As many of you know, I’ve been on TRT for about 10 years now.
Going on TRT (testosterone replacement therapy) as an over-40 man has been one of the top three best decisions of my entire life, and I recommend it to about 90% of men over the age of 40.
It’s an absolute game-changer financially, personally, with happiness, with relationships with women, with sleep, with fitness, with pretty much everything.
That being said, I’ve encountered a new problem with it. The good news is that it’s a fixable problem and it won’t ever happen again. I’m just continually surprised at all the new aspects I learn about TRT even though I’ve been doing it forever and it’s become a default part of my life.
I inject testosterone and a vitamin B compound 2-3 times a week. Historically, I will also inject HCG or gonadorelin depending on the protocol and what I’m doing (though right now I’m not injecting either of those).
I inject in my shoulder because it’s easiest and it doesn’t hurt. You can also inject into your thigh (but that hurts) or your upper buttocks (doesn’t hurt but it’s irritating because of the contortions you have to do to do it correctly).
A few weeks ago, my left deltoid started to ache a little. In typical dumb man fashion I didn’t pay any attention to it and figured it would just go away.
Instead, it slowly got worse, and finally, about 2 weeks ago, it was bad enough that when I lay on it at night (I sleep on my left side) it was starting to keep me awake.
Okay, that’s not good. Nothing is allowed to fuck with my sleep.
So, since ideal sleep is the number one most important thing in my physical life, I immediately contacted the physiotherapist to get this figured out.
She’s made two visits to my home so far (in Dubai everyone comes to your home because Dubai isn’t collapsing like the USA) and she showed me exactly what the problem was.
I have a little hunk of scar tissue in my delt muscle; that’s what’s causing this problem. It was created by too many injections. Even though the needles I use are tiny (.29 gauge or higher, which means the needle is really narrow), and even though I’ve been using proper injection technique (massaging the area after injection, etc), and even though I rotate multiple injection sites on both shoulders, 10 years of injecting there has taken its toll.
I asked her if this was a permanent problem and she said no. A few more physiotherapy visits and this will be 100% fixed. Good.
I then asked her if I was forever doomed to have scar tissue in both of my delts because of my constant injections. Again, she said no, that the scar tissue completely heals/dissolves within 12-18 months. It’s just that I can’t keep injecting in my shoulders anymore until they heal. (I have scar tissue in my other shoulder as well, but not nearly as much and there is no pain, likely because I don’t sleep on that side.)
So now I’m injecting into my upper buttocks instead of my shoulders, which is not a lot of fun because you have to twist around in weird angles to do it correctly (unless you have someone else to help you), but this is a very small price to pay for all of the benefits of TRT.
I’ll do this for about 12 months and then I’ll switch back to my shoulders in a year, next January, when they should be healed.
Then forevermore I’ll just alternate every January, shoulders/buttocks, and I’ll never have this problem again.
I use the word “forevermore” loosely because soon (as in within 10 years or so) I’m confident they will invent a version of TRT that is as effective and flexible as injections but without actually having to inject yourself. (Yes, I’m aware of the pellet implant, but that’s not as effective or flexible as injections; though I have nothing against the pellet and lots of guys have done it and are happy with it.)
TRT is just so awesome, despite its little inconveniences. I’m so thankful for it.


Testosterone doesn't need to be injected intramuscularly. I switched to subcutaneous T injections (in the fat pad on my stomach) and I haven't noticed any change in effectiveness at all.
Intramuscular injections get into your bloodstream faster, which is great when you're getting started, but once you've been doing TRT for a week or two, subcutaneous injections give you the same average T levels, and also smooth out the levels over time. Intramuscular injections give you more pronounced peaks and troughs of T; subcutaneous gives you more stable levels.
There are studies to back this up. If you want references, type "Is there any difference between the effectiveness of intramuscular testosterone injections and subcutaneous testosterone injections?" into perplexity.ai
BTW, thank you Caleb for introducing me to TRT and Dr. Faler all those years ago!
What are the other 2 in the top 3 best decisions of your life? I’m 39 soon and have already started to engage with a TRT Doc, thanks for the advise.