

The white paper similarly explains that the fatty tissue depot may release testosterone esters more gradually than highly perfused muscle.

That does not mean every patient automatically gets perfectly stable levels. Dose, ester, injection frequency, body composition, metabolism, medications, and individual biology all matter.

Laboratory testing remains essential.

Testosterone and Muscle, Bone, and Overall Body Health

Testosterone affects much more than sexual function.

In men with confirmed hypogonadism, testosterone replacement can increase lean body mass and muscle strength. It may also improve bone mineral density when testosterone deficiency is present (Bhasin et al., 2018).

These effects help explain the connection between hormone health and the musculoskeletal system.

Testosterone participates in:

• Maintenance of muscle tissue
• Muscle protein development
• Bone metabolism
• Fat distribution
• Red blood cell production
• Sexual and reproductive function
• Maintenance of male secondary sex characteristics

However, testosterone should not be viewed as a general “energy booster” or anti-aging drug. For men whose testosterone is low only because of aging, the American College of Physicians found stronger evidence for modest improvement in sexual function than for improvements in energy, cognition, or physical function (Qaseem et al., 2020).

Appropriate diagnosis matters.

Where Integrative Chiropractic Care Fits

Hormone therapy and chiropractic care perform different jobs.

Testosterone may influence muscle and bone biology when medically indicated. Chiropractic care does not replace testosterone, and testosterone does not correct poor movement patterns, restricted joints, weakness, or an incomplete rehabilitation program.

An integrative plan may address both sides of the problem.

For example, Dr. Alexander Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, describes a clinical model that evaluates the patient beyond one painful muscle or joint. His clinical observations consider biomechanics, joint movement, neurological function, strength, nutrition, metabolic health, and rehabilitation together.

Chiropractic and rehabilitation care may therefore focus on:

• Restoring healthy joint movement
• Improving spinal and extremity mechanics
• Building muscular stability
• Correcting movement patterns
• Gradually increasing resistance training
• Improving flexibility, mobility, and balance
• Supporting return to work, exercise, and sports
• Reducing mechanical stresses that may continue irritating muscles and joints

This creates an important connection. Hormonal health may support the biological environment of muscle and bone, while chiropractic rehabilitation helps teach the body how to move and load those tissues properly.

Neither should be presented as a substitute for the other.

What About Subcutaneous Testosterone for Women?

This area requires much more caution.

Women naturally produce testosterone, and testosterone has normal roles in female physiology. However, there is currently no FDA-approved testosterone product specifically indicated for women in the United States. Evidence supporting testosterone treatment in women is strongest for appropriately diagnosed hypoactive sexual desire disorder, particularly in postmenopausal women, and the strongest clinical evidence involves transdermal therapy, not SubQ injections (Parish et al., 2021).

The Hatzilabrou white paper makes this distinction clearly. It notes that SubQ evidence is much stronger in men and that using subcutaneous testosterone in women represents a more evidence-limited, individualized decision.

The paper further states that if a clinician chooses another route in a woman, treatment should involve individualized dosing, confirmation that testosterone remains within an appropriate physiologic range, monitoring, and shared decision-making.

So SubQ testosterone may be considered for selected women by a qualified clinician, but it should not be presented as proven superior to transdermal therapy in women.

A Multidisciplinary Approach at Injury Medical Clinic PA

At Injury Medical Clinic PA in El Paso, the practice describes a multidisciplinary structure bringing together chiropractic care, medical evaluation, functional medicine, personal injury care, rehabilitation, nutrition, and related health services.

Clinic materials identify Dr. Maria Guadalupe Cardenas, MD, as board-certified in Internal Medicine and as Medical Director and Collaborative Physician. The practice lists NPI #1164426749 and Texas medical license #J2933 and describes her as having more than 40 years of internal medicine experience.

Dr. Cardenas provides the medical component of this collaborative structure, while Dr. Alex Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, contributes chiropractic, musculoskeletal, functional medicine, personal injury, and rehabilitation expertise.

This type of coordinated model allows hormone-related medical questions to be considered alongside issues such as:

• Muscle strength and conditioning
• Joint and spinal function
• Body composition
• Nutrition
• Metabolic health
• Injury recovery
• Exercise progression
• Functional rehabilitation

For testosterone therapy, medical oversight remains particularly important because hormone treatment requires appropriate diagnosis, dosing, laboratory monitoring, and evaluation of risks.

SubQ Is an Option, Not a One-Size-Fits-All Answer

Subcutaneous testosterone offers another choice between deep IM injections, pellets, topical products, and other testosterone formulations.

For people who dislike pellets or deep intramuscular injections, SubQ treatment may be simpler and more comfortable. Remember, it is still an injection.

Testosterone treatment also requires ongoing monitoring. The Hatzilabrou white paper emphasizes that changing from an IM needle to a SubQ needle does not change testosterone’s systemic safety requirements. Testosterone levels and other appropriate laboratory markers still need to be followed.

The right question is therefore not simply, “Which injection is better?”

A better question is:

Which medically appropriate treatment gives this individual the safest, most sustainable path to normal physiologic hormone levels while supporting muscle, bone, movement, and overall health?

That is where medical oversight, chiropractic care, rehabilitation, nutrition, functional medicine, and patient preference can work together.

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References

Bhasin, S., Brito, J. P., Cunningham, G. R., et al. (2018). Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism, 103(5), 1715–1744.

Figueiredo, M. G., Gagliano-Jucá, T., & Basaria, S. (2022). Testosterone Therapy With Subcutaneous Injections: A Safe, Practical, and Reasonable Option. Journal of Clinical Endocrinology & Metabolism, 107(3), 614–626.

Hatzilabrou, T. A. (2026). The Quiet Case for the Subcutaneous Needle. Worldborne Medical, Clinical Frontiers: Androgen Series.

Mayo Clinic. (2026). Testosterone—Intramuscular Route, Subcutaneous Route.

Parish, S. J., Simon, J. A., Davis, S. R., et al. (2021). International Society for the Study of Women’s Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women. Journal of Sexual Medicine, 18(5), 849–867.

Spratt, D. I., Stewart, I. I., Savage, C., et al. (2017). Subcutaneous Injection of Testosterone Is an Effective and Preferred Alternative to Intramuscular Injection. Journal of Clinical Endocrinology & Metabolism, 102(7), 2349–2355.

Jimenez, A. (n.d.). Dr. Alex Jimenez—Integrative Chiropractic, Functional Medicine, and Injury Care.