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02-25-2018, 08:27 AM #1Junior Member
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189 ng/dL. Small pituitary gland. Starting Nebido in four days. Bloods inside.
Hello,
This is my first post, thanks for having me here.
I'm excited and scared at the same time. I wanted an advice on my situation, to understand it better.
I'm starting Nebido next week, I'm just wondering if I'm doing the right thing. I'm kinda scared actually. My Endo made me do a MRI and a few exams, and now we're ready to start.
Could you help me understand my situation?
I'm 29 years old, 6' tall, 33% body fat. No history of steroid use .
Lifted weights on and off for three years.
1) December 2017:
• Testosterone : 3.19 ng/mL (range: 2.7 - 10)
• Free Testosterone: 61 pg/mL (range: 75 - 124)
• Estradiol: 16 pg/mL (range: 11-45)
• FSH: 1.9 mUI/mL (range: 1.5 - 13)
• LH: 1.8 mUI/mL (range: 1-8)
• Prolactin: 11 ng/mL (range: 1.4 - 15)
• SHBG: 35 nMol/L (range: 13-71)
2) February 2018:
• Testosterone: 1.89 ng/mL
3) MRI contrast medium (translated, sorry if I made a few errors):
"Small pituary gland. The signal and the impregnation of the adenohypophysis are homogeneous. Sparsely visible the bright spot of the neurohypophysis (relief to be correlated with the clinic, in the absence of insipid diabetes, the relief is not to be considered pathological). In axis, of normal thickness the pituitary pedicle. Free the suprasellary tanks. No signal alterations of the cerebral parenchyma under and supra-enters. Median structures in axis. In the limits the ventricular system."
Thank you in advance for your support!
MarkLast edited by markwilliams; 02-25-2018 at 08:33 AM. Reason: Stats
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02-25-2018, 09:00 AM #2
Your hormone numbers are crap, you even have low estrogen coupled with high body fat (fat is where most of estrogen in the male is made).
Low LH/FSH points to a central or pit issue, but yours sounds fine, not idea what the technician meant by "small gland", probably more of a physiological variation with no pathological meaning.
So duh, I'd point to a central issue. Not doing the wrong thing with TRT imo but in the case I'd advise to lose some fat, as the Test surge in the system will aromatize (convert to estrogen) at an high rate (but really not so much with nebido) and that can hinder some of the benefits from TRT.
What are the symptom your experiencing, that led to the tests above?
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02-25-2018, 09:15 AM #3Junior Member
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Thanks for your answer.
The symptoms started in 2014, if I recall correctly.
I started to gain fat easily, libido dropped hard, difficulty to get hard and stay hard, pretty intense derealization (I sort of live in a bubble, and I don't feel the world as real). I bulked and cut a few times going back to the same body I always had, and generally in the last few months I can't get out of bed without some serious self talk. No energy whatsoever. Can't climb stairs properly, can't run, can't train with weights more than 15-20 minutes.
What's a central issue?
I believe it would have been easier to blame the pituitary gland but it doesn't seem like there's anything wrong with it.
I'm kinda scared actually because I'm starting Nebido with my endo (he's a very cool and straightforward guy) but without knowing why my numbers are this bad.
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02-25-2018, 09:24 AM #4
Sorry to know about the derealization I had that very badly with similar T levels, too.
Central I meant an issue within the hypothalamus, a small area of the brain that also commands the pituitary hormones.
Central hypogonadism is often obscure in etiology and referred to as "idiopathic" when there are no obvious and apparent causes, I'd just put mind at peace in your (mine too) case.
Don't be scared get it fixed you don't have to live in that "bubble".
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02-25-2018, 09:33 AM #5Junior Member
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02-25-2018, 10:04 AM #6
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02-25-2018, 10:56 AM #7Junior Member
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When did you think this started?
People that suffer from secondary hypogonadism in general, is it a gradual thing? Excluding pituitary tumors.
For example, I've always felt kinda lazy despite my inner motivation. Sex drive has been moderate for years, and i've always felt too tired to do sports in high school. You know, these things that now start to make sense.
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02-25-2018, 11:10 AM #8
I recall onset being very gradual, minor loss of interest starting around 22 (not that it has ever been great), at 23 I started believing I was asexual, at 24 I developed ED so bad I even experienced loss of sensation (sort of dick not being there) and that I point I understood I had an issue going on. Pulled T levels and they were 150 ng/dl.
Don't expect too much from nebido it takes some time to work, it's also recommended to do a booster pin at six weeks mark after first injection, maybe your endo already told you about this.
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02-25-2018, 11:13 AM #9Junior Member
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I've read about the booster, yes.
Why do you say don't expect too much? I've seen on their website that it takes A LOT of time to work (up to 24 months even). That's what you meant? Don't expect too much too soon?
From your experience if I have around 200 ng/ml, where should Nebido put me?
I'm also going to monitor how I feel since my endo want to space the pinning according to the protocol, but I've seen everywhere that 3 months is too much.
Cheers
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02-25-2018, 02:11 PM #10Junior Member
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UPDATE:
My endo just told me via e-mail that he won't be able to inject me Nebido, and that I'll have to find someone who does. Is this normal?
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02-26-2018, 02:55 AM #11Productive Member
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02-26-2018, 08:56 AM #12
Yeah be patient and let it do its job.
It's impossible to predict how your levels will far at any given point but I won't bother as long as you feel fine.
He's just being lazy, or going through an hectic schedule. You can ask GP to inject you with nebido, or find a nurse.
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02-26-2018, 02:04 PM #13
Can you just order some syringes from online and do your own injection? Will you get in trouble if you do that?
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02-27-2018, 01:20 PM #14Junior Member
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I have an appointment with my endo tomorrow, wish me luck.
My questions for him will be:
1) What are the causes for my condition? (in other words, WTF is going on)
2) Why isn't him giving me injections? Who's going to do that? Am I responsible for looking for someone to do them to me?
3) Does it make sense to do a DEXA my first week of treatment and another one a year later?
4) Do I pay for Nebido entirely or is it covered by some kind of insurance? (I currently live in Rome, Italy).
5) Is monitoring of the prostate necessary?
6) My family has a history of heart disease. Should I be worried?
7) Do I need aromatase inhibitors?
8) I'm currently sitting at 33%. Is this a problem or will it be?
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02-28-2018, 01:52 PM #15Junior Member
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My endo said that having a small pituary gland is an issue and we'll proceed with Nebido. So far so good.
The only problem is that he wants me to skip the 6 weeks booster. Nothing I could do to stop it, my parents are paying for Nebido, my dad was there and it simply isn't going to happen.
How bad is this? Skipping the 6 weeks booster I mean.
Regarding all my doubts the endo has been truly helpful, he's going to keep me monitored with bloods at month six, he gave me his personal e-mail, and he's generally a very professional guy.
When I asked him what my levels will be in a few months, he said "around 400 - 450 ng/dl, we don't want you more than that, it would be too much and you'll be fine with those levels".
Once again I raised an eyebrow but I'll stick to injecting and writing my symptoms. If I'm going to feel like shit he's going to know and we'll fix with a shorter timespan for Nebido. I don't want to feel like I fell now ever again in my life.Last edited by markwilliams; 02-28-2018 at 01:53 PM. Reason: Formatting
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02-28-2018, 03:12 PM #16Associate Member
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6) Low T actually carries cardiovascular risks, so fixing it will be good for your heart.
7) Most likely u won't, but only future blood work can tell.
8) Hopefully TRT will improve your body composition, plus u'll have more energy to exercise, and this issue will take care of itself.
By the way, if u don't like nebido, u can ask your doc if he can import cyp from another country (assuming u can't get it in Italy). I live in the EU as well, and my doc can get cyp from Germany. It only costs around 20$ a month, which is cheaper than nebido.Last edited by Ephemeral; 02-28-2018 at 03:14 PM.
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02-28-2018, 03:30 PM #17Associate Member
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I don't know much about nebido and how big an issue the 6 week booster is (there are some threads here about it though), but once I saved a graph from this forum, and as u can see, after the first shot your levels are not great, at the 6 week mark u're at 12.5 nmol/l (360 ng/dl) which is pretty low. After a while it gets better, but the levels are never too great or smooth in my opinion.
It can also tell u that the doc pulled the 400-450 number out of his ass, coz he didn't want to say that he had no idea.
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02-28-2018, 07:10 PM #18
Nebido is only covered by insurance in some regions of Italy but most do not subside it. I know this cause I'm Italian living in Italy, so if you need anything, just drop me a pm.
DEXA now and at one year mark makes perfect sense.
You do not need to worry about heart disease, most recent studies do point Test to help in that department.
You do not need AI with nebido (usually).
Being in a healthy shape is always a good thing anyway, so duh try to lose weight if you can
No need to worry about prostate at 29 either, maybe later
Your endo is lazy and doesn't want to pin patients arses (it's common).
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02-28-2018, 07:13 PM #19
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02-28-2018, 08:01 PM #20
Testoviron is marketed in Italy, but most endos nowadays refuse to prescribe it in favour of nebido, but protocols for Test E are of "old school" - 250mg every two weeks to one month (!).
450 before next pin is good enough imo, your levels are going to be much higher during most of the interval.
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03-01-2018, 09:48 AM #21Junior Member
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That's exactly what he said regarding my options: gels, injections every three weeks or Nebido.
450 before next pin is good enough imo, your levels are going to be much higher during most of the interval.
Where does a standard Nebido protocol put you? For ex. around 500 ng/dL, 700 ng/dL... etc.
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03-25-2018, 04:27 AM #22New Member
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I have used nebido for two years now with inject every 10 weeks. My t is 11 nmol/l with this protocol, so i think nebido sucks. I change the protocol now and split it to 1 ml every third week, but it feels like i need it every other week.
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03-25-2018, 09:53 AM #23Senior Member
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I've personally never used this long acting ester, but like aby form of T, I believe that the protocol needs to be customized to the individual. Doctors are being bombarded by advertising from the manufacturer (Bayer) with a one size fits all 3 month protocol that will be Gods gift to the TRT world. They have a vested interest in getting docs to prescribe their product. Also, the European regulatory agencies have a vested interest in getting patients onto this protocol (fewer doctor visits and lower costs). However, the variability in the response needs to be considered and that can only be determined by frequent labs during the first year (just like T-cyp or T-eth).
Bottom line, Nebido may turn out to have it's place in the TRT world by simplifying protocols but that does not negate the need for follow up labs every 6 to 8 weeks during the first year to optimize the protocol to the individual. Take the guesswork out of the equation and let the labs dictate the protocol.
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06-07-2018, 06:05 AM #24Junior Member
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Hello,
A quick update.
I did my second injection two days ago, on the opposite side of last time (I had two abscesses, so this time we injected in 2'30'' and massaged the area for a decent amount of time).
I skipped the booster since I couldn't find an endo that agreed to it and as a result weeks 4-10 have been TRASH. Sometimes I was crying in my bed at night, with no reason. No energy, ZERO libido. I took bloods on my own to determine what was going on (I attached them at the end of this message).
On week 11, I finally decided to inject and not wait till week 12. Nothing happened so far, but I'm positive.
||| Bloods - Week 8 after my first injection. |||
LH: 1.0 (1-8) [before starting treatment, LH was 1.8]
SHBG: 36 (13-71) [before starting treatment, SHBG was 38]
Testosterone : 3.85 (2.7 - 10) [before starting treatment, TEST was 3.20]
Free Testosterone: 74.6 (75-124) [before starting treatment, FREE TEST was 62]
What do you guys think?
Cheers
M.
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06-07-2018, 07:34 AM #25
LH should be suppressed, otherwise it means you are probably pulling your own endogenous T again, ie. it's like you stopped TRT and are recovering....
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06-07-2018, 08:39 AM #26Productive Member
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My test was around 15nmol 6 weeks after booster. Im confident it was a big help in feeling good. Wish you could have got it.
It will just take a long time to build up
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06-07-2018, 08:52 AM #27Senior Member
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What do I think? To be blunt, it's a shitty protocol. Now for the more constructive comments.
Bizzarro is correct. While on a good and stable TRT protocol, your LH should be below detection at all times. This is a strong indicator that your T levels are too low for a good TRT protocol, but then again, you TT and FT tests show that anyway. You should be at least mid-range.
SHBG is not a problem, so don't mess with that.
As I previously comments, Nibido may eventually have its place in the TRT world, but they haven't worked out optimum protocols yet. I also believe that with TRT, a one size fits all protocol is never the correct approach. You should do frequent labs at the start and use the data to steer the boat until it is on a steady course and then you can just do maintenance labs and minor adjustments.
Hope you get your boat on course.
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06-07-2018, 04:38 PM #28Junior Member
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There's something that has to be said: Nebido takes time to build up.
Before jumping ship I want to give it at least a full year, at 11 weeks intervals, or 10 if I will feel the need to shorten the interval.
It was data from my first injection with no booster, and I also had those two nasty abscesses in the second month, took antibiotics and cortisone for a week, something fucked up must have happened.
Regarding LH, I started Nebido three months ago. Should it indicate zero already?
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06-07-2018, 05:25 PM #29
Cant find my last bloodwork, but I think around 800 ng/dl at week 11.
But you are right, it is a silly question. Most men can be perfectly fine at 300 or 400 ng/dl. Its just a number, we are all slightly different human beings and there is no magic numbers up from which everybody will feel wonderful. Testosterone is a sex hormone, if you have less than you body needs you will eventually have side effects, but its a gradual slow process. If you have enough, you will feel normal, that does not mean you will never be depressed or unhappy, or even never have erectile dysfunction.
Nebido is a proven protocol, and one that works for the general public. General ppl do not want to self inject, or even inject at all. Reducing the number of injections it is important for the majority of non-AAS world.
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06-07-2018, 05:27 PM #30
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06-08-2018, 06:25 PM #31Junior Member
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Thank you for the encouraging answer, it means a lot. I really hope Nebido will work, injecting more often would be a pain in the ass for me. I just want to forget that I have this condition.
And you're right, my endo told me that I should feel ok with levels ranging from 320 to 380, but so far I felt like trash except when Nebido worked (week 2-3-4). I didn't feel incredible, I just felt OK.
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06-19-2018, 08:45 AM #32Junior Member
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UPDATE on my Nebido protocol:
Two weeks after my second injection (no booster) total test came at 520 ng/dL.
Small increase in libido and erections, a few hot flushes, no other major positive symptom. With a result this low, it makes me wonder how the hell am I going to last for another ten weeks.
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06-19-2018, 08:56 AM #33
You really needed the booster shot, its the protocol whats stated for a reason otherwise its going to take a lot longer for you to get up at decent levels. I've been on nebido for year and its far superior than any trt treatment I've ever used or seen. Keep with it you'll get there
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06-19-2018, 09:33 AM #34
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08-22-2018, 10:31 AM #35Junior Member
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UPDATE
Results of bloods, 10th week after the second injection of Nebido with no booster.
Testosterone 3.43 ng/mL
Free Testosterone 79.0 pg/mL
According to my symptoms and my diary, Nebido lasted around 5-6 weeks. That's quite shocking.
I finally followed hammerheart's suggestion and looked for an andrologist. The andrologist suggested I make the interval even shorter, at ten weeks, and to see what happens. He agreed to reduce it even further, in the future, down to eight weeks if necessary. He recommended to more exams after ten weeks. He said "let's start from ten, and see what happens".
So far my experience with Nebido has been terrible.
First injection: I felt ok for four weeks.
Second injection, I felt ok for five.
With both, during my "ok" time I often had mood swings.
M.
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08-22-2018, 11:04 AM #36Productive Member
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Thanks for the update.
Hate to hear that you're not doing well.
I am getting better and better at the latter weeks as the injection comes to an end. I was started in a ten week protocol including the booster.
I am unsure of what would be the answer but I would request the booster 6 weeks after your second injection due to the lack of it on the first. I believe you are put at a severe disadvantage starting without the booster
See what you can get from your new doc. But I would push for the booster if it was me.
Best of luck sir. Let us know how you do
Edit - misread your post. I would still push for booster in your 3rd pin. It will still aid in levels peaking sooner rather than later
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08-22-2018, 12:07 PM #37Junior Member
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Thanks for your support. I wish I started at a ten weeks protocol as well.
This new andrologist is firmly against the booster, and that makes him the fourth person I met who's against it.
But what I still can't wrap my head around is why they're all are against this booster shot. He says that I don't need it because my natural/base test levels are somehow decent (more or less 320 ng/dL) and that I'm not starting from zero. But he's very accomodating, and listened to my concerns. I'll find a way to contact him via e-mail and ask for the shot in six weeks.
My other option is to see how this third pin goes and when it starts to wear off, and see if I can push a shorter interval next time.
My preoccupation is that two weeks after my second injection (no booster) total test came at 520 ng/dL. Was that normal?
M.
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08-23-2018, 09:15 AM #38Senior Member
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Any doc, particularly one claiming to be an Andologist, that says this needs to go back and review his/her class notes from reproductive physiology 101. Testosterone has a relatively short half life in the body, on the order of a few hours. When you provide supplemental T, even at low doses, it will shut down endogenous LH production and thus endogenous T production. The body will quickly (within days) strip away any reserve T it has in the SHBG pool. So, your baseline T is going to be gone in a matter of a day or two.
As I've said many times, Nebido may someday have it's place in the TRT world, but they've got a long way to go to work out the protocols.
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08-23-2018, 10:05 AM #39
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08-24-2018, 06:15 AM #40
The booster wasnt something some moron thought about, it is the manufacturer recommendation. Why is the new andrologist against the booster? Whats his reasoning? I wouldnt trust a doctor that dont explains his reasons to me.
Still if no booster eventually the steady levels will be reached, it will just take longer. 520ng/ml are very normal levels for any adult to be able to function.
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