Ventrogluteal Testosterone Injection: Location & Technique
The ventrogluteal site is on the side of the hip, not the buttock. It is thick muscle under a thin layer of fat, well away from the sciatic nerve, and it takes more volume than any other IM site. Here is how to find it with the V method, which needle fits, and why it is harder to use on yourself than the arm or thigh.
- The ventrogluteal (VG) site targets the gluteus medius on the side of the hip. Put the heel of the hand on the greater trochanter, the index finger on the front hip bone (ASIS) and the middle finger back along the iliac crest, then inject into the centre of the V between the two fingers.
- It avoids the sciatic nerve by location. In one study cited in a 2023 meta-analysis, the sciatic nerve was on average 18 cm from the VG site and 9 cm from the old dorsogluteal (upper-outer buttock) site.
- Across 17 studies with 1,429 participants, VG injections caused less pain, less bleeding and fewer haematomas than dorsogluteal ones.
- Nursing references allow up to 3 mL at the VG site in an average adult and call it the preferred site for oily solutions. Needle length runs from 5/8–1 inch in thin adults to 1–1.5 inches in larger ones.
"Glute injection" used to mean the upper-outer quarter of the buttock, the dorsogluteal site. Nursing practice has largely moved away from it, toward a spot a few inches forward and higher on the side of the hip, the ventrogluteal site. It matters for testosterone because the cypionate label says IM injections "should be given deep in the gluteal muscle"9, and the ventrogluteal site is the safer way to reach that gluteal muscle. This guide covers the anatomy, the hand-placement method, needle choice by body type, and the practical problem that it is the hardest IM site to reach on yourself. It is one of three site guides linked from our injection sites hub. For the complete injection procedure, see how to inject testosterone.
Why the ventrogluteal site avoids the sciatic nerve
The sciatic nerve is the largest nerve in the body. It leaves the pelvis deep in the buttock and runs down the back of the thigh. The dorsogluteal site sits over the buttock, close to its path, and nursing texts now say to avoid it unless otherwise recommended "because of the increased risk of injury including sciatic nerve damage and paralysis of the leg"3. The ventrogluteal site is on the side of the hip, forward of and above that path, over the gluteus medius and gluteus minimus3. Nursing references describe it as "free from penetrating nerves and blood vessels"4.
The numbers support this. A 2023 systematic review and meta-analysis of dorsogluteal versus ventrogluteal injections pooled 17 studies and 1,429 participants. Only one of those studies measured nerve distance, and it found the sciatic nerve an average of 18 ± 3.5 cm from the ventrogluteal site against 9 ± 2.3 cm from the dorsogluteal site1. The risk is not only theoretical. In a case series of 92 people with nerve palsy after an injection, 80 (87%) involved the sciatic nerve, mostly after gluteal injections, and the authors recommended the ventrogluteal site over the buttock5.
Other advantages: less fat, more muscle, less pain
The same meta-analysis found the fat layer at the ventrogluteal site significantly thinner than at the dorsogluteal site, and ventrogluteal injections were linked to less pain (9 studies), less bleeding, and fewer haematomas at 48 and 72 hours1. A separate meta-analysis of IM injection technique also found less pain with ventrogluteal than dorsogluteal injections6. A review of gluteal injection accuracy found the fat, muscle and total tissue at the dorsogluteal site were all significantly thicker than at the ventrogluteal site7. That matters because a needle that stops in fat deposits the dose under the skin rather than in the muscle.
How to find the ventrogluteal site: the V method
Nursing texts use three bony landmarks: the greater trochanter, the anterior superior iliac spine (ASIS), and the iliac crest1,3. These steps are written for a helper injecting you, which is how the method is usually taught:
- Relax the muscle. Lie on your side, or stand with your weight on the other leg. Clinicians often recommend relaxing the gluteal muscle before an injection to reduce pain8.
- Find the greater trochanter, the bony knob on the side of the upper thigh just below the hip. It moves under your fingers if you roll the leg in and out.
- The helper places the heel or palm of the hand on the trochanter, fingers pointing up toward the pelvis and thumb pointing toward the navel3,4.
- The index finger goes onto the ASIS, the bony point at the front of the hip3,4.
- The middle finger spreads backward along the iliac crest, the top ridge of the pelvis, making a V between the two fingers3,4.
- Inject into the centre of that V, at 90 degrees to the skin. You are now over the gluteus medius4.
Check yourself: the site should be on the side of the hip, below the top ridge of the pelvis and above the trochanter. If you are on the rounded back of the buttock, you have drifted too far back toward the dorsogluteal area.
Doing it on yourself
The V method is designed for a second person, and landmarking your own hip, often in a mirror, is the hard part. Two practical approaches: have a nurse locate the site on you and mark it the first time so you learn what it feels like, or use the ventrogluteal site only when a partner can inject for you and use the thigh or deltoid on other days. In a study of nurses, 74% said they never chose the ventrogluteal site, mostly because they did not know how to identify it and worried about hitting bone2. That tells you the landmarking is the difficult part, not the injection.
Needle length and gauge by body type
The fat over the hip varies a lot between people, and in gluteal measurements it is thicker in women on average. In the gluteal-injection studies summarized in one review, successful IM injections had an average of 13.6 mm of fat over the muscle, against 36.2 mm for injections that failed to reach muscle. A 37 mm needle would not have reached muscle in 54.7% of female and 14% of male subjects7. Those figures cover gluteal injections in general, including the thicker dorsogluteal site, but the principle holds at the VG site too: needle length has to match your build.
| Build | VG needle length (Open RN) | Gauge |
|---|---|---|
| Thin adult | 5/8–1 inch | Oily or viscous: 18–21G4 |
| Average adult | 1 inch | Oily or viscous: 18–21G4 |
| Larger adult (over 70 kg) | 1–1.5 inches | Oily or viscous: 18–21G4 |
A nursing study of the ventrogluteal site reported typical needles of 2.5–4 cm at 21 gauge, and cited evidence that a needle shorter than about 45 mm would not contact the iliac bone2, which addresses the bone worry above. At higher body weight, a long-acting HIV injection given into the gluteal muscle showed higher early drug levels in people with a BMI of 30 or more when a 2-inch needle was used instead of a shorter one8. That is a different drug, but it shows that depth changes whether the dose reaches muscle. Oil does pass through finer needles than 18–21G, just more slowly, so gauge is a trade-off between flow and comfort that your prescriber decides.
How much volume the ventrogluteal site takes
This is the site with the most room. Up to 3 mL can be given into the ventrogluteal muscle of an average adult2,4, and Open RN calls it the "preferred site for all oily and irritating solutions for patients of any age"4. By comparison, the deltoid is usually capped at about 1 mL4. At the label's 200 mg/mL strength9, 1 mL is 200 mg. The VG site is the natural choice if your prescribed volume is too much for the arm. Use the TRT dose calculator to convert your dose from milligrams to millilitres.
Pain and post-injection soreness at the hip
Pain is where the ventrogluteal site does best in head-to-head studies against the buttock site1,6. Across injections in general, firm manual pressure over the site and rhythmic tapping reduced pain, while the evidence for the Z-track technique was insufficient6. Nursing texts recommend injecting slowly, at about 10 seconds per mL3, and oil usually takes longer. Clinicians giving long-acting gluteal injections ranked a slow push, bringing the medication to room temperature, and relaxing the gluteal muscle as the most useful ways to reduce pain8.
Stop and call your clinician if the injection causes a sharp, shooting pain down the leg, or if you notice numbness, tingling or weakness in the leg or foot afterwards. In the nerve palsy series, most patients had severe pain along the nerve immediately after the injection5. Spreading redness, heat, or a lump that keeps growing are also reasons to get the site checked rather than keep using it.
Is there a SubQ version of this site?
No. The ventrogluteal site is an intramuscular site only. Subcutaneous testosterone goes into the abdomen, about 3–5 cm to the side of the navel, or the thigh10. See SubQ vs IM testosterone for how the routes compare, and the thigh guide for the SubQ thigh technique.
Common ventrogluteal mistakes
- Drifting backward onto the buttock, which moves you toward the dorsogluteal site and the sciatic nerve.
- Going too low, down onto the trochanter itself instead of up into the V.
- Using the upper-outer quadrant method because it is familiar. The two methods do not identify the same spot.
- Using a short needle on a hip with more fat, so the oil stays in the fat layer.
- Tensing the glute by standing with your weight on that leg.
- Using the same hip every time instead of alternating sides.
Rotation
Alternate left and right hips and move the entry point about an inch within the V each time. For solo injections, a practical pattern is to use the VG site on days when someone can help, and the thigh or deltoid otherwise. The injection sites hub compares all three sites side by side and gives a simple rotation schedule. Peptide Me logs each shot to a point on a body map and suggests the site you have used least recently.
Disclaimer: this guide describes general anatomy and published nursing guidance and is not medical advice. Testosterone is a prescription, controlled medication. Ask your prescriber or nurse to show you the ventrogluteal site in person before you or a partner inject it for the first time.
FAQ
References
Primary sources — PubMed / NEJM / The Lancet.
- Roldán-Chicano MT, Rodríguez-Tello J, Cebrián-López R, Moore JR, García-López MdM. Adverse effects of dorsogluteal intramuscular injection versus ventrogluteal intramuscular injection: A systematic review and meta-analysis. Nurs Open. 2023;10(9):5975-5988. https://pmc.ncbi.nlm.nih.gov/articles/PMC10415997/
- Gürol Arslan G, Özden D. Creating a change in the use of ventrogluteal site for intramuscular injection. Patient Prefer Adherence. 2018;12:1749-1758. https://pmc.ncbi.nlm.nih.gov/articles/PMC6145361/
- OpenStax. Clinical Nursing Skills (senior contributor Christy Bowen). Section 12.6: Administering Intramuscular Injections. OpenStax; 2024. https://openstax.org/books/clinical-nursing-skills/pages/12-6-administering-intramuscular-injections
- Ernstmeyer K, Christman E, eds. Nursing Skills (Open RN), Chippewa Valley Technical College. Chapter 18.6: Administering Intramuscular Medications. https://med.libretexts.org/Bookshelves/Nursing/Nursing_Skills_(OpenRN)/18:_Administration_of_Parenteral_Medications/18.06:_Administering_Intramuscular_Medications
- Kakati A, Bhat D, Devi BI, Shukla D. Injection nerve palsy. J Neurosci Rural Pract. 2013;4(1):13-18. https://pmc.ncbi.nlm.nih.gov/articles/PMC3579035/
- Ayinde O, Hayward RS, Ross JDC. The effect of intramuscular injection technique on injection associated pain; a systematic review and meta-analysis. PLoS One. 2021;16(5):e0250883. https://pmc.ncbi.nlm.nih.gov/articles/PMC8092782/
- Soliman E, Ranjan S, Xu T, et al. A narrative review of the success of intramuscular gluteal injections and its impact in psychiatry. Biodes Manuf. 2018;1(3):161-170. https://pmc.ncbi.nlm.nih.gov/articles/PMC6267269/
- Teichner P, Chamay N, Elliot E, et al. Cabotegravir + Rilpivirine Long-Acting: Overview of Injection Guidance, Injection Site Reactions, and Best Practices for Intramuscular Injection Administration. Open Forum Infect Dis. 2024;11(6):ofae282. https://pmc.ncbi.nlm.nih.gov/articles/PMC11179104/
- DEPO-TESTOSTERONE (testosterone cypionate) injection, prescribing information. Pharmacia & Upjohn Company LLC. Revised June 2025. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=735b5bf3-4464-412c-a072-1bd02f2e5380
- Figueiredo MG, Gagliano-Jucá T, Basaria S. Testosterone Therapy With Subcutaneous Injections: A Safe, Practical, and Reasonable Option. J Clin Endocrinol Metab. 2022;107(3):614-626. https://academic.oup.com/jcem/article/107/3/614/6410585