:HRT therapy Nebido:

[mockery]

hello, so in regards to shot frequency and test levels after blood work, if i wanna sit around 900-1100 on trt, i would just have to increase my shot frequency?

any info on how triptorelin will effect the use of nebido?

thanks mate

[marcus300]

Bump for someone

[clarky.]

I started my nebido the day so another in 6wk then wait and see what the bloods say for dosing frequency glad to be of the gels they didn't work and they are sh*t on the skin for me any way.

The nurse used a 21g a 21g could not believe it the first thing that came to mind was a garden hose lol

[Back In Black]

Marcus, when you switched to nebido did you notice any change in test levels during the transition? I don't suppose you had transitional blood tests done so I mean did you physically or mentally notice? If so, for how long?

I'm due to start Nebido in a couple of weeks but I will be coming off prop and don't want to feel like shit if nebido takes a long time to kick in, I may have to overlap.

Also, I read that nebido patients feel better and better after each injection over the course of the first year before it truly levels off, did you find this?

[marcus300]

Marcus, when you switched to nebido did you notice any change in test levels during the transition? I don't suppose you had transitional blood tests done so I mean did you physically or mentally notice? If so, for how long?

I'm due to start Nebido in a couple of weeks but I will be coming off prop and don't want to feel like shit if nebido takes a long time to kick in, I may have to overlap.

Also, I read that nebido patients feel better and better after each injection over the course of the first year before it truly levels off, did you find this?

This is great news for you really pleased you have been put on this treatment.
I was taking Test E on prescription from my doc and we just changed over when I was due an injection, I did follow myself up with my own test e 250mgs 10 days later I didn't have the booster shot of nebido at the 6 week interval like your suppose to do because he said I was already running test e and my test levels were at a good number so you would need one. But normall they will do a booster at the 6 week mark then every 12 weeks or so. I am on 11 week protocol now and I know other guys using 10 weeks.

I didn't feel any drop and believe me when I had low test I was in hell on a daily basis so I would know if anything went south on me but I was fine all I did was my own top up after 10 days of test e at 250 mgs and I was fine for the next 12 weeks.

I had my 12 week protocol knocked down to 11 week because I could feel a slight drop around the 10 week mark so he put me on 11 weeker which is fine.

Normally guys feel better and better the longer they are on the treatment some it takes up to 6-9 months before they feel fine but I was good to go pretty quick. It takes around 3-4 injection before you get the full levels running at speed but all ive heard from my doctor is people are finding this therapy remarkable and the NHS want everyone on it due to cost saving

Once I was fully on nebido I felt like I was in my 20's again, honestly I spent around 4 years steroid free to sort my low test out and once I got onto nebido I started to gain size, my muscle tissue came back, my bf dropped my mental alertness was sharp again and I could train very intensely. Infact I gained nearly as much muscle back on nebido as I was on cycle. Its remarkable in my eyes and I really suit it.

What protocol have you gone on 10,11,12 weeks?

[Back In Black]

Thanks for that mate.

I have a booster after 6 weeks and then a follow up after another 12 weeks but they are insistent on a blood test just before that one to check trough levels to ascertain future timings.

I have a feeling I won't be able to overlap as I will be out the country only a few days after my first injection so I'm a little scared I will have a little crash but you're right, the long term effects should be worth it. The endo wanted to start me on gel. It didn't take any persuading when I asked for Nebido

[marcus300]

Thanks for that mate.

I have a booster after 6 weeks and then a follow up after another 12 weeks but they are insistent on a blood test just before that one to check trough levels to ascertain future timings.

I have a feeling I won't be able to overlap as I will be out the country only a few days after my first injection so I'm a little scared I will have a little crash but you're right, the long term effects should be worth it. The endo wanted to start me on gel. It didn't take any persuading when I asked for Nebido

If they are going to do the booster shot stay away from any other test, it may alter your blood work later down the line and you want them to check it so they get the right protocol for you. You should feel a drop if your on prop now and going onto nebido and its 6 weeks part but you will feel great soon. I hope it works out for you

[moscow]

Marcus,
Do you know anyone who uses Hcg with NEBIDO?

I started 3 weeks ago as the NEBIDO shut me completely down and I would like another child in the near future so hopefully the Hcg fires the factory up again...

[marcus300]

Marcus,
Do you know anyone who uses Hcg with NEBIDO?

I started 3 weeks ago as the NEBIDO shut me completely down and I would like another child in the near future so hopefully the Hcg fires the factory up again...

Many people use hcg on test therapy, if you require testicle size and function then use it

[clarky.]

I really feel a big difference since i had the inj 2wks ago

[Back In Black]

I really feel a big difference since i had the inj 2wks ago

Interesting. What was your baseline test level? When did you stop using the gel, the day you started Nebido?

[clarky.]

When I went back to see her she said that they were still too low we were to busy talking about the nebido I forgot to get a copy of the resent bloods.
Yes I used the jel until I got the nebido what a difference already libido nrg are amazing

[Back In Black]

When I went back to see her she said that they were still too low we were to busy talking about the nebido I forgot to get a copy of the resent bloods.
Yes I used the jel until I got the nebido what a difference already libido nrg are amazing

That's good to hear

[limey1664]

For everyones info.
I do believe in the UK that there are some modern endos. My endo is NHS (although i paid for the consultation) and he is very understanding and progressive in thinking. After my first Nebido i was feeling rough a couple of weeks later so he also perscribed 2% gel at 2.5g a day which i lowered to 1.5 g after second jab. my injection period was 1,6,6 weeks i had my bloods done 6 weeks after the 3rd jab and my test was 14.9nmol. The endo said this should be way higher and there was a possibility that a chemical process was metabolising the test. He told me he wants me in the upper reaches of the scale and has moved the Nebido jab to every 8 weeks AND use test gel at 1.5g pd.
I have to say i haven't felt hugely better as yet (I've had 5 shots now) I've put some of my weight back on and I'm pretty lean but certainly haven't felt '21' like some guys on this thread. I also notice no difference from the gel.
My stats are
43
86kg
5,10
14%bf
old school weights (25yr) with emphasis on big moves ,deadlift, clean & press etc

[marcus300]

For everyones info.
I do believe in the UK that there are some modern endos. My endo is NHS (although i paid for the consultation) and he is very understanding and progressive in thinking. After my first Nebido i was feeling rough a couple of weeks later so he also perscribed 2% gel at 2.5g a day which i lowered to 1.5 g after second jab. my injection period was 1,6,6 weeks i had my bloods done 6 weeks after the 3rd jab and my test was 14.9nmol. The endo said this should be way higher and there was a possibility that a chemical process was metabolising the test. He told me he wants me in the upper reaches of the scale and has moved the Nebido jab to every 8 weeks AND use test gel at 1.5g pd.
I have to say i haven't felt hugely better as yet (I've had 5 shots now) I've put some of my weight back on and I'm pretty lean but certainly haven't felt '21' like some guys on this thread. I also notice no difference from the gel.
My stats are
43
86kg
5,10
14%bf
old school weights (25yr) with emphasis on big moves ,deadlift, clean & press etc

I would stick with it, a lot feel better the more jabs they have and other feel it straight away. If your going on a 8 week protocol that sure should keep you in the high range. I must say 5 shots and you feel no difference is alarming but at least you put some weight back on maybe the 21 feeling will come soon

[limey1664]

I was surprised especially as i'd read up on Nebido (mostly thanks to you Marcus, so thank you for all the info) i think I'm probably making it sound worse than it is, i certainly feel better than i did but after 3 shots in a 12 week period (apparently there's confusion if the initial protocol should be 1,6,6 or 1,6,12 week spacing) then having bloods 6 weeks after 3rd i wasn't expecting middle of the road levels. i did have a Oestridol reading of 178pmol which i thought was high although endo said nothing to worry about and he wouldn't consider an AI until he was happy with stable test readings.

[mojo1]

I was using an UGL and the thought of what i was buying was making me cringe but now I am going to use nebedo and just to keep my BW stable I will use testocaps 40mg of test undeconate but they are not long acting they hit you within a couple of hours and are handy to have, I think you will see them called anadrol in the US to be honest I dont know what my levels r just now but theyll soon be alot higher.

[marcus300]

Testosterone undecanoate can improve sexual function and quality of life in males with type 2 diabetes
Image: Blood meter Testosterone replacement therapy with long-acting testosterone undecanoate improves sexual function and quality-of-life parameters vs. placebo in a population of men with type 2 diabetes. Hackett G, Cole N, Bhartia M, et al. J Sex Med 2013; 10(6):1612-1617.

This editorial discusses the key findings and implications of a study published in 2013 by Hackett et al.1 (The BLAST study) that investigated the effect of testosterone replacement therapy on sexual function and quality of life parameters versus placebo in males with type 2 diabetes (T2D). The study was separated into two phases. The first phase was a 30-week, prospective, randomized, double-blind, placebo-controlled multicenter study conducted between September 2008 and June 2011 at eight UK Midland centers. A total of 190 males (age >18 years) with T2D received long-acting Testosterone Undecanoate (TU) 1000 mg or placebo for 30 weeks (at weeks 0, 6, and 18). The second phase was a 52-week follow-on with open-label TU therapy in 96 patients proceeding from the first phase. The primary outcome of the study was a statistically significant change from baseline in the 15-item International Index of Erectile Function (IIEF) domains. Notable secondary outcomes included health-related quality-of-life symptoms, as measured by the 17-item Ageing Male Symptom Scale (AMS) questionnaire.
Key Points


To date, the BLAST study is the largest and longest (82 week) study that has investigated the effects of TU therapy in males with T2D1


A total of 199 males age > 18 years with T2D were randomized to treatment, with 190 patients completing the 30-week, double-blind, placebo-controlled phase
Of the 106 patients who entered the open-label phase (weeks 30 to 82), final visit (week 82) data were available for 96 patients
The study was largely performed within the primary care setting by general practitioners who included eligible patents in the study following screening of the diabetic population recommended by Endocrine Society guidelines1,2


This is in contrast to similar studies, where patients were referred by general practitioners to specialist diabetes centers, from which they were recruited
In the total cohort, there were clear statistically significant improvements at 30 weeks in all IIEF domains for TU versus placebo (Figure 1)1


At 30 weeks, improvements with TU versus placebo included erectile function, p=0.005; intercourse satisfaction, p=0.015; sexual desire, p=0.001; orgasm, p=0.004
For erectile function, there were significant improvements at 18 and 30 weeks with TU versus placebo in males aged ≥60 years
Significant improvements at 18 weeks with TU versus placebo were seen for intercourse satisfaction (p=0.024) and overall satisfaction (p=0.051), orgasm (p=0.020), and sexual desire (p=0.001)
In males with baseline depression (Hospital Anxiety and Depression Scale [HADS] scores ≥11; n=48 [24%]), all IIEF domain scores fell compared with baseline for TU and placebo
Improvements in IIEF domains were seen as early as 6 weeks1


For TU versus placebo at 6 weeks, there were significant improvements in sexual desire
Sexual function scores continued to improve to the end of the 12-month open-label extension phase1


An improvement from baseline in erectile function was observed for the active group continuing on TU therapy and the placebo group proceeding to TU therapy (4.31 and 2.97, respectively)
In the active group continuing on TU therapy, there were greater increases in intercourse satisfaction (2.83) and orgasm (1.53) domains compared with placebo (1.11 and 0.5, respectively)
Health-related quality-of-life measures improved with TU versus placebo, but not in males with baseline depression1


At 30 weeks, AMS improved significantly (3.45 units improvement; p=0.02) in men without depression
In a subgroup (n=31) of males taking phosphodiesterase type 5 inhibitors (PDE5I), there was no change in erectile function during the double-blind phase, but large improvements during the open-label phase1


Fifteen patients taking PDE5Is in the double-blind phase (TU, n=7; placebo, n=8) proceeded to the open-label phase
By week 82, patients from the TU and placebo groups showed an improvement in erectile function score of 9.34 and 1.27, respectively; suggesting that clinical improvements in erectile function may take a longer period of time to achieve

What is known
Patients with T2D are at high risk of comorbidities. The high prevalence of hypogonadism in T2D, independent of obesity, has been well-reported.2-6 Furthermore, the prevalence of clinically assessed depression in males with T2D was determined as 9.8% in a meta-analysis of 51,331 patients across 10 controlled studies.7 In a separate meta-analysis of 22 studies that focused on the impact of diabetic complications on depression, sexual dysfunction was most commonly associated with depression. To effectively diagnose and manage such comorbidities, guidelines published by the UKs National Institute for Health and Clinical Excellence (NICE) recommend a yearly screening for erectile dysfunction in males with T2D,8 whilst separate guidelines for erectile dysfunction recommend measurement of testosterone levels in males at high risk, such as those with T2D.9 As a result, clinicians who adhere to these guidelines are likely to be faced with patients who present with T2D, low testosterone levels, depression, and erectile dysfunction.What these studies add
The results from the BLAST study confirm the beneficial effects of TU on IIEF domains and health-related quality of life in males with T2D, and complement previously published data.10,11 However, data from this 82-week study illustrate the effect of depression on the response to testosterone replacement therapy; with baseline depression diminishing any response to sexual function altogether. Adding to this, a significant reduction in AMS was observed only in patients without depression. Depression has been shown to independently impact sexual function, as well as reduce diabetes medication response and adherence, which should be considered during treatment decisions.12-14

The addition of a subgroup of males taking PDE5Is is novel, as similar studies investigating testosterone replacement therapy in diabetic males fail to identify whether PDE5Is were excluded.15-17 Males with T2D within this subgroup showed no improvement in IIEF domains during the double-blind phase, but showed large improvements after a further 12 months of open-label treatment. This delayed improvement may be explained through the achievement of sustained levels of TU beyond ≥5 injections, and the long 54-day half-life of long-acting TU. This is of clinical importance, as current guidelines recommend only 3 to 6 months of testosterone replacement therapy and the duration of TU therapy in previously published studies may have been too short for benefits in sexual function to present. As a result, males with T2D should be screened for low testosterone levels and depression, and considered for testosterone replacement therapy beyond the 6 months currently recommended.


References
1. Hackett G, Cole N, Bhartia M, et al. Testosterone Replacement Therapy with Long-Acting Testosterone Undecanoate Improves Sexual Function and Quality-of-Life Parameters vs. Placebo in a Population of Men with Type 2 Diabetes. J Sex Med 2013;10(6):1612-1627.
2. Bhasin S, Cunningham G, Hayes F, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2006;91(6):1995-2010.
3. Isidori A, Giannetta E, Gianfrilli D, et al. Effects of testosterone on sexual function in men: results of a meta-analysis. Clin Endocrinol (Oxf) 2005;63(4):381-394.
4. Hackett G, Cole N, Deshpande A, et al. Biochemical hypogonadism in men with type 2 diabetes in primary care practice. Br J Diabetes Vasc Dis 2009;9:226-231.
5. Bacon C, Hu F, Giovannucci E, et al. Association of type and duration of diabetes with erectile dysfunction in a large cohort of men. Diabetes Care 2002;25(8):1458-1463.
6. Dhindsa S, Prabhakar S, Sethi M, et al. Frequent occurrence of hypogonadotropic hypogonadism in type 2 diabetes. J Clin Endocrinol Metab 2004;89(11):5462-5468.
7. Anderson R, Freedland K, Clouse R, et al. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001;24(6):1069-1078.
8. Home P, Mant J, Diaz J, et al. Management of type 2 diabetes: summary of updated NICE guidance. BMJ 2008;336:1306
9. Hackett G, Kell P, Ralph D, et al. British Society for Sexual Medicine guidelines on the management of erectile dysfunction. J Sex Med 2008;5(8):1841-1865.
10. Khera M, Bhattacharya R, Blick G, et al. Improved sexual function with testosterone replacement therapy in hypogonadal men: real-world data from the Testim Registry in the United States (TRiUS). J Sex Med 2011;8(11):3204-3213.
11. Corona G, Rastrelli G, Forti G, et al. Update in testosterone therapy for men. J Sex Med 2011;8(3):639-654.
12. Dinan TG. Inflammatory markers in depression. Curr Opin Psychiatry 2009;22(1):32-36.
13. Papelbaum M, Moreira RO, Coutinho W, et al. Depression, glycemic control and type 2 diabetes. Diabetol Metab Syndr 2011;3(1):26.
14. Ciechanowski P, Katon W, Russo J. Impact of Depressive Symptoms on Adherence, Function, and Costs. Arch Intern Med 2000;160(21):3278-3285.
15. Giltay E, Tishova Y, Mskhalaya G, et al. Effects of testosterone supplementation on depressive symptoms and sexual dysfunction in hypogonadal men with the metabolic syndrome. J Sex Med 2010;7(7):2572-2582.
16. Kalinchenko SY, Tishova YA, Mskhalaya GJ, et al. Effects of testosterone supplementation on markers of the metabolic syndrome and inflammation in hypogonadal men with the metabolic syndrome: the double-blinded placebo-controlled Moscow study. Clin Endocrinol (Oxf) 2010;73(5):602-612.
17. Jones T, Arver S, Behre H, et al. Testosterone Replacement in Hypogonadal Men With Type 2 Diabetes and/or Metabolic Syndrome (the TIMES2 Study). Diabetes Care 2011;34(4):828-837.

[yettibecsuse]

In Aus it's called Reandron; I dont use Hcg doesn't worry me the size of my testes either, too old to worry about that;; my e2 did raise after the second loading shot in about week 5; and I took bloods to track it every couple of weeks and my ft and tt did drop slower than the ethanate; for me it drops off about week 7/8; its financially subbed by the gov so it costs nothing.

[clarky.]

I feel it on wk 8 aswell i'm on every 10 wks just now. I spoke to ma endo about it last time and she said we will talk about it next time so thats next month so hoping she will change it to every 8wks

[marcus300]

I feel it on wk 8 aswell i'm on every 10 wks just now. I spoke to ma endo about it last time and she said we will talk about it next time so thats next month so hoping she will change it to every 8wks

I was on 12 weeks but could feel a slight drop off at week 10, I'm on 11 weeks now and don't really feel anything drastic but I am sure 10 weeker would be my sweet spot

[Trevtrev]

Marcus, curious regarding those on trt using test C that are experiencing hair thinning, would Nebido's longer ester help with this issue? Thinking not, but thought I'd ask.

[marcus300]

The international medical societies European Association of Urology (EAU), International Society for the Study of the Aging Male (ISSAM), International Society of Andrology (ISA), American Society of Andrology (ASA), and European Academy of Andrology (EAA) have issued recommendations on the definition, investigation, treatment and follow-up of men with late-onset hypogonadism.1,2 They recommend:Evaluate the patient 3 months after commencing treatment then annually to assess response of signs and symptoms of hypogonadism to treatment and to evaluate any adverse effects. Failure to benefit clinical manifestations should result in discontinuation of treatment. As testosterone normally results in improvements in mood and well-being, the development of negative behavioral patterns during treatment calls for dose modifications or discontinuation of therapy

Monitor serum testosterone levels 2–3 months after commencing treatment to ensure levels in the mid-normal physiological range have been attained

Check hematocrit at baseline, at 3 months, and then annually. Therapy should be stopped if hematocrit is >54%, indicating erythrocytosis.

Patient should be evaluated for hypoxia and sleep apnea. When hematocrit decreases to a safe level therapy may be reintroduced at a decreased dose

Measure bone mineral density of lumbar spine and/or femoral neck after 1–2 years of testosterone therapy in men with osteoporosis or low trauma fracture

Perform digital rectal examination and determination of prostate-specific antigen (PSA) levels at baseline in men over the age of 45 years, then at 3 to 6 months after commencing testosterone treatment, at 12 months, and then yearly thereafter (or according to standard prostate cancer screening protocols)
Evaluate formulation-specific adverse events at each visit

[BigIce]

I was on Nebido for few years and it is the best treatment out there IMO

I however developed an allergy to benzyl benzoate and ended my treatment in the ER getting six shots of adrenaline

I am now back on the gel. 75 mg. (1.5 dose) and it is miles away from being the treatment Nebido was.

I sure hope you guys will get it in the states soon

[marcus300]

I was on Nebido for few years and it is the best treatment out there IMO

I however developed an allergy to benzyl benzoate and ended my treatment in the ER getting six shots of adrenaline

I am now back on the gel. 75 mg. (1.5 dose) and it is miles away from being the treatment Nebido was.

I sure hope you guys will get it in the states soon

I thought the main carrier was Castor oil and only a small amount of BB. But saying that if your allergic from it any amount will have an effect.

[marcus300]

Efficacy and safety of injectable TU for the treatment of hypogonadism
Nebido products Drug Evaluation: Injectable testosterone undecanoate for the treatment of hypogonadism Corona G, Maseroli E, Maggi M; Expert Opin. Pharmacother 2014;15(13):1903-1926

Since its approval in 2004, many clinical studies have been conducted with testosterone undecanoate, the first long-acting injectable form of testosterone. Testosterone undecanoate has been proven to have an excellent safety profile and need only be administered four times annually to produce stable testosterone levels .1 Long-term studies have validated the clinical efficacy of testosterone undecanoate in maintaining stable therapeutic levels of testosterone and safely conferring the desired benefits of androgen replacement.1

Here we summarize the results from a comprehensive meta-analysis of all uncontrolled and placebo-controlled randomized clinical trials (RCTs) demonstrating the effect of injectable testosterone undecanoate on multiple clinical outcomes.2
Key Points


Injectable testosterone undecanoate is a long-acting testosterone formulation that has been available in EU for the treatment of male hypogonadism since 2003.
A meta-analysis of 33 intervention studies, of which 11 were randomized controlled trials (RCTs), using injectable testosterone undecanoate for treatment of hypogonadism, found the following main significant effects after a mean study duration of 34.1 months (2.8 years) in men with a mean age of 56.8 years:


reduction of BMI and body weight (mean weight loss; 5.88 kg, range 2.64-9.11 kg)
reduction of waist circumference (mean waist loss; -7.11 cm, range -4.64 to -9.59 cm)
reduction in fat mass; mean fat loss of -4.56% (range 3.36% to -5.76%)
reduction of fasting glucose (mean -0.51 mmol/L, range -0.27 to 0.75)
reduction of HbA1c levels (mean -0.68%, range -0.32% to -1,04%), and improvement of insulin resistance (measured by HOMA index)
reduction of total cholesterol (mean -0.89 mmol/L, range -0.60 to -1.19 mmol/L)
reduction of triglyceride levels (mean -0.44 mmol/L, range -0.24 to -0.63 mmol/L)
increase in HDL levels (mean +0.15 mmol/L, range +0.08 to +0.23 mmol/L)
reductions in systolic and diastolic blood pressure of 10 mmHg and 7 mmHg, respectively.
improvement in sexual function, International Prostate Symptom Score (IPSS), bone mineral density and depressive symptoms.
Testosterone undecanoate treatment is well tolerated and no increased risk of prostate cancer or cardiovascular disease was observed, and has a more favorable pharmacokinetic and safety profile than older short-acting testosterone formulations.
Figure 1 provides a summary of the main effects of testosterone undecanoate treatment:

What is known
In contrast to shorter-acting injectable testosterone formulations, like for example testosterone enanthate , cypionate and propionate , testosterone undecanoate only need to be injected at 10 to 14 week intervals, after initial loading dose.

In Europe and Australia, testosterone undecanoate is marketed under the brand names Nebido® and Reandron®, which contains 1000 mg/4 ml vial. In the US, testosterone undecanoate is marketed under the brand name Aveed®, which contains 750 mg/3 ml vial.

For Nebido®/Reandron®, the initial loading is 1000 mg at 6 weeks after the first injection, and then every 12 weeks thereafter.3
For Aveed®, the initial loading is 750 mg at 4 weeks after the first injection, and then every 10 weeks thereafter.4
1000 mg testosterone undecanoate injected into male patients with hypogonadism at 12-wk intervals is well tolerated and results in testosterone levels within normal ranges, using only 4 instead of 17 or more injections per year compared to shorter acting testosterone esters.3 Thereby, testosterone undecanoate is more advantageous from a practical standpoint.

The large IPASS study (International Post-Authorization Surveillance Study) on the tolerability and effectiveness of injectable testosterone undecanoate for the treatment of male hypogonadism according to these recommendations, was conducted in a worldwide sample of 1,438 hypogonadal men.5 Patients received up to 5 testosterone undecanoate injections during 9-12 months; a total of 6333 injections were analyzed. Mean testosterone levels rose from a baseline of 9.6 nmol/L to 15.2, 16, 17 and 17.3 nmol/L, at second, third, fourth and fifth injections, respectively.5 Mean trough serum total testosterone increased from 9.6 nmol/L at baseline to 17.3 nmol/L before the fifth injection (p<0.0001). At the time of injection 5, there was a significant improvement in the overall levels of sexual desire/libido compared with baseline. Significant improvements over each injection interval were seen in the overall levels of vigor/vitality, mood and ability to concentrate (p<0.0001 for each). The proportion of patients reporting moderate, severe or extremely severe ED was significantly decreased from baseline at the time of the fifth TU injection, from 65% to 19% (p<0.0001). Mean waist circumference decreased from 100 to 96 cm, and serum triglyceride, total cholesterol, LDL cholesterol and blood pressure was significantly improved from baseline at injection 5.5

The pharmacokinetics of Aveed® (750 mg/3 ml) were investigated in a multicenter, US study on 130 hypogonadal men (total testosterone < 10.4 nmol/L) followed up to 24 weeks.6 Injections were administered at baseline and week 4, and thereafter every 10 weeks. A steady state was obtained after the third injection. About 94% of all men had a mean testosterone level ranging within the normal range (10.4 - 34.7 nmol/l) during the 10 weeks after the third injection, and 92% of the subjects had a maximum testosterone concentration (Cmax) of < 1500 ng/dl (52 nmol/l), meeting threshold criteria requested by the FDA.6
What this study adds
This comprehensive meta-analysis of 33 intervention studies unequivocally confirms that treatment of hypogonadism with injectable testosterone undecanoate confers multiple beneficial effects.

Body composition
Injectable testosterone undecanoate treatment was found to result in a significant reduction of BMI (mean close to 1 kg/m2). The reduction in BMI was significantly lower in older patients and was increased as a function of trial duration and/or BMI at baseline. Thus, maximal effect is obtained in younger, more obese subjects, and in subjects treated for a longer time. The impact of treatment duration on outcomes (in this case BMI, see figure 2) confirms previous findings that longer-term treatment may be necessary in most patients for full expression on benefits.7

The positive effect of injectable testosterone undecanoate on BMI reduction was confirmed in a multivariate analysis, after adjusting for age, BMI at baseline and trial duration. However, when the analysis was stratified according to baseline population characteristics, the data were confirmed in those trials enrolling only hypogonadal subjects (total testosterone level ≤ 12 nmol/L), but not in those enrolling a mixed eugonadal/hypogonadal cohort.

In line with the reduction in BMI, there was a significant reduction of total weight (mean weight loss: -5.88 kg, range -2.64 to -9.11 kg) and waist circumference (mean waist loss: -7.11 cm, range -4.64 to -9.59 cm). These reductions in weight and waist were confirmed after the adjustment for the aforementioned confounders and the change in BMI.

In addition, treatment was found to result in a significant reduction in fat mass, with a mean fat loss of -4.56% (range -3.36% to -5.76%).

Glyco-metabolic profile and blood pressure
Injectable testosterone undecanoate treatment resulted in a significant reduction of fasting glucose (mean -0.51 mmol/L, range -0.27 to -0.75) and HbA1c levels (mean -0.68%, range -0.32% to -1.04%), as well as improvement of insulin resistance (measured by HOMA index).

Treatment also improved the lipid profile by reducing total cholesterol (mean -0.89 mmol/L, range -0.60 to -1.19 mmol/L) and triglyceride levels (mean -0.44 mmol/L, range -0.24 to -0.63 mmol/L), and increasing high-density lipoprotein (HDL) cholesterol levels (mean +0.15 mmol/L, range +0.08 to +0.23 mmol/L).

Improvement was also seen in blood pressure, with mean reductions in systolic and diastolic blood pressure of 10 mmHg and 7 mmHg, respectively.

Sexual function
A significant improvement of erectile function was found after treatment with injectable testosterone undecanoate. This finding was especially notable in studies of clearly hypogonadal men with total testosterone level ≤ 12 nmol/L, and confirms previous research showing that sexual symptoms are among the main manifestations of full-blown testosterone deficiency.8,9

International Prostate Symptom Score (IPSS)
Treatment was also found to result in a significant reduction of the International Prostate Symptom Score (IPSS). As for sexual function, this finding was especially notable in studies of clearly hypogonadal men with total testosterone level ≤ 12 nmol/L.

Bone mineral density
A significantly increased lumbar bone mineral density was also found.

Depression
Depressive symptoms significantly improved after treatment.

Safety parameters
When looking at occurrence of side effects, it is important to know the total sample size to get a perspective. In this meta-analysis, the included studies together had 3359 men in the treatment group and 478 patients on placebo.

An elevated hematocrit above the physiological level was reported in 4 subjects enrolled in non-placebo controlled studies and by some subjects in placebo-controlled RCT (event rate 0.02 %).

Non-placebo controlled studies did not report any major adverse cardiovascular event (MACE), whereas 8 MACEs were observed in placebo-controlled RCTs (3 in the treatment groups and 5 in placebo groups).

Among placebo-controlled RCTs, prostate specific antigen (PSA) levels > 4 ng/ml were reported in 7 cases (5 in treatment groups and 2 in placebo groups, however between-group difference being non-significant at p = 0.26), whereas 11 subjects experienced PSA > 4 ng/ml in non-placebo controlled trials (event rate 0.04%). 11 subjects in non-placebo controlled trials had a new diagnosis of prostate cancer during follow up (event rate 0.03%). However, prostate cancer was not reported in any of the placebo-controlled RCTs.
Commentary
This meta-analysis clearly demonstrates multiple beneficial effects of testosterone undecanoate treatment in hypogonadal men2, consistent with conclusions from a previous review.1 It also raises some important aspects of testosterone treatment.

Firstly, many of the important effects of testosterone therapy reach statistical significance only after longer treatment durations. Because long-term studies are almost impossible to do in a placebo-controlled fashion, it comes as no surprise that statistical significance was reached exclusively in uncontrolled studies for several outcomes; waist circumference, body weight, lipid profile and blood pressure. This underscores the importance of treatment duration and adherence for achievement of maximal results, which was described in a previous analysis by Saad et al. "Onset of effects of testosterone treatment and time span until maximum effects are achieved".7 As an accumulating body of evidence shows, hypogonadism is a condition which cannot simply be left untreated.10-17 Therefore, it would be unethical to conduct long-term placebo-controlled studies.

Secondly, while testosterone therapy improves glycemic control and insulin resistance in subjects with the metabolic syndrome and type 2 diabetes18-24 this meta-analysis shows that testosterone undecanoate treatment also may improve glucose profile even in hypogonadal populations without overt diabetes. This supports the hypothesis that testosterone might be causally involved in the pathogenesis of the metabolic syndrome and type 2 diabetes. Further support for this comes from prospective studies demonstrating that a low testosterone level at baseline predicts the development of both the metabolic syndrome and type 2 diabetes at follow up.7,15,22,23

Regarding safety aspects, 11 new cases of prostate cancer were found among a total of 3359 (11/3359=0.0032) men who were treated with testosterone undecanoate.2 This is similar to the incidence rate for prostate cancer in the general population for men aged 50-59, which has been reported to be 221 per 100,000 men (221/100,000 =0.0022).25

The results of the present meta-analysis found no increased risk of MACEs. There were actually more MACEs in placebo groups compared with treatment groups, 5 and 3 respectively. This is in line with results from another recent meta-analysis that specifically investigated cardiovascular risk associated with testosterone boosting medications, which did not observe any increase in MACE risk associated with testosterone treatment, either when composite or single cardiovascular end points were considered.26

The lack of a significantly increased risk of prostate-related disease (cancer or PSA > 4 ng/ml) in this meta-analysis confirms the findings from another recent meta-analysis which specifically evaluated the relationship between TRT and prostate cancer.27 For more information on testosterone and prostate health, see our previous editorial "Testosterone and Prostate Cancer - a paradigm shift".

Major advantages of testosterone undecanoate over shorter-acting formulations like testosterone enanthate are its lower frequency of administration and its better tolerability and safety profile.28,29 A side effect that is relatively common with older short-acting injectable preparations, erythrocytosis, is rare with injectable testosterone undecanoate and not statistically different from placebo in RCTs.2

Hypogonadism is a chronic condition that often requires chronic, if not lifelong, treatment. Long-lasting testosterone undecanoate therapy, with only 4-5 injections per year (instead of up to 24) offers a practical administration schedule. Patient preference for the convenient dosing schedule can be expected to lead to better compliance and thus greater therapeutic benefit. This is an important aspect, as compliance to other testosterone formulations has been reported to be poor.30 More importantly, testosterone undecanoate does not result in supraphysiological spikes in testosterone levels as is seen with short-acting testosterone formulations. This explains why patients treated with injectable testosterone undecanoate report less mood swings and less fluctuations in energy levels and sexual desire, than patients treated with older short-acting preparations.2

The take home message from this comprehensive meta-analysis is that injectable testosterone undecanoate offers a patient-friendly, effective and safe treatment option for hypogonadism, and is especially suitable for chronic treatment, and thereby achievement of maximal benefits, thanks to its favorable pharmacokinetic and safety profile.
References
1. Edelstein D, Basaria S. Testosterone undecanoate in the treatment of male hypogonadism. Expert opinion on pharmacotherapy. Aug 2010;11(12):2095-2106.
2. Corona G, Maseroli E, Maggi M. Injectable testosterone undecanoate for the treatment of hypogonadism. Expert opinion on pharmacotherapy. Jul 31 2014:1-24.
3. Schubert M, Minnemann T, Hubler D, et al. Intramuscular testosterone undecanoate: pharmacokinetic aspects of a novel testosterone formulation during long-term treatment of men with hypogonadism. The Journal of clinical endocrinology and metabolism. Nov 2004;89(11):5429-5434.
4. Wang C, Harnett M, Dobs AS, Swerdloff RS. Pharmacokinetics and safety of long-acting testosterone undecanoate injections in hypogonadal men: an 84-week phase III clinical trial. Journal of andrology. Sep-Oct 2010;31(5):457-465.
5. Zitzmann M, Mattern A, Hanisch J, Gooren L, Jones H, Maggi M. IPASS: a study on the tolerability and effectiveness of injectable testosterone undecanoate for the treatment of male hypogonadism in a worldwide sample of 1,438 men. The journal of sexual medicine. Feb 2013;10(2):579-588.
6. Morgentaler A, Dobs AS, Kaufman JM, et al. Long acting testosterone undecanoate therapy in men with hypogonadism: results of a pharmacokinetic clinical study. The Journal of urology. Dec 2008;180(6):2307-2313.
7. Saad F, Aversa A, Isidori AM, Zafalon L, Zitzmann M, Gooren L. Onset of effects of testosterone treatment and time span until maximum effects are achieved. European journal of endocrinology / European Federation of Endocrine Societies. Nov 2011;165(5):675-685.
8. Wu FC, Tajar A, Beynon JM, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. The New England journal of medicine. Jul 8 2010;363(2):123-135.
9. Corona G, Isidori AM, Buvat J, et al. Testosterone supplementation and sexual function: a meta-analysis study. The journal of sexual medicine. Jun 2014;11(6):1577-1592.
10. Jones TH. Testosterone deficiency: a risk factor for cardiovascular disease? Trends in endocrinology and metabolism: TEM. Aug 2010;21(8):496-503.
11. Traish AM. Outcomes of testosterone therapy in men with testosterone deficiency (TD): Part II. Steroids . May 24 2014.
12. Traish AM. Adverse health effects of testosterone deficiency (TD) in men. Steroids. Jun 2 2014.
13. Mesbah Oskui P, French WJ, Herring MJ, Mayeda GS, Burstein S, Kloner RA. Testosterone and the cardiovascular system: a comprehensive review of the clinical literature. Journal of the American Heart Association. Dec 2013;2(6):e000272.
14. Saad F. Androgen therapy in men with testosterone deficiency: can testosterone reduce the risk of cardiovascular disease? Diabetes/metabolism research and reviews. Dec 2012;28 Suppl 2:52-59.
15. Saad F, Aversa A, Isidori AM, Gooren LJ. Testosterone as potential effective therapy in treatment of obesity in men with testosterone deficiency: a review. Current diabetes reviews. Mar 2012;8(2):131-143.
16. Saad F, Gooren L. The role of testosterone in the metabolic syndrome: a review. The Journal of steroid biochemistry and molecular biology. Mar 2009;114(1-2):40-43.
17. Saad F, Gooren LJ. The role of testosterone in the etiology and treatment of obesity, the metabolic syndrome, and diabetes mellitus type 2. Journal of obesity. 2011;2011.
18. Francomano D, Bruzziches R, Barbaro G, Lenzi A, Aversa A. Effects of testosterone undecanoate replacement and withdrawal on cardio-metabolic, hormonal and body composition outcomes in severely obese hypogonadal men: a pilot study. J Endocrinol Invest. Mar 18 2014;37:401-411.
19. Francomano D, Lenzi A, Aversa A. Effects of five-year treatment with testosterone undecanoate on metabolic and hormonal parameters in ageing men with metabolic syndrome. International journal of endocrinology. 2014;2014:527470.
20. Haider A, Yassin A, Doros G, Saad F. Effects of Long-Term Testosterone Therapy on Patients with “Diabesity”: Results of Observational Studies of Pooled Analyses in Obese Hypogonadal Men with Type 2 Diabetes. International journal of endocrinology. 2014:Article ID 683515.
21. Cai X, Tian Y, Wu T, Cao CX, Li H, Wang KJ. Metabolic effects of testosterone replacement therapy on hypogonadal men with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Asian journal of andrology. Jan-Feb 2014;16(1):146-152.
22. Corona G, Monami M, Rastrelli G, et al. Type 2 diabetes mellitus and testosterone: a meta-analysis study. International journal of andrology. Dec 2011;34(6 Pt 1):528-540.
23. Corona G, Monami M, Rastrelli G, et al. Testosterone and metabolic syndrome: a meta-analysis study. The journal of sexual medicine. Jan 2011;8(1):272-283.
24. Corona G, Rastrelli G, Maggi M. Diagnosis and treatment of late-onset hypogonadism: systematic review and meta-analysis of TRT outcomes. Best practice & research. Clinical endocrinology & metabolism. Aug 2013;27(4):557-579.
25. Li J, Djenaba JA, Soman A, Rim SH, Master VA. Recent trends in prostate cancer incidence by age, cancer stage, and grade, the United States, 2001-2007. Prostate cancer. 2012;2012:691380.
26. Corona G, Maseroli E, Rastrelli Gea. Cardiovascular risk associated with testosterone boosting medications - a systematic review and meta-analysis. Exp Opin Saf Drug. 2014:in press.
27. Cui Y, Zong H, Yan H, Zhang Y. The effect of testosterone replacement therapy on prostate cancer: a systematic review and meta-analysis. Prostate cancer and prostatic diseases. Jun 2014;17(2):132-143.
28. Jockenhovel F, Minnemann T, Schubert M, et al. Comparison of long-acting testosterone undecanoate formulation versus testosterone enanthate on sexual function and mood in hypogonadal men. European journal of endocrinology / European Federation of Endocrine Societies. May 2009;160(5):815-819.
29. Minnemann T, Schubert M, Freude S, et al. Comparison of a new long-acting testosterone undecanoate formulation vs testosterone enanthate for intramuscular androgen therapy in male hypogonadism. J Endocrinol Invest. Aug 2008;31(8):718-723.
30. Schoenfeld MJ, Shortridge E, Cui Z, Muram D. Medication adherence and treatment patterns for hypogonadal patients treated with topical testosterone therapy: a retrospective medical claims analysis. The journal of sexual medicine. May 2013;10(5):1401-1409.

[Flier]

"The large IPASS study (International Post-Authorization Surveillance Study) on the tolerability and effectiveness of injectable testosterone undecanoate for the treatment of male hypogonadism according to these recommendations, was conducted in a worldwide sample of 1,438 hypogonadal men.5 Patients received up to 5 testosterone undecanoate injections during 9-12 months; a total of 6333 injections were analyzed. Mean testosterone levels rose from a baseline of 9.6 nmol/L to 15.2, 16, 17 and 17.3 nmol/L, at second, third, fourth and fifth injections, respectively.5 Mean trough serum total testosterone increased from 9.6 nmol/L at baseline to 17.3 nmol/L before the fifth injection (p<0.0001). At the time of injection 5, there was a significant improvement in the overall levels of sexual desire/libido compared with baseline. Significant improvements over each injection interval were seen in the overall levels of vigor/vitality, mood and ability to concentrate (p<0.0001 for each). The proportion of patients reporting moderate, severe or extremely severe ED was significantly decreased from baseline at the time of the fifth TU injection, from 65% to 19% (p<0.0001). Mean waist circumference decreased from 100 to 96 cm, and serum triglyceride, total cholesterol, LDL cholesterol and blood pressure was significantly improved from baseline at injection 5.5"

Do you know what the nmol/L ref range is for the levels referred to?

[marcus300]

"The large IPASS study (International Post-Authorization Surveillance Study) on the tolerability and effectiveness of injectable testosterone undecanoate for the treatment of male hypogonadism according to these recommendations, was conducted in a worldwide sample of 1,438 hypogonadal men.5 Patients received up to 5 testosterone undecanoate injections during 9-12 months; a total of 6333 injections were analyzed. Mean testosterone levels rose from a baseline of 9.6 nmol/L to 15.2, 16, 17 and 17.3 nmol/L, at second, third, fourth and fifth injections, respectively.5 Mean trough serum total testosterone increased from 9.6 nmol/L at baseline to 17.3 nmol/L before the fifth injection (p<0.0001). At the time of injection 5, there was a significant improvement in the overall levels of sexual desire/libido compared with baseline. Significant improvements over each injection interval were seen in the overall levels of vigor/vitality, mood and ability to concentrate (p<0.0001 for each). The proportion of patients reporting moderate, severe or extremely severe ED was significantly decreased from baseline at the time of the fifth TU injection, from 65% to 19% (p<0.0001). Mean waist circumference decreased from 100 to 96 cm, and serum triglyceride, total cholesterol, LDL cholesterol and blood pressure was significantly improved from baseline at injection 5.5"

Do you know what the nmol/L ref range is for the levels referred to?

There are no range's its was s study conducted on hypogonadal men showing their baseline levels pre treatment during and at different injection times. It shows the increase test levels during these periods. There are many other studies regarding TU which are posted in the first post of this thread

[MuscleScience]

I know this is now several years on. Do you still like this therapy Marcus?

[marcus300]

I know this is now several years on. Do you still like this therapy Marcus?

Yes its remarkable for me. It gets better with age so the longer your on it the more stable higher levels.

[Obs]

Yes its remarkable for me. It gets better with age so the longer your on it the more stable higher levels.

This sounds like a dream and much smarter than cyp. Does blasting mess your levels up or require changes to dosages afterward?

[marcus300]

Full article = https://www.nebido.com/en/hcp/resear...deficiency.phpInteresting article on the nebido site which you may find uselful with wording your email to the endo
UK policy statements on testosterone deficiency
Testosterone deficiency (also known as hypogonadism) and its treatment is a medical issue that has long been neglected, despite causing significant physiological and psychological health complications among affected men. Longstanding dogmatic fears about prostate cancer and more recent misleading studies alluding to heart attack and stroke risk, has made testosterone treatment a controversial topic.

Here we summarize the newly published UK policy statements on testosterone deficiency, which are based on an International expert consensus conference on testosterone deficiency and its treatment.1 These statements, developed by the British Society for Sexual Medicine (BSSM), address widespread media and scientific concerns over the appropriate treatment of testosterone deficiency with testosterone therapy .

What caused recent concerns about testosterone therapy?
Testosterone has been used in medicine since the 1940s.2,3 With the growing recognition of health consequences of testosterone deficiency and the beneficial effects of proper testosterone treatment (the words treatment and therapy are commonly used interchangeably),4-7 it has attracted interest both in the scientific community and the media.

What these policy statements add
1) Testosterone deficiency is a well-established, significant medical condition

To make the diagnosis of hypogonadism, signs/symptoms indicative of testosterone deficiency need to occur in the presence of low testosterone levels . The European Association of Urology (EAU), International Society for Sexual Medicine (ISSM) and BSSM guidelines suggest that a level of:
Total testosterone of <8 nmol/L or free testosterone of <180 pmol/L (based on two separate 8-11 morning blood samples) requires testosterone therapy.
Total testosterone of >12 nmol/L or free testosterone of >225 pmol/L does not require testosterone therapy.

Between these levels, a trial of testosterone therapy for a minimum of 6 months should be considered based on symptoms.5

It is recommended that total testosterone levels are measured in men with a disease in which testosterone deficiency is common and/or who are taking medications that reduce testosterone levels.12 This includes men with:

-Sexual dysfunction.-Type 2 diabetes.- Metabolic syndrome.Obesity. Treatment with medications that cause suppression of testosterone levels e.g. corticosteroids and opiates. Moderate to severe chronic obstructive lung disease.-- Infertility. Osteoporosis or low-trauma fractures. HIV infection with sarcopenia.Pituitary mass, following radiation involving the sellar region and other diseases in the hypothalamic and sellar region.
2) Testosterone deficiency has well-established symptoms

The most common symptoms of hypogonadism are reduced sexual desire and sexual activity, erectile dysfunction, loss of morning erections and hot flushes.5,7,12,13 Other factors found associated with low testosterone include increased waist circumference, obesity, metabolic syndrome and impaired health status. Other less-specific symptoms are loss of physical strength and muscle mass, fatigue, changes in mood, anger, sleep disturbance and cognitive impairment. Classical signs are gynaecomastia, decreased testicular volume and less body hair.

3) Testosterone therapy for men with testosterone deficiency is effective, rational and evidence based

In the largest double-blind placebo-controlled study to date, 790 men over 65 years were treated with testosterone therapy for 12 months.20 Results showed significant improvements in sexual function and modest improvement in 6-minute walking test, functional performance, mood, depression and fatigue.20 The composite benefits of these improvements are likely to translate into major quality of life and health-related economic benefit.1

Cessation of testosterone therapy results in relapse and reversal of benefits within 6 months 29,30. A study that specifically investigated the effects of intermission and resumption of long-term testosterone replacement therapy on body weight and metabolic parameters confirmed that withdrawal of testosterone treatment reverses beneficial effects, which appear again when treatment is resumed.31 Therefore, hypogonadism may require lifelong testosterone treatment.1

It is important to note that the clinical response to testosterone treatment is unrelated to the underlying cause of hypogonadism 4, as all the previously mentioned meta-analyses and the two milestone RCTs showed benefits in men without “classical hypogonadism” (hypogonadism caused by Klinefelter’s syndrome, pituitary injury, or testicular damage).

4) There is no scientific basis for withholding testosterone therapy from men on the basis of age

While testosterone levels, especially the free testosterone fraction, decline with age, lifestyle factors (sedentariness, stress, unhealthy food habits), obesity, metabolic syndrome, diabetes and other chronic diseases also greatly contribute to the declining testosterone levels (in some cases more so than aging per se).32

The beneficial effects of testosterone therapy are seen in both younger and older men.33-35 Some benefits, such as muscle mass and strength, may be of greater clinical and economic significance in older men, as reduced muscle mass and lower limb strength are related to frailty and increased rate of falls.36 As shown in figure 1, men over 75 who receive testosterone therapy (gray bar) have the greatest reduction in all-cause mortality when compared to age-matched hypogonadal men who do not receive testosterone therapy (blue bar).37

Figure 1: Effect of testosterone therapy in hypogonadal men on reduction in mortality, compared to non-treated hypogonadal and eugonadal men, in various age groups.

5) Testosterone deficiency is associated with increased cardiovascular and all-cause mortality

Several long-term studies show that hypogonadism is associated with increased cardiovascular and all-cause mortality.38-40 Importantly, even after adjusting for waist circumference, smoking habits, high-risk alcohol use, physical activity, renal insufficiency, and levels of dehydroepiandrosterone sulfate, low testosterone levels continued to be significantly associated with a 2-fold increased risk of mortality.39

6) The evidence does not support an increased cardiovascular risk associated with testosterone therapy

The fear of increased risk of heart attack and stroke was mainly caused by two high profile but flawed studies.8,9 Since the publication of these studies, many new studies have refuted the alleged cardiovascular risks.41-54

7) There is no evidence that supports any increase in the risk of prostate cancer with testosterone replacement therapy.

Historically, fear of prostate cancer was the major reason men were denied testosterone therapy. All major guidelines - EAU, ESSM, ISSM, ES and BSSM – conclude there is no evidence that testosterone therapy is associated with increased risk of prostate cancer.5,7,12,55

The 2017 EAU guidelines make the following statement: 12

Testosterone replacement therapy results in a marginal increase in PSA and prostate volume, plateauing at twelve months.56 Previous fears that testosterone treatment might increase the risk of prostate cancer have been contradicted by large meta-analyses.57,58

However, prostate monitoring is required during testosterone therapy. Patients with a substantial or continuous increase in PSA level (taking the level 6 months after treatment initiation as baseline) need to be investigated further to exclude prostate cancer.12

8) A major research initiative to explore the benefits of T Therapy in cardio-metabolic disease is overdue

A common theme in medical research on testosterone is a call for more research and longer-term RCTs. The Testosterone for the prevention of Diabetes Mellitus (T4DM) – T4DM - T4DM - study in Australia is conducted in (n=1007), obese men with glucose intolerance and testosterone levels of 14 nmol/L or lower, randomised to treatment with testosterone undecanoate or placebo.59 The goal is to establish whether testosterone therapy will reduce the development of type 2 diabetes.
.
Commentary
Many physicians are unsure how to make the diagnosis of hypogonadism. Several factors are contributing to the diagnostic dilemma; uncertainty about what testosterone levels should be considered low, wide variation in laboratory reference ranges for different testosterone assays, weak correlations between signs, symptoms and testosterone levels.60

The UK policy statements on testosterone deficiency are helpful by recommending that a trial of testosterone therapy for a minimum of 6 months should be considered in symptomatic men. It was suggested already 10 years ago that a therapeutic trial should be an integral part of a trio of diagnostic criteria; assessment of symptoms and signs, laboratory results and efficacy of a therapeutic trial.61,62

Several guidelines recommend a trial of treatment as a component of the diagnostic process, particularly in patients with borderline testosterone levels. What is at issue is the length of the trial.63the International Society for Sexual Medicine Guideline 5 recommend a minimum period of 6 months when assessing response to a trial of testosterone treatment.

[cousinmuscles]

I was on 12 weeks but could feel a slight drop off at week 10, I'm on 11 weeks now and don't really feel anything drastic but I am sure 10 weeker would be my sweet spot

Seeing this is an old post, and recently you said you had to back down to 13 week intervals due to too high hb/RBC? If I'm understanding this right there is a very slow build up of the undecanoate ester that takes years, and at first makes it seem like the regular interval isn't enough...

[marcus300]

Seeing this is an old post, and recently you said you had to back down to 13 week intervals due to too high hb/RBC? If I'm understanding this right there is a very slow build up of the undecanoate ester that takes years, and at first makes it seem like the regular interval isn't enough...

My high hct is my own fault but here are two posts relating to my therapy below what you may find interesting

Remarkable

Update

None of you know this but I came off TRT just over 6 months ago due to some health issues I was/ am going through, these issues aren't related to my therapy even though I am under my haematologist due to high RBC's which is because for years I was only donating blood on and off due to my work schedule and this caused things to rise into the danger area which I am having treatment for. I run high anyway I'm just a blood making machine lol. I don't want to go into why I had to come off therapy but I came off and all I've had in just over 6 months is 250mgs of TU around 3 months ago, so in total 250mgs in just over 6 months.

I have been on Nebido for over 10 years and I usually run around 30nmol/l ( 866ng/dl ) with all rest of my bloods in range except for recent issues. I don't need any AI my E is within range and everything is good to go except the HCT etc due to the above issues.

Now, this is remarkable I had a blood test recently and they tested my hormones. I've not got the full details yet but you would think for a guy who's been on TRT for around 13yrs and had Test levels of a 85 year old man my T after over 6 months without any T except the slight 250mg I slotted in it would be on the floor. Well I am 17.5nmol/l ( 504ng/dl ) that's fuking remarkable, I asked my endo about this and he tells me not a lot of people know this but Nebido takes around 15-18months to fully dial in and to get up to levels were this type of therapy is unique. He thinks I metabolize T very slowly and the build up over the years I've been on this therapy it will take along time to fully get out of my system.

I was shocked because I feel sh1t and feel like I have zero T in me but I am in range, the range for me is 6 - 25.8 ( 173 - 743 ) and I am 504 after just over 6 months off except 250 3 months ago. I would of thought I would be around the 3-6 mark if that to be honest especially after what's been going on with other things..

Fuking excellent therapy in the long run wooow

Check out this chart on Nebido showing the slow build up of T levels, 1st chart is on the 1st injection and 2nd chart is 13th injection at 12 wk intervals. Now imagine this over my time period of time ive been on it and the smoothing effect Nebido as on the peaks and low range. You can see how someone who could possibly metabolizes T slowly the effect it would have on the balance of the two points. I can see from this that over time you could possibly lengthen the injection protocol due to rising T levels to keep them under control but what a remarkable compound over a long term period. I'd like to see in comparison TE at the same length with injections of every week, that would be interesting data

[Trembolono]

Hello, after reading all the thread I have many doubts, since I am quite scared to be a noob.
My endo diagnosed me "hypogonadism" and wants us to start with a trt, using reandron 1000mg (nebido). By reading your experience and positive feedback after its use, it helped me a lot. I have been training for 4 years, this last year, I started to have low libido, weak erections, fatigue etc ... after the analytics and several consultations with my endo, it was his decision to start with the trt. I love to train, and for that reason I would like to ask you to notice "physically" when starting with the trt. Body recomposition? did you gain muscle? you lost fat? How did you focus your bulking / cutting stages? diet? macros? Thank you!

pd:
Do you recommend starting the Trt with 1000mg Nebido and after 6 weeks reinforce again with 1000mg? and after this and go assessing whether to do every 10-12 weeks, right? I hope my endo was put to me that way.

[marcus300]

Do the Nebido protocol suggested by your endo, it usually first injection and 6 weeks later another booster injection. They usually start you off around the 10-12 week mark and adjust accordingly after your blood work. It does take some time for you to get dialled in when using Nebido but I can honestly say its a remarkable compound and the studies have shown they outshone any other trt protocol. I've tried gels, test E and been on Nebido for many yrs and I find it amazing but remember some people it does take some time around the 3rd/4th injection before they start getting dialled in.

You should be around the mid to top end of your T range so all the benefits will follow