IM injection technique for pain-free shots: what nurses get right

What's this video probably claiming?

Based on the caption, @nurse_a7med is walking through intramuscular injection technique with a focus on reducing patient pain. Two specific points come through clearly: first, that the needle should be changed after drawing up medication, because contact with the rubber stopper and vial can dull the needle tip; second, that patient positioning matters, with relaxed muscle positioning (likely referring to the ventrogluteal or dorsogluteal site) reducing discomfort. In the TRT context, these tips are directly applicable. Testosterone cypionate and enanthate are oil-based, viscous injectables that are routinely self-administered or nurse-administered IM, and poor technique is one of the most common patient complaints on platforms like Reddit and in clinical settings. This video is likely aimed at both healthcare providers and patients doing home injections, which is a legitimate and growing population given the expansion of telehealth TRT programs.

What does the science actually show?

The needle-change advice is well-supported. A needle passed through a rubber stopper sustains measurable tip deformation. Workman's 2000 paper in Nursing Standard documented that reusing the same needle for both drawing and injecting increases patient-reported pain scores. The viscosity of oil-based testosterone formulations compounds this: a dull tip dragging through dense muscle tissue creates more tissue trauma than a sharp one. On positioning, the evidence is equally clear. Müller-Staub et al. and multiple injection technique reviews confirm that muscle relaxation at the injection site reduces resistance and procedural pain. For the ventrogluteal site specifically, having the patient lie on their side with the top knee flexed is the textbook approach for achieving gluteus medius relaxation. The Z-track method, which may or may not be mentioned in the video, adds another layer of evidence-backed pain reduction by sealing the medication within the muscle tissue and preventing subcutaneous leakage of irritating compounds like testosterone oil.

Where does the social media noise diverge from clinical reality?

The main area where TRT injection content on TikTok tends to go wrong is not technique, it is dosing confidence and site selection dogma. Creators frequently present the dorsogluteal site as the default when clinical guidelines have increasingly shifted toward ventrogluteal as the preferred adult IM site due to lower risk of sciatic nerve injury. The dorsogluteal site sits uncomfortably close to the sciatic nerve and superior gluteal artery in a non-trivial percentage of patients, and Nicoll and Hesby published a thorough site-preference analysis in Applied Nursing Research (2002) that pushed the field toward ventrogluteal. Social media largely ignored this. Additionally, self-injection videos often skip aspiration debates entirely or present outdated mandatory aspiration guidance. The WHO and most current nursing standards removed aspiration as a requirement for most IM sites, though some practitioners still teach it. The gap between what nurses learned in school and current evidence-based practice is real and the content space reflects that confusion.

What should you actually know?

If you are self-injecting testosterone as part of a medically supervised TRT protocol, the technique details in this video are genuinely worth paying attention to. Changing needles between draw and injection is a low-cost, high-impact step that most patients skip because the instructions they receive at prescription are often bare minimum. A 23-gauge drawing needle contacting a rubber stopper even once can reduce tip sharpness enough to increase pain on injection, particularly with a 1.5-inch 22-gauge or 23-gauge injection needle through gluteal tissue. Muscle relaxation is not optional comfort advice, it is physiology: contracted muscle increases tissue resistance and intramuscular pressure during injection, both of which amplify discomfort. For anyone on a telehealth TRT program, these technique refinements are worth discussing with your prescribing provider. Site selection, needle gauge, injection volume per site, and rotation protocols all fall within the scope of a clinical conversation, not a TikTok comment section.