What is pulmonary oil microembolism?
It is a reaction to small droplets of the injection oil reaching the lungs. Testosterone for injection is dissolved in oil and meant to stay in muscle. If some of it slips into a small vein during the shot, the droplets travel to the lungs and trigger an urge to cough, coughing fits or a feeling of tightness.
The Aveed label describes POME symptoms as cough, urge to cough, shortness of breath, sweating, throat tightening, chest pain, dizziness and fainting, occurring during or immediately after the injection. Because of that risk, Aveed carries a boxed warning, and men are watched in the clinic for 30 minutes after each dose.
How uncommon is it?
It is uncommon, and the clearest numbers come from long-acting testosterone undecanoate. In a study of 3,022 injections in 347 men at an andrology clinic, POME followed 56 injections in 43 men, a rate of about 19 per 1,000 injections. Two thirds of episodes were mild and about a fifth were severe, and in 40% the symptoms began before the injection was finished.
| Product | What the evidence says |
|---|---|
| Testosterone undecanoate (Aveed) | About 19 per 1,000 injections in a clinic study; boxed warning and 30-minute observation |
| Testosterone enanthate | Label reports rare post-marketing cases of cough and breathing difficulty right after injection |
| Testosterone cypionate | The Depo-Testosterone label does not describe POME, but it is also an oil-based shot |
The testosterone enanthate label describes these reactions as transient. Cypionate and enanthate doses given every one to two weeks are smaller in volume than an undecanoate shot, and their labels give no rate beyond calling such reactions rare.
How long does an episode usually last?
Usually minutes. The Aveed label says most events lasted a few minutes and resolved with supportive care, though some lasted up to several hours and needed emergency care. The AUA guideline, summarizing the clinic study, notes coughing episodes of 1 to 10 minutes, all managed in the clinic without supplemental oxygen.
If it happens at home, stop injecting if you have not finished, sit upright, breathe slowly and stay with someone if you can. Note the time it started and how long it lasted.
When is it an emergency?
Call 911 if breathing trouble is getting worse rather than better, or if you have chest pain, faint, or develop hives, itching or swelling of the lips, face or throat. The Aveed label also describes anaphylaxis, including life-threatening reactions, after testosterone undecanoate. Do not drive yourself, and do not wait to call the clinic first.
Can you lower the chance of it happening again?
Often, by tightening technique. The enanthate label asks for slow injection deep into the gluteal muscle while avoiding injection into a vessel. Our page on seeing blood when injecting testosterone explains the pull-back check some clinicians teach for that reason.
If episodes recur, your provider may change the site, the injection speed or the form of treatment. Reactions with hives or swelling point toward an ingredient allergy instead; see allergic reactions to testosterone injections.
What Ultimate Male does after a reaction
Call the clinic the same day once you feel well, even if the cough passed in a minute. Your provider will go over when it started, how long it lasted and how the shot was given, and may suggest having your next few injections given in the clinic. Our guide to injecting testosterone into muscle covers the technique step by step.
If injections no longer feel right for you, other forms of testosterone therapy, including oral Kyzatrex and pellets, can be discussed at a consultation in San Gabriel or Downey.
