Subcutaneous Testosterone for Hormone Balance Therapy Guide

Subcutaneous Testosterone for Hormone Balance Support

Abstract

Subcutaneous testosterone injections, often called SubQ or SC injections, place testosterone into the fatty tissue just beneath the skin instead of deep inside a muscle. Research shows that subcutaneous testosterone can provide stable testosterone levels and may be easier for many people to self-administer than traditional intramuscular injections. The strongest evidence supports its use in men with testosterone deficiency and in testosterone-based gender-affirming therapy. In women, testosterone therapy requires greater caution because the best evidence supports low-dose transdermal treatment for carefully selected women with hypoactive sexual desire disorder, while direct research on SubQ testosterone in women remains limited. This article explains how SubQ testosterone works, how it compares with intramuscular injections and pellets, and how medical hormone management may fit with chiropractic care, rehabilitation, functional medicine, and whole-body musculoskeletal health.

What Is a Subcutaneous Testosterone Injection?

Testosterone injections have traditionally been placed deep into a muscle, usually in the thigh, buttock, or another large muscle. A subcutaneous testosterone injection takes a different route. The medication is placed into the layer of fatty tissue between the skin and muscle.

This difference may seem small, but it can change the patient experience.

The Worldborne Medical white paper, The Quiet Case for the Subcutaneous Needle, authored by Thomas A. Hatzilabrou, MD, reviews evidence suggesting that testosterone esters delivered under the skin can achieve testosterone exposure comparable to traditional intramuscular delivery while being easier for many patients to self-administer.

A major scientific review reached a similar conclusion. Figueiredo et al. (2022) found that available research supports SubQ testosterone as a practical option that can produce predictable testosterone concentrations with easier self-administration and generally less discomfort than deep intramuscular injections.

SubQ testosterone is still an injection. It should not be described as needle-free. However, it may be an option for someone who wants to avoid deep intramuscular injections or surgically implanted testosterone pellets.

SubQ Testosterone vs. Intramuscular Testosterone

Both routes can deliver testosterone into the bloodstream. The main differences involve where the medication is deposited and how the injection is performed.

Research suggests several practical differences:

• Needle depth: SubQ treatment uses the fatty layer beneath the skin, while IM injections must reach muscle tissue.
• Self-administration: A short SubQ injection may be easier for some patients to perform at home.
• Comfort: Studies have reported less injection-related discomfort and greater patient preference for SubQ treatment.
• Blood levels: Weekly SubQ therapy can provide stable and predictable testosterone concentrations, although dosing still must be individualized.
• Muscle involvement: SubQ administration does not require repeated penetration of a large muscle.

In a study by Spratt et al. (2017), subcutaneous testosterone cypionate or enanthate successfully produced target testosterone levels in the study population. Among participants who had previously used intramuscular testosterone, all 22 preferred the subcutaneous route to some degree.

The Worldborne white paper also compares the routes and describes SubQ therapy as easier to self-administer, involving a shorter and finer needle, with less injection discomfort in the reviewed research.

This does not mean every patient should automatically switch routes. Dose, formulation, injection schedule, symptoms, laboratory results, and individual response all matter.

Does SubQ Testosterone Produce Steadier Levels?

One reason SubQ testosterone has gained attention is its absorption pattern.

Muscle has a strong blood supply. Fatty tissue has less blood flow. When an oil-based testosterone ester is deposited in subcutaneous tissue, the medication can be released gradually from that tissue depot.

Clinical research suggests that SubQ testosterone enanthate and cypionate can produce stable and predictable testosterone concentrations. Some studies have also shown smaller peak-to-trough changes compared with less frequent, higher-dose IM schedules (Figueiredo et al., 2022).

However, a SubQ dose should not simply be assumed to behave exactly like a previous IM dose. The Worldborne paper specifically stresses checking laboratory values and clinical response after a route change rather than assuming simple milligram-for-milligram equivalence.

The goal is not simply to inject testosterone. The goal is to achieve an appropriate physiologic testosterone level while avoiding unnecessary hormone exposure.

Can Women Use Subcutaneous Testosterone?

Women naturally produce testosterone. Testosterone has roles in sexual health, metabolism, reproductive physiology, and other body systems.

However, testosterone treatment in women is very different from testosterone replacement in men.

Current evidence does not support the claim that SubQ testosterone is superior for women. In fact, the Worldborne white paper makes an important distinction: although the male SubQ evidence is encouraging, randomized testosterone research in women has mainly studied transdermal treatment, not subcutaneous injections.

Current international guidance identifies the strongest evidence for testosterone treatment in appropriately selected postmenopausal women with hypoactive sexual desire disorder, or HSDD. Treatment is generally aimed at keeping testosterone within the normal physiologic range seen in premenopausal women (Davis et al., 2019; Kling, 2025).

There is also no FDA-approved testosterone product specifically designed for women in the United States. Kling (2025) notes that the lack of female-specific, FDA-approved formulations is partly due to limited long-term safety data.

For this reason, SubQ testosterone for a woman should be considered an individualized, off-label clinical decision, not a routine wellness treatment.

How Testosterone May Affect the Body

Testosterone is much more than a reproductive hormone. In people with medically confirmed deficiency, restoring testosterone to an appropriate physiologic range may affect several body systems.

Depending on the patient and the reason for treatment, appropriate testosterone therapy may support:

• Muscle mass and strength
• Bone mineral density
• Sexual function and libido
• Red blood cell production
• Energy and sense of well-being
• Maintenance of normal androgen-dependent body functions

The Endocrine Society recommends testosterone therapy for men with properly diagnosed hypogonadism rather than simply treating fatigue, aging, weight gain, or a single borderline laboratory result (Bhasin et al., 2018). Its 2026 statement continues to stress that diagnosis requires compatible symptoms together with consistently low, accurately measured testosterone levels.

Testosterone should therefore not be viewed as a general muscle-building, anti-aging, or weight-loss treatment.

Connecting Testosterone With Chiropractic and Musculoskeletal Health

Testosterone therapy and chiropractic care work in very different ways.

Testosterone may influence the biological environment involved in muscle mass, bone health, sexual function, and other hormone-dependent processes when a true medical indication exists. Chiropractic care does not replace testosterone and does not directly raise testosterone levels.

Instead, integrative chiropractic care may address the mechanical side of musculoskeletal health.

Dr. Alexander Jimenez, DC, APRN, FNP-BC, CCST, CFMP, IFMCP, ATN, describes a clinical approach that considers joint motion, spinal mechanics, muscular function, inflammation, rehabilitation, nutrition, metabolic health, and a patient’s ability to return to normal activity rather than looking only at the painful area.

For example, chiropractic and rehabilitation may be used to address:

• Restricted joint movement
• Mechanical neck or back problems
• Muscular imbalance
• Movement limitations after injury
• Progressive rehabilitation needs
• Return to exercise and resistance training

Chiropractic adjustments themselves should not be described as building muscle. Progressive resistance exercise builds strength. Chiropractic treatment and rehabilitation may help selected patients move more comfortably and participate more effectively in the exercises needed to restore muscular strength and function.

This creates a logical connection: hormone management addresses appropriate medical and biological needs, while chiropractic and rehabilitation can address biomechanics, mobility, and functional recovery.

A Multidisciplinary Model in El Paso

At Injury Medical Clinic PA in El Paso, Texas, Dr. Jimenez works within a multidisciplinary model that combines chiropractic care with medical oversight, functional medicine, personal injury care, rehabilitation, and related health services. His professional profile identifies him as both a chiropractor and a board-certified Family Nurse Practitioner.

Medical direction is provided in collaboration with Maria Guadalupe Cardenas, MD, an internal medicine physician with more than four decades of medical experience. Clinic materials identify Dr. Cardenas as Medical Director and Collaborative Physician. Public provider data list her Texas medical license as J2933 and her verified NPI as 1164426748.

Credential note: Some clinic materials have displayed NPI 1164426749, but current NPPES-derived provider records and insurer directories identify 1164426748 as Dr. Cardenas’ NPI. The verified number should be used for publication.

Within this type of integrated model, medical evaluation can address hormone indications, medications, laboratory values, contraindications, and monitoring, while chiropractic and rehabilitation can focus on the musculoskeletal and functional side of care.

What About People Who Do Not Want Pellets or Deep Injections?

Testosterone pellets can provide long-term delivery, but they require an implantation procedure. Traditional IM therapy requires repeated deep muscle injections.

For the right patient, a SubQ injection may offer a middle ground: it remains injectable therapy, but it uses a shallow injection into fatty tissue.

Patients who want no needle at all may need to discuss other available formulations with their healthcare professional, such as transdermal preparations or other approved options. The choice depends on sex, diagnosis, treatment goals, risks, cost, fertility plans, and available formulations.

Mayo Clinic and Cleveland Clinic both recognize subcutaneous testosterone as an established route for specific testosterone products and stress the importance of medical supervision and proper injection training.

Monitoring Still Matters

A smaller needle does not make testosterone a smaller medication.

The Worldborne paper stresses that testosterone safety requirements remain important, whether the medication goes into fat or muscle.

Depending on the patient, monitoring may include testosterone levels, complete blood count and hematocrit, prostate-related assessment in appropriate men, blood pressure, symptoms, medication response, fertility concerns, and signs of excessive androgen exposure.

Women require especially careful dosing because female physiologic testosterone concentrations are much lower than male concentrations. Acne, unwanted hair growth, scalp hair changes, or other androgenic effects can signal excessive exposure.

Testosterone can also suppress sperm production. Patients who want future fertility should discuss this before beginning therapy.

The Bottom Line

Subcutaneous testosterone is not simply a smaller version of an intramuscular injection. It is a different delivery route that may make testosterone therapy easier to self-administer and more comfortable for appropriately selected patients.

Research supporting SubQ testosterone is strongest in men with testosterone deficiency and in testosterone-based gender-affirming care. Evidence specifically supporting SubQ testosterone in women remains much more limited, and current women’s health guidance continues to favor carefully dosed transdermal therapy when testosterone is indicated.

At the same time, hormone therapy should not be viewed in isolation. At Injury Medical Clinic PA, the multidisciplinary model involving Dr. Alex Jimenez and Dr. Maria Guadalupe Cardenas brings together medical oversight, integrative chiropractic care, functional medicine, injury care, and rehabilitation. The goal is not merely to change a laboratory number. It is to evaluate the whole patient, protect musculoskeletal health, restore function, and choose a treatment route that is medically appropriate and practical enough for the patient to follow.

References

Bhasin, S., Brito, J. P., Cunningham, G. R., et al. (2018). Testosterone therapy in men with hypogonadism: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 103(5), 1715–1744.

Davis, S. R., Baber, R., Panay, N., et al. (2019). Global consensus position statement on the use of testosterone therapy for women. Climacteric, 22(5), 429–434.

Figueiredo, M. G., Gagliano-Jucá, T., & Basaria, S. (2022). Testosterone therapy with subcutaneous injections: A safe, practical, and reasonable option. The Journal of Clinical Endocrinology & Metabolism, 107(3), 614–626.

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

Kling, J. M. (2025). Testosterone for the treatment of hypoactive sexual desire disorder in perimenopausal and postmenopausal women. Obstetrics & Gynecology, 146(3), 341–349.

Mayo Clinic. (2026). Testosterone: Intramuscular route and subcutaneous route.

Spratt, D. I., Stewart, I. I., Savage, C., et al. (2017). Subcutaneous injection of testosterone is an effective and preferred alternative to intramuscular injection. The Journal of Clinical Endocrinology & Metabolism, 102(7), 2349–2355.

Jimenez, A. (2026). Regenerative medicine and integrative chiropractic approaches. DrAlexJimenez.com.