Abstract
Subcutaneous testosterone injections, often called SubQ or SC injections, deliver testosterone into the fatty tissue just under the skin instead of deep into a muscle. For appropriately selected patients, this route may offer a smaller needle, easier self-administration, less injection discomfort, and more flexible dose adjustment than some traditional approaches. Research in men supports subcutaneous testosterone as a practical alternative to intramuscular injections, with comparable testosterone exposure when therapy is properly prescribed and monitored (Figueiredo et al., 2022). Evidence for subcutaneous testosterone in women is much more limited, so treatment requires careful medical oversight and individualized decision-making. In an integrative setting, hormone management can be combined with chiropractic care, rehabilitation, nutrition, functional medicine, and strength training to address both hormonal and musculoskeletal health.
What Is a Subcutaneous Testosterone Injection?
Traditional testosterone injections have often been given intramuscularly, or IM. This means the medication is placed deep into a muscle, usually with a longer needle. A subcutaneous injection goes into the layer of fat between the skin and muscle.
The physician-authored paper The Quiet Case for the Subcutaneous Needle by Thomas A. Hatzilabrou, MD, describes why this difference may matter. The paper reviews evidence suggesting that testosterone esters placed under the skin can achieve useful blood testosterone exposure while making self-administration easier for many patients (Hatzilabrou, n.d.).
A major clinical review reached a similar conclusion. Figueiredo et al. (2022) found that available evidence supports subcutaneous testosterone enanthate and cypionate as practical options that can produce predictable testosterone concentrations. They also noted that SubQ injections are generally easier to self-administer and may cause less discomfort than deeper IM injections.
The important point is that SubQ testosterone is still an injection. It is better described as an alternative for patients who may not want testosterone pellets or repeated deep intramuscular injections.
Why Some Patients Prefer the SubQ Route
Comfort matters when treatment may continue for months or years. A medication can work well biologically, but if a patient dreads every dose, adherence can suffer.
Potential practical advantages of SubQ testosterone may include:
- A shorter and finer needle than many IM injections
- Easier provider-taught self-administration
- Less deep muscle soreness
- Less anxiety about reaching a large muscle
- The ability to adjust future doses without removing an implanted pellet
- More frequent, smaller dosing schedules in selected treatment plans
- Avoidance of a minor surgical procedure required for pellet placement
In one comparative study, 22 patients who had previously used IM testosterone switched to SubQ treatment. Every one of those patients preferred the subcutaneous route, either mildly or strongly (Spratt et al., 2017).
Patient-facing medical sources from Mayo Clinic and Cleveland Clinic also describe properly prescribed subcutaneous testosterone as something that can be administered at home after appropriate training. Technique, dose, injection site, and product instructions should always come from the prescribing clinician.
SubQ Versus Intramuscular Testosterone
Intramuscular testosterone is not a poor treatment. It has been used successfully for decades. The question is whether every patient needs a deep IM injection to obtain the desired hormone exposure.
The paper's comparison describes the main practical differences. IM therapy is associated with deeper injections and potentially larger peak-to-trough changes, while SubQ administration is described as easier to self-administer, more comfortable, and capable of producing comparable average exposure with certain testosterone esters. Importantly, both routes still require medical monitoring (Hatzilabrou, n.d.).
Research reviews also suggest that weekly SubQ testosterone can provide fairly stable levels in many patients. However, a clinician should not assume that changing from IM to SubQ means the same dose will automatically produce the same result in every person. Blood tests, symptoms, clinical response, formulation, and dosing schedule still matter.
Where Testosterone Pellets Fit
Pellets offer another way to deliver hormones. Their main advantage is convenience because they can release testosterone over an extended period. However, pellet placement requires a minor procedure, and once a pellet is inserted, you can't change its dose as quickly as with the next injection.
The Worldborne Medical paper compares pellets, transdermal products, oral options, IM injections, and SubQ injections. It describes SubQ ester injections as a patient-controlled option that avoids an implanted procedure while allowing continued medical adjustment (Hatzilabrou, n.d.).
This does not make SubQ therapy automatically "better." It makes it another option that can be matched to the patient's goals, medical history, preference, laboratory findings, and ability to follow a treatment plan.
Subcutaneous Testosterone for Men
The strongest evidence for subQ testosterone is in men and other populations treated with male-range testosterone concentrations.
Clinical studies show that testosterone enanthate or cypionate given subcutaneously can achieve therapeutic testosterone levels in appropriately selected patients. The FDA has also approved a testosterone enanthate autoinjector for subcutaneous administration in certain adult men with testosterone deficiency.
Testosterone replacement may also have musculoskeletal effects when a man truly has testosterone deficiency. Research in older men with low testosterone has found improvements in muscle strength with testosterone therapy, while other studies have shown increases in lean body mass (Hou et al., 2023). These findings do not mean testosterone should be used simply as a muscle-building medication. Treatment should address a real clinical indication and restore appropriate physiologic levels.
What About Subcutaneous Testosterone for Women?
This area requires much more caution.
Women naturally produce testosterone, and testosterone has important functions in both sexes. However, there is currently no FDA-approved testosterone product specifically designed for women in the United States. The strongest randomized evidence for testosterone therapy in women involves transdermal therapy, especially for carefully diagnosed hypoactive sexual desire disorder, or HSDD, in postmenopausal women.
The paper makes the same important distinction. It states that while the principles of steady hormone delivery may be attractive for women, the evidence supporting SubQ injections in women is not as established as it is for men. Female-specific SubQ dosing and long-term outcomes still need better studies.
Therefore, for a woman who is an appropriate candidate for testosterone therapy, a small SubQ injection may be technically easier than a deep IM injection, but current evidence does not establish SubQ testosterone as the preferred route for women. Current women's sexual-health guidance favors carefully dosed transdermal therapy and recommends keeping exposure within the physiologic premenopausal range while watching for acne, unwanted hair growth, scalp hair changes, voice changes, and other signs of excess androgen exposure (Parish et al., 2021).
Testosterone, Muscular Strength, and Chiropractic Care
Hormone therapy and chiropractic care perform different jobs.
When testosterone deficiency is appropriately treated, restoring physiologic testosterone may support lean muscle mass, strength, sexual function, energy, and other hormone-dependent functions. Chiropractic care does not replace testosterone or directly correct a hormone deficiency.
Instead, integrative chiropractic care can address the mechanical side of health by assessing spinal and joint function, mobility, soft-tissue problems, posture, movement patterns, and rehabilitation.
Dr. Alexander Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, describes this as a combined approach in his clinical materials. His observations emphasize evaluating hormonal health alongside body composition, nutrition, mobility, strength, rehabilitation, and musculoskeletal function, rather than treating hormone numbers alone. His published material also stresses that hormone therapy does not replace movement and rehabilitation.
A practical care plan may therefore combine medically supervised hormone treatment with progressive resistance exercise, chiropractic care when appropriate, mobility work, rehabilitation, sleep improvement, protein-rich nutrition, and metabolic health management.
A Multidisciplinary Model in El Paso
At Injury Medical Clinic PA in El Paso, Dr. Jimenez works within a multidisciplinary model that combines chiropractic care, functional medicine, personal injury care, rehabilitation, and medically supervised services.
Clinic materials identify Dr. Maria Guadalupe Cardenas, MD, as the medical director and collaborative physician and describe her as board-certified in internal medicine with more than 40 years of medical experience. Public NPI records confirm her internal medicine specialty and Texas medical license J2933. The public registry lists her NPI as 1164426749.
Within this model, Dr. Cardenas provides medical oversight while Dr. Jimenez integrates chiropractic, functional, and rehabilitative strategies. The goal is not to suggest that chiropractic treatment changes testosterone levels. Rather, hormone health and musculoskeletal health can be evaluated as different but connected parts of the patient's overall function.
Safety and Monitoring Still Matter
A smaller needle does not mean testosterone becomes a lighter medication. The systemic hormone still reaches the body.
The paper specifically stresses that changing the injection route does not remove the need for monitoring. Testosterone levels and hematocrit still require follow-up, and prostate monitoring may be appropriate for certain men. Fertility goals should also be discussed because outside testosterone can suppress normal reproductive hormone signaling.
SubQ injections can also cause temporary redness, bruising, itching, tenderness, or a small lump at the injection site. Any testosterone plan should therefore be based on a proper diagnosis, individual risks, medication formulation, laboratory testing, and regular clinical follow-up.
The Takeaway
Subcutaneous testosterone offers another way to deliver hormone therapy. For many men who require testosterone treatment, evidence supports it as a practical alternative to deep IM injections. It may use a smaller needle, make self-administration easier, reduce injection discomfort, and allow future dose adjustments without the procedure required for pellets.
For women, the idea is promising, but the evidence is weaker. SubQ testosterone should not be presented as an established replacement for evidence-based female testosterone treatment. When it is considered, the decision should involve careful medical evaluation, shared decision-making, conservative physiologic dosing, and close monitoring.
In an integrative setting, testosterone therapy can address appropriate hormonal needs while chiropractic care, rehabilitation, nutrition, functional medicine, and resistance exercise address movement, strength, joint health, and recovery. These approaches can complement one another without blurring their separate roles.
References
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. (n.d.). The quiet case for the subcutaneous needle. Worldborne Medical.
Hou, Y.-C., et al. (2023). Effects of testosterone replacement therapy on muscle strength in older men with low to low-normal testosterone levels: A systematic review and meta-analysis.
Jimenez, A. (2026). BHRT support for joint health and flexibility solutions. DrAlexJimenez.com.
Jimenez, A. (2026). Women's hormonal health insights on testosterone deficiency. DrAlexJimenez.com.
Mayo Clinic. (n.d.). Testosterone: Intramuscular route, subcutaneous route.
Parish, S. J., 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 Women's Health, 30(4), 474–491.
Spratt, D. I., 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.
Cleveland Clinic. (n.d.). Testosterone subcutaneous injection: Uses and side effects.
Dawkins, M. (2025). The hidden cost of needle fear: What healthcare systems overlook. Thimble Health.
The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, and physical medicine, as well as wellness, sensitive health issues, and functional medicine articles, topics, and discussions. We provide and facilitate clinical collaboration with specialists across disciplines. Each specialist follows their professional scope of practice and the jurisdiction in which they are licensed. We utilize functional health and wellness protocols to treat and support care for musculoskeletal injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters and issues that directly or indirectly support our clinical scope of practice. Our office has made a reasonable effort to provide supportive citations and identify relevant research studies for our posts. We provide copies of supporting research studies upon request to regulatory boards and the public.
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Dr. Alex Jimenez, DC, MSACP, APRN, FNP-BC*, CCST, IFMCP, CFMP, ATN
Email: coach@elpasofunctionalmedicine.com
Multidisciplinary Licensing & Board Certifications:
Licensed as a Doctor of Chiropractic (DC) in Texas & New Mexico*
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Graduate with Honors: ICHS: MSN-FNP (Family Nurse Practitioner Program)
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Dr. Alex Jimenez, DC, APRN, FNP-BC*, CFMP, IFMCP, ATN, CCST
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Dr. Maria Cardenas, MD
(Board Certified in Internal Medicine)
Medical Director & Collaborative Physician
NPI # 1164426749
MD License #: J2933
Dr. Maria Cardenas, MD
(Board Certified in Internal Medicine)
Medical Director & Collaborative Physician
NPI # 1164426749
MD License #: J2933
