Prescribed Nebido, need input please!

[ShaRkKy]

Hello guys,

Still totally natural. I've been lifting for 7 years. Stats now 78kg. pretty lean, abs & obliques showing. around 9% BF.However every year I was feeling more and more low T symptoms. So now I'm 25 and i decided to get a blood test done/ routine test/hormone panel.
It did cost me since my insurance doesn't cover any hormonal tests. But due to the symptoms doctor advised that I do them.

Got transferred to a urologist/endocrinologist. My levels were low specially for a 25 male. My levels are like a 50-60 years old male....

Tests Results:

Testosterone Total: 4.48 nmol/L Normal range is 8.33 - 30.20 nmol/L
Free Testosterone: 4.5 pg/mL Normal Range is 7.0 - 22.7 pg/mL
TSH: 2.23 uIU/mL Normal range is 0.35-4.94
Estradiol: <5.00 pg/mL Normal Range is 7.63 - 42.6

He gave me 3 options:

1) Nebido + HCG 'pregnyll'
2) Clomid + HCG + Testomax
3) Testomax

He explained each. Finally chose Nebido. Since the rest are a joke honestly.

I have 2days to decide since he already gave me the prescription which lasts 3 days since Nebido is a controlled drug. Or else I would need to see him again

So the protocol is

1) Nebido 250mgx4 which is 1000mg once every 3 month(12 weeks) Slow Intramuscular over 2minutes
After 6 weeks of my first shot there is a 1000mg booster shot.

#he mentioned that he may adjust it to 10 weeks between each injection depending on how I feel and blood work. Specially for lifters. Some get it every 9 weeks based on his lifting clients.#

2) HCG 5000 IU/ML 1. 500 units 3xweek in a month. So one week of a month i have 3 shots of 500 units hcg.

After reading Alot on trt on this forum and others. Many are using test cyp 2xweek at 100 to 200mgs. To keep steady levels. However requires more frequent pinning compared to Nebido.
And hcg eod of 250 to 500 units.
Also keeping on the side an AI(aromatize inhibitor) such as aromasine or arimidex . To keep E2 levels controlled if needed.

He told me you wont need it since my E2 is already very low. But if it increased he would give Clomid.
I'm scared my estrogen will increase and i have nothing on hand.....

In terms of pricing:

-Nebido is 102$ every three month. (prescription needed)
-HCG is 8$ (doesn't require prescription)

Guys I don't want to screw up myself from this urologist. I got a second opinion also but wasn't satisfied at all since he told me to live with it because I'm young and he fears infertility. I would risk that but not live my life depressed and low confidence, libido, energy all day. It sucks.

I'm thinking of starting it in two days if I don't get any other options or suggestions from experienced guys.

My friend who is a competitor (master's now +50 of age)
Told me I can get testosterone Cyp 250mgx10 ampules for 55$ to 68$ depending on quantity ordered and this is the best quality. There is cheaper ones but I won't risk it.

Please guys feel free to advise me on which route to take/ what to change or add.
Many thanks!

[kelkel]

Ok so you know your test is low. Question is why? Is it pituitary related or testicular related (secondary or primary) or a combination of both? I would never enter into TRT without knowing exactly why it's low and whether it can be fixed or not, especially at your age. I'd hate to have that on my conscience.

Some things that can/will effect hormone levels are thyroid, prolactin and cortisol. It would be nice to see these levels along with LH/FSH which shows pituitary finction. Have you suffered any head or testicular trauma? Been checked for varicoceles? So many things can play into this.

Regarding your choices, clomid is not a joke. It's a viable alternative and used by many as a form of TRT. Especially those who are young and concerned with procreation in the future. Problem is your doctor wants to add HCG in with it which is counter productive. HCG is suppressive to LH/FSH output over time while clomid is stimulatory. HCG is just not needed whatsoever in this scenario.

Testomax = no.

Re your doc giving you clomid to control E2 levels is another ridiculous option. Clomid will do nothing to control estrogen levels. WTF is he thinking, or actually not thinking....

There are plenty of guys here on Nebido and they will chime in soon. They all seem to love it as well. I don't quite understand the HCG protocol you listed with it though. You're saying that HCG is used only one week per month at a dosage of 500 IU's x 3? If so that's ridiculous. HCG should be used consistently for best results. It simply makes no sense to only take it one week out of the month. It would be like only taking a normal estered testosterone (cyp/en) for one week out of the month and expecting positive results. Won't happen. HCG is about far more than just maintaining testicular function. Read the sticky at the top of this forum on it please.

Do not self-medicate via your friend. That would be a mistake. I'd seriously press your doctor to find the causative factor here and discuss ways to correct it. If it's not possible then at least you can enter into TRT with a clear conscience.

[Youthful55guy]

I would be concerned about the knowledge and experience of the doctor giving you these options. As Kel mentioned, what doctor would prescribe clomid with HCG ???? Then again, what doctor would prescribe clomid with undetectable E2 levels??? Clomid is a Selective Estrogen Modulator (SERM) that specifically inhibits feedback of your nonexistent E2 on the hypothalamus to increase endogenous LH/FSH production. Without E2, there's nothing to block, so you get all the side-effects of clomid but none of the benefits. More than likely your E2 lavels are low because you are lean and there is little testosterone to serve as a substrate for aromatization.

Testomax???? Do I even need to comment on that one?

I agree with Kel too that you need to dig deeper to find the cause, especially at your age before starting on a lifelong drug. It's treating the symptoms without understanding the cause. I would look into prolactin levels first, particularly if you suddenly jump your T levels up with exogenous T. Your E2 levels will probably follow the T levels and the combination of higher E2 with high prolactin (if that is indeed the case) sets you up for the possibility of gynecomastia .

I also think you should look at the problem from a testicular level. Were you ever injured? Did the doctor check for a cystocele or other testicular anomalies that would make the testicles less responsive to gonadotropins. If that's the case, HCG would not do much at all.

Where do you live that HCG does not require a prescription?

[ShaRkKy]

deleted

[ShaRkKy]

Ok so you know your test is low. Question is why? Is it pituitary related or testicular related (secondary or primary) or a combination of both? I would never enter into TRT without knowing exactly why it's low and whether it can be fixed or not, especially at your age. I'd hate to have that on my conscience.

Some things that can/will effect hormone levels are thyroid, prolactin and cortisol. It would be nice to see these levels along with LH/FSH which shows pituitary finction. Have you suffered any head or testicular trauma? Been checked for varicoceles? So many things can play into this.

Regarding your choices, clomid is not a joke. It's a viable alternative and used by many as a form of TRT. Especially those who are young and concerned with procreation in the future. Problem is your doctor wants to add HCG in with it which is counter productive. HCG is suppressive to LH/FSH output over time while clomid is stimulatory. HCG is just not needed whatsoever in this scenario.

Testomax = no.

Re your doc giving you clomid to control E2 levels is another ridiculous option. Clomid will do nothing to control estrogen levels. WTF is he thinking, or actually not thinking....

There are plenty of guys here on Nebido and they will chime in soon. They all seem to love it as well. I don't quite understand the HCG protocol you listed with it though. You're saying that HCG is used only one week per month at a dosage of 500 IU's x 3? If so that's ridiculous. HCG should be used consistently for best results. It simply makes no sense to only take it one week out of the month. It would be like only taking a normal estered testosterone (cyp/en) for one week out of the month and expecting positive results. Won't happen. HCG is about far more than just maintaining testicular function. Read the sticky at the top of this forum on it please.

Do not self-medicate via your friend. That would be a mistake. I'd seriously press your doctor to find the causative factor here and discuss ways to correct it. If it's not possible then at least you can enter into TRT with a clear conscience.

thank you for your reply. I know i've been this way for over 2years now (with the symptoms)
I have been checked for varicoceles. clear. After all the examination he said that my testis are lazy. I didnt mention the other results that weren't on hand during the time of this post.

LH is 2.62 mIU/mL Normal Range is 1.7 - 8.6 mIU/mL
FSH is 1.85 mIU/mL Normal Range is 1.5 - 12.4 mIU/mL
Prolactin is 6.38 ng/ml Normal Range is 4.04 - 15.2 ng/mL

I know i was so confused when he mentioned clomid because i've been doing alot of reading lately and I was already following such matter earlier to my diagnosis.
I have noticed a knowledgeable member named marcus300 and I hope he can provide his input from his Nebido experience.

HCG is 3xweek / one week out of a month which I never read on forums that is actually practiced. Usually i see 3x week of 250iu to 500iu.....
I did question his practice when I was there and he told me all his patients are following the same protocol and its standard. the only thing he would change is injection frequency from 12 week to as low as 9weeks.

I know an AI should be on hand just in case my e2 rises but when i told him that he said yeah ill give you clomid?? :/
This urologist is recommended and is always booked. which seems weird.

I am going to purchase the nebido since my prescription expires after 2 days.. however i will not proceed unless I set my mind to it and get everything settled.

[ShaRkKy]

I would be concerned about the knowledge and experience of the doctor giving you these options. As Kel mentioned, what doctor would prescribe clomid with HCG ???? Then again, what doctor would prescribe clomid with undetectable E2 levels??? Clomid is a Selective Estrogen Modulator (SERM) that specifically inhibits feedback of your nonexistent E2 on the hypothalamus to increase endogenous LH/FSH production. Without E2, there's nothing to block, so you get all the side-effects of clomid but none of the benefits. More than likely your E2 lavels are low because you are lean and there is little testosterone to serve as a substrate for aromatization.

Testomax???? Do I even need to comment on that one?

I agree with Kel too that you need to dig deeper to find the cause, especially at your age before starting on a lifelong drug. It's treating the symptoms without understanding the cause. I would look into prolactin levels first, particularly if you suddenly jump your T levels up with exogenous T. Your E2 levels will probably follow the T levels and the combination of higher E2 with high prolactin (if that is indeed the case) sets you up for the possibility of gynecomastia .

I also think you should look at the problem from a testicular level. Were you ever injured? Did the doctor check for a cystocele or other testicular anomalies that would make the testicles less responsive to gonadotropins. If that's the case, HCG would do much at all.

Where do you live that HCG does not require a prescription?

thank you for your reply.
He said that my estrogen is low because testosterone is low. however clomid is just stupid. I agree.
Testomax is a joke yes. thank you

LH is 2.62 mIU/mL Normal Range is 1.7 - 8.6 mIU/mL
FSH is 1.85 mIU/mL Normal Range is 1.5 - 12.4 mIU/mL
Prolactin is 6.38 ng/ml Normal Range is 4.04 - 15.2 ng/mL

I live in the ME. country with the tallest building.
only nebido is a controlled drug. however hcg, aromasin , arimidex do not require a prescription.
I got the pricing of aromasin and arimidex and they are very expensive. both are almost same price of 180$.... is it this expensive usually?

[kelkel]

Well, at least his Nebido protocol seems relatively normal. HCG you can alter yourself as what he's recommending is basically retarded. He needs to crack open a book now and then and re-educate himself. Some docs just have a god complex and aren't open to patient input.

I don't know what the ME. country with the tallest building is? UAE, Dubai?

There are on line pharmacies where ancillaries can be purchased for very reasonable prices.

Oh, and Marcus will give you a glowing report on Nebido.

[ShaRkKy]

Well, at least his Nebido protocol seems relatively normal. HCG you can alter yourself as what he's recommending is basically retarded. He needs to crack open a book now and then and re-educate himself. Some docs just have a god complex and aren't open to patient input.

I don't know what the ME. country with the tallest building is? UAE, Dubai?

There are on line pharmacies where ancillaries can be purchased for very reasonable prices.

Oh, and Marcus will give you a glowing report on Nebido.

Yes I agreed on that from what I read on here. Haha that's for sure, need to introduce him to forums at least..
Yes correct.

hmm i will do some research and hopefully find something.
However do you recommend if I am willing to start trt, have an AI on hand? and which one. aro or ari. thanks

Yes I am waiting for him to comment because I cannot send him a private as of yet.....'new member'

[kelkel]

Rarely does someone need to start out with an AI. Normally that decision would be made after your first BW. Which in your case would/should be prior to your booster shot. Most here prefer Adex. If you know for sure your doc won't prescribe it then I'd probably try and source some ahead of time.

[Mr.BB]

Dont take nebido before you properly diagnose the reason why you have low testosterone .

Like kell mentioned above there are a lot medical reasons for your condition, and to patch it up with testosterone is a very lazy solution (to say the least).

[ShaRkKy]

Rarely does someone need to start out with an AI. Normally that decision would be made after your first BW. Which in your case would/should be prior to your booster shot. Most here prefer Adex. If you know for sure your doc won't prescribe it then I'd probably try and source some ahead of time.

Alright, I was supposed to get started with nebido however I postponed it after reading your posts guys. So now i'm thinking of doing another bw in two weeks. meanwhile I'm also still searching for another TRT/HRT specialist or urologist that actually is experienced in diagnosing the issue if there is one. But until now i get redirected to the one I started in the first place.

I already purchased the nebido and hcg . hcg is in the fridge and nebido in my closet. good that their expiry is in 2019 so i got time to figure it out lol. thank you

[ShaRkKy]

Dont take nebido before you properly diagnose the reason why you have low testosterone .

Like kell mentioned above there are a lot medical reasons for your condition, and to patch it up with testosterone is a very lazy solution (to say the least).

Yes i understand, which is why i still didnt proceed with the treatment. But I would like to know how can i get down to the sole reason of my bw results.... until now my first endocronologist who said your values are low but i will not prescribe now since you may shutdown and risk fertility in the long run. so give it a month or two and do another bw. the reason is that the produced amount is low.

The other urologist who is well known in my region and recommended by many, said that the signaling system for my body is lazy for it to produce enough T and gave me the prescription. I'm holding on to the trt until i confirm the diagnosis but figuring the reason is my concern now and I am not sure how i can do that... thanks

[Mr.BB]

Yes i understand, which is why i still didnt proceed with the treatment. But I would like to know how can i get down to the sole reason of my bw results.... until now my first endocronologist who said your values are low but i will not prescribe now since you may shutdown and risk fertility in the long run. so give it a month or two and do another bw. the reason is that the produced amount is low.

The other urologist who is well known in my region and recommended by many, said that the signaling system for my body is lazy for it to produce enough T and gave me the prescription. I'm holding on to the trt until i confirm the diagnosis but figuring the reason is my concern now and I am not sure how i can do that... thanks

What were the LH and FSH values on the bloodwork? cant you post the whole thing?

[ShaRkKy]

What were the LH and FSH values on the bloodwork? cant you post the whole thing?

Tests Results:

Testosterone Total: 4.48 nmol/L Normal range is 8.33 - 30.20 nmol/L
Free Testosterone: 4.5 pg/mL Normal Range is 7.0 - 22.7 pg/mL
TSH: 2.23 uIU/mL Normal range is 0.35-4.94
Estradiol: <5.00 pg/mL Normal Range is 7.63 - 42.6
LH: 2.62 mIU/mL Normal Range is 1.7-8.6 mIU/mL
FSH: 1.85 mIU/mL Normal Range is 1.5 - 12.4 mIU/mL
Prolactin: 6.38 ng/ml Normal Range is 4.04 - 15.2 ng/ml
Vitamin D: 29.17 ng/ml Insufficient 10-30 Sufficient: 30-100 Toxic: >100

these are what i did. also a normal blood panel which is all normal. thanks

[Youthful55guy]

That is very low T (both total and free). You say you've been lifting natural for 7 years any you have low BF (~9%). I'm beginning to wonder if you are overdoing the exercise. It is well documented that excessive exercise and dieting will decrease both T & E & fertility. In men the decreased E is probably a result of the decreased T. In both men and women, the mechanism is suppressed gonadotropin production (LH & FSH).

My recommendation is that before you start TRT at such a young age, that you first find the cause of the low T. I'm venturing to guess that it might be over exercise. You might want to consider cutting way back for a month and then repeating the tests.

[Mr.BB]

That is very low T (both total and free). You say you've been lifting natural for 7 years any you have low BF (~9%). I'm beginning to wonder if you are overdoing the exercise. It is well documented that excessive exercise and dieting will decrease both T & E & fertility. In men the decreased E is probably a result of the decreased E. In both men and women, the mechanism is suppressed gonadotropin production (LH & FSH).

My recommendation is that before you start TRT at such a young age, that you first find the cause of the low T. I'm venturing to guess that it might be over exercise. You might want to consider cutting way back for a month and then repeating the tests.

Agreed. Make sure you eat some good carbs.

[hammerheart]

That is very low T (both total and free). You say you've been lifting natural for 7 years any you have low BF (~9%). I'm beginning to wonder if you are overdoing the exercise. It is well documented that excessive exercise and dieting will decrease both T & E & fertility. In men the decreased E is probably a result of the decreased T. In both men and women, the mechanism is suppressed gonadotropin production (LH & FSH).

My recommendation is that before you start TRT at such a young age, that you first find the cause of the low T. I'm venturing to guess that it might be over exercise. You might want to consider cutting way back for a month and then repeating the tests.

Most guys underestimate their %bf, and while it's true dieting and nutrition do impact Test levels, quantitatively speaking I wouldn't say it's the case of OP unless he's being extremely unhealthy and malnourished.

Seven years of weight training doesn't mean overexercising, tell that to a 50yo construction worker... prolactin also is elevated in overtraining.

[hammerheart]

Agreed. Make sure you eat some good carbs.

I missed the good 'ol Mr.BB and his carb up advise

[Youthful55guy]

Here's an interesting case study on the effects of natural bodybuilding contest preparation on various health parameters. In particular, note the effect on T production. Granted, contest preparation is an extreme case, but it does validate that excessive exercise and calorie restriction impact on T product.

http://www.ncbi.nlm.nih.gov/pubmed/23412685

Abstract:
Bodybuilding is a sport in which competitors are judged on muscular appearance. This case study tracked a drug-free male bodybuilder (age 26-27 y) for the 6 mo before and after a competition. PURPOSE: The aim of this study was to provide the most comprehensive physiological profile of bodybuilding competition preparation and recovery ever compiled. METHODS: Cardiovascular parameters, body composition, strength, aerobic capacity, critical power, mood state, resting energy expenditure, and hormonal and other blood parameters were evaluated. RESULTS: Heart rate decreased from 53 to 27 beats/min during preparation and increased to 46 beats/min within 1 mo after competition. Brachial blood pressure dropped from 132/69 to 104/56 mmHg during preparation and returned to 116/64 mmHg at 6 mo after competition. Percent body fat declined from 14.8% to 4.5% during preparation and returned to 14.6% during recovery. Strength decreased during preparation and did not fully recover during 6 months of recovery. Testosterone declined from 9.22 to 2.27 ng/mL during preparation and returned back to the baseline level, 9.91 ng/mL, after competition. Total mood disturbance increased from 6 to 43 units during preparation and recovered to 4 units 6 mo after competition. CONCLUSIONS: This case study provides a thorough documentation of the physiological changes that occurred during natural bodybuilding competition and recovery.

[ShaRkKy]

That is very low T (both total and free). You say you've been lifting natural for 7 years any you have low BF (~9%). I'm beginning to wonder if you are overdoing the exercise. It is well documented that excessive exercise and dieting will decrease both T & E & fertility. In men the decreased E is probably a result of the decreased T. In both men and women, the mechanism is suppressed gonadotropin production (LH & FSH).

My recommendation is that before you start TRT at such a young age, that you first find the cause of the low T. I'm venturing to guess that it might be over exercise. You might want to consider cutting way back for a month and then repeating the tests.

It might be this cause but I've also had these symptoms even way back this year and wasn't in the shape i am in today. However my carbs are on a low now. of a 100g per day and now i am transitioning into my bulk.

[ShaRkKy]

Here's an interesting case study on the effects of natural bodybuilding contest preparation on various health parameters. In particular, note the effect on T production. Granted, contest preparation is an extreme case, but it does validate that excessive exercise and calorie restriction impact on T product.



Abstract:
Bodybuilding is a sport in which competitors are judged on muscular appearance. This case study tracked a drug-free male bodybuilder (age 26-27 y) for the 6 mo before and after a competition. PURPOSE: The aim of this study was to provide the most comprehensive physiological profile of bodybuilding competition preparation and recovery ever compiled. METHODS: Cardiovascular parameters, body composition, strength, aerobic capacity, critical power, mood state, resting energy expenditure, and hormonal and other blood parameters were evaluated. RESULTS: Heart rate decreased from 53 to 27 beats/min during preparation and increased to 46 beats/min within 1 mo after competition. Brachial blood pressure dropped from 132/69 to 104/56 mmHg during preparation and returned to 116/64 mmHg at 6 mo after competition. Percent body fat declined from 14.8% to 4.5% during preparation and returned to 14.6% during recovery. Strength decreased during preparation and did not fully recover during 6 months of recovery. Testosterone declined from 9.22 to 2.27 ng/mL during preparation and returned back to the baseline level, 9.91 ng/mL, after competition. Total mood disturbance increased from 6 to 43 units during preparation and recovered to 4 units 6 mo after competition. CONCLUSIONS: This case study provides a thorough documentation of the physiological changes that occurred during natural bodybuilding competition and recovery.

This is very relevant to my case... During my routine i got transferred to a cardiologist due to having a Heart Rate of 34 in the ECG test and did another one later with a resting BPM of 37.
Also my bloodpressure is 98/64mmHG. also my testosterone is affected as shown above in my results. and my mood is screwed up. cannot tolerate a joke. feeling like sh*t most of the time.

I'm transitioning into a clean bulk right now. I still didnt start anything from my prescription. although symptoms are still here....
thanks