# STEROIDS FORUM > HORMONE REPLACEMENT THERAPY- Low T, Anti-Aging >  :HRT therapy Nebido:

## marcus300

Ive recently had a few questions regarding the new HRT therapy Nebido whats available, hopefully this thread will answer some of those questions I keep getting asked. Nebido is a 1000mgs 4ml amp of testosterone undecanoate set in castor oil.

When I was put on HRT a few yrs ago my Endocrinologist tried various therapies to bring my Testosterone levels back up to a level were I was feeling better, eventually we got this from Test E which was shot every 12-14 days, my life completely changed and the demons what I use to fight everyday finally went.

Over 18 months ago my Endocrinologist started to tell me about this new therapy what he wanted to try because it was claiming remarkable results, he quoted me study after study and told me this product is getting alot of headline news and many Endo's are talking about how this kind of application will out date every other method when its available world-wide.

i've been using this product now for over 12 months and ive found it to be far superior than any other HRT therapy i've ever used. My blood values are more stable than ive ever had and i feel like 21yrs old again,

There is a loading phase for the first 6 wks and then its one injection every 12 wks or in some case's 10 wks depending on how your BW comes back and what protocol your doctor use's.It has a very long half life which is why your doing a loading phase to bring blood values up and then a maintenance dose to keep them there, at first I wasn't convinced but after using it and reading the studies I cant recommend this product highly enough, its simply remarkable and definitely worth trying.

Below are some studies what have been done which make excellent reading, there are many more available but here a just a few:

2.5 yrs study- http://jcem.endojournals.org/cgi/con...ull/89/11/5429

8yrs study- http://www.agingmale2006.com/abstrac...onadal_men.asp

9 yrs study- Agingmale2006.com

http://www.expert-reviews.com/doi/ab...750708.3.6.709

http://www.drugs.com/nda/nebido_070828.html

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## zaggahamma

thanks marcus

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## marcus300

> thanks marcus


I know its not yet available in a few Countries but its worth looking into when it is, I have 4 injection a year which is amazing to what I use to have.

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## Merc.

I am on HRT also ( for many years ) .. I am using 100 mg of cyp EW ( which still has my total test - as well as free test ) levels on the high end ( of begin in range)..


I have been debating using this for quite some time ( was also looking into pellets ).. I think I am going to give the Nebido a try ..




Merc.

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## marcus300

> I am on HRT also ( for many years ) .. I am using 100 mg of cyp EW ( which still has my total test - as well as free test ) levels on the high end ( of begin in range)..
> 
> 
> I have been debating using this for quite some time ( was also looking into pellets ).. I think I am going to give the Nebido a try ..
> 
> 
> 
> 
> Merc.


What are your levels at that dose Merc?

Pellets?? are you talking about those time released pellets or is this something else?

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## Merc.

> What are your levels at that dose Merc?
> 
> Pellets?? are you talking about those time released pellets or is this something else?


Yea the time released test pellets ..

My latest bloodwork my total test levels were 987 Nanograms ( ng/DL ) ..

My free test was at 29.7 pg/mL ( the refrence ranges at the lab I use for free test is 8.7 - 25.1 pg/mL ) ... 


Merc.

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## marcus300

> Yea the time released test pellets ..
> 
> My latest bloodwork my total test levels were 987 Nanograms ( ng/DL ) ..
> 
> My free test was at 29.7 pg/mL ( the refrence ranges at the lab I use for free test is 8.7 - 25.1 pg/mL ) ... 
> 
> 
> Merc.


Yes I looked into these many yrs ago when they were only available for women and there was talk about using it for men, I am sure i read reports regarding the delivery of the drug wasnt consistent and there were massive fluctuations within the blood and there were problems with judging when the drug needed re-implanting, I've never tried them but I wouldnt swap anything for nebido, I believe its breaking all records but not sure if its available in the US yet, but worth a try when it is :Smilie:

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## Merc.

> Yes I looked into these many yrs ago when they were only available for women and there was talk about using it for men, I am sure i read reports regarding the delivery of the drug wasnt consistent and there were massive fluctuations within the blood and there were problems with judging when the drug needed re-implanting, I've never tried them but I wouldnt swap anything for nebido, I believe its breaking all records but not sure if its available in the US yet, but worth a try when it is


Yea not sure if it is in the USA yet .. I do kinda remember reading that they have extend the release date a few more months ..( I think they might have said it will be available in Nov or maybe it was Dec in the USA ).. 

When I checked a while back the FDA had concern about a couple of cases in Europe where the patient experienced a cough ( similar to tren cough ) after injecting the 4 ML of Nebido ..

I know they ( the FDA) were testing a 3ML ( 750 mg ) version of Nebido for the USA ( instead of the 1000 mg 4 ML like you have in Europe ).. but I havent checked recently if they plan on using a 3 ml ( 750 mg) version for the USA or the 4 ML like in Euorpe ...



Merc.

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## marcus300

> Yea not sure if it is in the USA yet .. I do kinda remember reading that they have extend the release date a few more months ..( I think they might have said it will be available in Nov or maybe it was Dec in the USA ).. 
> 
> When I checked a while back the FDA had concern about a couple of cases in Europe where the patient experienced a cough ( similar to tren cough ) after injecting the 4 ML of Nebido ..
> 
> I know they ( the FDA) were testing a 3ML ( 750 mg ) version of Nebido for the USA ( instead of the 1000 mg 4 ML like you have in Europe ).. but I havent checked recently if they plan on using a 3 ml ( 750 mg) version for the USA or the 4 ML like in Euorpe ...
> 
> 
> 
> Merc.


I know the release date is soon or from what ive read, but I didnt see anything about a smaller dose, there have been studies going on for 8 and 9yrs with 1000mgs and ive not seen anything regarding a smaller dose.

I think if people are really happy with their HRT therapy treatment they should stick with it, but with less injections and better stable levels in the mid to high end I guess it will make a few try it.

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## Merc.

> I know the release date is soon or from what ive read, but I didnt see anything about a smaller dose, there have been studies going on for 8 and 9yrs with 1000mgs and ive not seen anything regarding a smaller dose.
> 
> I think if people are really happy with their HRT therapy treatment they should stick with it, but with less injections and better stable levels in the mid to high end I guess it will make a few try it.




Here you go Marcus ... 


*Company Announces Revised Operating Plan to Respond to Nebido Delay*

LEXINGTON, Mass., June 30, 2008 /PRNewswire-FirstCall/ -- Indevus Pharmaceuticals, Inc. today announced that it has received an approvable letter from the U.S. Food and Drug Administration (FDA) for Nebido related to a New Drug Application (NDA) submitted to the FDA in August 2007. The letter, received on June 27, 2008, indicated that the application may be approved if the Company is able to adequately respond to certain clinical deficiencies related to the product. The letter generally confirmed the Company's previously-announced indications from the FDA based on telephone discussions.

The FDA has expressed a concern about a relatively small number of patients in European post-marketing use who have experienced respiratory symptoms immediately following the intramuscular injection of Nebido 1000 mg, 4 cc injection volume, (versus the 750 mg, 3 cc injection volume used in the United States). The Company believes and the FDA concurs that the reaction is likely the result of a small amount of the oily solution immediately entering the vascular system from the injection site, a known, rare complication of oil-based depot injections.

The phenomenon is characterized by short-term reactions involving an urge to cough, coughing episodes or a shortness of breath. In rare cases the reaction has been classified as serious or the patient experiences other symptoms such as dizziness, flushing or fainting. In the Company's U.S. clinical trials of Nebido 750 mg (3 cc injection volume), the proposed dose in the U.S., there was a single, mild, non-serious case of oil-based cough observed. In addition, the FDA believes that four cases in the European post-marketing experience may have an allergic, anaphylactoid component, although the Company believes these cases were improperly classified and represent the same oil-based phenomenon.

The FDA has requested the Company address these clinical deficiencies by providing detailed safety information from clinical studies to determine the precise incidence of serious post-injection oil-based reactions and allergic reactions. Specifically, the FDA has requested follow-up data from the on-going U.S. and European studies in which patients are being treated with Nebido on an extended basis. A majority of these trials are scheduled to be completed within twelve months. The FDA stated that depending on the findings, the number of subjects and the number of injections of testosterone undecanoate from the studies listed above, the safety database may need to include data from additional clinical studies. They have requested that the Company propose the size of the safety database (i.e., total number of subjects exposed to testosterone undecanoate intramuscular injection and total number of injections) and the rationale for the size of the proposed safety database.

FDA has also requested the Company provide a plan to minimize the risks associated with the clinical use of testosterone undecanoate intramuscular injection, namely, to reduce the incidence and/or severity of the serious oil-based reactions and has requested certain in vitro and skin-testing data to exclude an allergic component to the drug or some of its excipients.

Glenn L. Cooper, M.D., chairman and chief executive officer of Indevus stated, "We believe that Nebido is a safe and effective drug for its intended use and continue to be disappointed that the FDA was not willing to approve the drug at this time with adequate labeling of the oil-based reactions and how to minimize them with proper injection technique. However, we are encouraged that this approvable letter provides a road map for the product's eventual approval. We will work with the FDA and our partner, Bayer Schering Pharma AG, to respond to the approvable letter and devise a plan to address the deficiencies. While the FDA has not specifically requested additional clinical studies, we believe that an additional study will likely be required to demonstrate that Nebido 750 mg (3 cc volume) administered with careful and proper intramuscular injection technique, has an acceptably low incidence of oil-based reactions to gain approval. In addition, we are pleased that FDA has provided guidance on how we can demonstrate that the product does not cause allergic reactions. We hope to be able to articulate a development plan to address FDA concerns within the next few months, and for now are maintaining our previous guidance that it may take the Company approximately 18 months to re-submit the revised NDA. We will communicate specific guidance on clinical plans and timelines when they are available."

Link to above copy and paste .. http://www.drugs.com/nda/nebido_080630.html


And Heres info on the release date ..


*Testosterone drug Nebido to treat low sexual libido in men delayed in US*


Thursday, September 3, 2009, 17:21 

Nebido, a testosterone drug for men with low sexual drive from Endo Pharma, has been delayed for approval in US.

Testosterone treatment Nebidos review date has been extended by three months by the U.S. Food and Drug Administration. USFDA, however, did not request for additional data, said Endo Pharmaceuticals Holdings Inc in an official release.

US FDA extended the review date for Nebido from Sept. 2 to Dec. 2 and has stated that it needs more time to complete its review of the application and finalize the risk evaluation and mitigation strategy (REMS) for the long acting version undecanoate of the testosterone product.

Nebido is already approved outside the United States as a treatment for hypogonadism or low testosterone .

Nebido, discovered and developed by Bayer Schering Pharma AG, Germany, has subsequently been approved in 86 countries worldwide and is available in more than 50 countries across Europe, Asia Pacific and Latin America.

Our goal is to make this significant new treatment option available to the millions of men in the U.S. suffering from low testosterone, stated David Holveck, president and chief executive officer of Endo Pharmaceuticals.

Nebido was licensed by Bayer Schering Pharma to Indevus Pharmaceuticals, a company that Endo acquired earlier this year.


And heres the link to that info 

http://www.dancewithshadows.com/pill...delayed-in-us/



I cant wait ... I am starting to get excited now.. I am definitely going to give it a try  :7up:  :7up:  :7up:  ... Thanks for your info on it ( i was wanting to get some feedback from someone who has use it ...


Merc.

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## marcus300

The coughing can occur from any type of injection if you nick a vein lol, kind of funny that one.

Its a shame if the US are going to go with the 750mgs injection instead of the 1000mgs one because of all the remarkable studies what have come through with the bigger dose, but I do feel it will still break results in the field of HRT, i know a few guys who have started this treatment in the UK who are very pleased with it.

Guess time will tell

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## Merc.

> The coughing can occur from any type of injection if you nick a vein lol, kind of funny that one.
> 
> Its a shame if the US are going to go with the 750mgs injection instead of the 1000mgs one because of all the remarkable studies what have come through with the bigger dose, but I do feel it will still break results in the field of HRT, i know a few guys who have started this treatment in the UK who are very pleased with it.
> 
> Guess time will tell



Yea I thought that was funny also ( the cough part).. 

I hope they go with the 1000 mg dose in the USA as well.. I mean like you said .. all the studies ( for many years are done with that 1000mg dose ).. 



Merc.

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## marcus300

> Yea I thought that was funny also ( the cough part).. 
> 
> I hope they go with the 1000 mg dose in the USA as well.. I mean like you said .. all the studies ( for many years are done with that 1000mg dose ).. 
> 
> 
> 
> Merc.


With 4 injection every year, half the planet will be on it sooooon  :Smilie:

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## Merc.

> With 4 injection every year, half the planet will be on it sooooon


I agree.. Screw this dam weekly injection for HRT shit.....



Merc.

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## flatscat

> I agree.. Screw this dam weekly injection for HRT shit.....
> 
> 
> 
> Merc.



I'll throw in with you on that one -

Flats

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## Merc.

> I'll throw in with you on that one -
> 
> Flats


Yea cant wait until Dec .. so i only have to do 4 shots per year.( SWEET)






Merc.

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## zaggahamma

as inexpensive as my cyp??????????????

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## Merc.

Sup Jpk

Not sure what $ is going be in the USA... 



Merc.

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## zaggahamma

> Sup Jpk
> 
> Not sure what $ is going be in the USA... 
> 
> 
> 
> Merc.


finally got one by

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## kesam1

My experience with Nebido is that unless injected at 8 week intervals it can cause a rollercoaster and even then I prefer to split the 4cc into 4 different injections and shoot every 2 weeks.

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## marcus300

> My experience with Nebido is that unless injected at 8 week intervals it can cause a rollercoaster and even then I prefer to split the 4cc into 4 different injections and shoot every 2 weeks.


Did you do the loading phase for the first 6 wks?

Did your have bloodwork done?

I know including myself around 5 people who are using Nebido and 4 of us are doing 1 every 12 wks and one is doing 1 every 10 wks, strange your having a rollercoast ride unless you didnt load correctly, but if for some reason your different than most 8 wks is still great but your the only one ive seen under 10 wks.

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## Vettester

Wow, this is very interesting! I'm going to talk to my HRT team and see if this can be implemented into my program for next year. Thanks for sharing this, Marcus.

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## marcus300

http://www.fiercebiotech.com/node/7168

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## warchild

aww fvck, i forgot to ask my trt doc about nebido...how would it work if i want to do a cycle of test with nebido???

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## Charlie6

yea bump for this question ^^

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## marcus300

> aww fvck, i forgot to ask my trt doc about nebido...how would it work if i want to do a cycle of test with nebido???


Guess there are two ways to go about it and it would depend when you started the cycle because of the long ester I would cycle on and off a course while maintaining the HRT dose, starting a cycle at the start of a injection of HRT that will give you 3 months to finish the cycle before the nexted shot but you would have to take in consideration the HRT dose when planning the cycle, or you could not take the next shot of HRT and start a cycle and finish it when your ready for the next HRT injection in 12 wks, which ever suits you better.

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## zaggahamma

> Guess there are two ways to go about it and it would depend when you started the cycle because of the long ester I would cycle on and off a course while maintaining the HRT dose, starting a cycle at the start of a injection of HRT that will give you 3 months to finish the cycle before the nexted shot but you would have to take in consideration the HRT dose when planning the cycle, or you could not take the next shot of HRT and start a cycle and finish it when your ready for the next HRT injection in 12 wks, which ever suits you better.


i would just jab more when i felt like it

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## kesam1

> Did you do the loading phase for the first 6 wks?
> 
> Did your have bloodwork done?
> 
> I know including myself around 5 people who are using Nebido and 4 of us are doing 1 every 12 wks and one is doing 1 every 10 wks, strange your having a rollercoast ride unless you didnt load correctly, but if for some reason your different than most 8 wks is still great but your the only one ive seen under 10 wks.


Load was carried out ie 2nd jab at six weeks, levels prior to week 12 injection were 19 Doc prescribed next injections (self administered) at 9 week intervals but was happy to let me go to 8 if felt the need. I had my third full 4ml jab at week 12 (used this as another load) and have since done 1ml every 2 weeks. Started on liquidex 0.25 eod and crashed my e2 (not tested) I have only just got the liquidex dosage where i feel good at 0.25ew. 

I feel the 12week load inj I did was unnecessary and stupid of me but the 1ml e2w is now feeling lovely and now on week 18 the 2nd load from week 12 should be dying out and I hope not so much E2 trouble.

I love the nebido and 8 to 9 weeks seems correct for me but splitting it I feel will stop the large rise in t and e2 post injection. imo

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## ottomaddox

I'd pay anything to not have to inject every 10 days.

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## marcus300

http://emc.medicines.org.uk/document...cumentId=15661

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## BREW-MAN

i got this on the black market,whoop whoop.

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## FlyingIllini

Anyone see a blood work profile over the 12 wks to see how the blood levels of testosterone vary ?

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## marcus300

> Anyone see a blood work profile over the 12 wks to see how the blood levels of testosterone vary ?


Read the studies what ive posted, there are many more and all with detailed BW, some of the studies were taken over 2.5yrs,8yrs and 9 yrs

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## BJJ

Very interesting thread.

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## Sharky72

Anybody have a update on this? Thanks

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## marcus300

> Anybody have a update on this? Thanks


Update on what exactly?

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## lovbyts

I think he is/was referring to is it available in the US yet.  :Frown:

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## marcus300

The drug is approved in 86 countries but recently in the US its come across a delay due to the FDA having concerns about post injection anaphylactic reactions as well as pulmonary oil mircoembolisms, further studies are taking place but Schering stated it will be approved but some opposition have delayed the launch.

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## martyjack

Marcus....you seem to have alot of experience with Nebido! I just recently started Nebido....I take my second injection in a week! I just want to see if you have estrogen problems....do you take arimidex and how often? Do you include any HCG for testicle shrinkage....if so how often? Also my semen levels and morning wood are non-existant. I have been on HRT for about six years...so these symtoms were already there. Can you please give any advice? Thanks

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## marcus300

> Marcus....you seem to have alot of experience with Nebido! I just recently started Nebido....I take my second injection in a week! I just want to see if you have estrogen problems....do you take arimidex and how often? Do you include any HCG for testicle shrinkage....if so how often? Also my semen levels and morning wood are non-existant. I have been on HRT for about six years...so these symtoms were already there. Can you please give any advice? Thanks


How are you taking your Nebido? what is your frontload?

I dont take anything for estrogen related sides because I dont suffer any while on Nebido, but if your prone I would keep something to hand like a-dex.

I have done HCG to keep my testicles full for cosmetic purposes but I dont anymore because it doesnt bother me having some shrinkage, 

While on HRT you semen levels do go down alot or the amount of fluid does, have you had any bloodwork done to see what levels you are, how is your sex drive? do you have erection problems? what was your previous HRT protocol

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## martyjack

Marcus,
The front load on the Nebido was the entire vial....think 4ml? I go back soon and take the second one...then suppose to to wait 4 months.
I'm from the US....working a job here in Israel and I had done some reading about Nebido...went to the Endo guy...the rest is history. I was sorry to see it got shot down again in the US! I was just tired of the weekly shots...I was injected about 150-165-mg Testeviron 250 weekly...been doing that for about eight months. In the US, i was taking weekly depot-testosterone 200 shots....tried the gel, patches, etc. I just can't seem to get a good balance without feeling like crap or not getting the best I can from the HRT. I first started on Androgel in 2001....six months on that was the best I've felt in years! Then everything fell off, couldn't keep my levels up, etc. My job has kept me on the move alot....I can sympathize with all the people having trouble finding physicians who understand HRT! I have had my share! I think I have tried them all...just can't get things exactly right. My libido is suffering...think it could be much better! I don't have much punch when I unload during sex! The amount of semen is nothing like it should be!
How do you tell if your estrogen is high....do you feel bloated.....water weight? Do you think .25 EOD arimidex could help?I have access to HCG ...5000.......not sure how to break that down in small amounts given the water to mix it with?
Give me a routine you think will help me with the Nebido...please. I'm 45..5'10", 220lbs, not fat, but need to loose about 20 lbs. 
Thanks,
Marty

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## marcus300

> Marcus,
> The front load on the Nebido was the entire vial....think 4ml? I go back soon and take the second one...then suppose to to wait 4 months.
> I'm from the US....working a job here in Israel and I had done some reading about Nebido...went to the Endo guy...the rest is history. I was sorry to see it got shot down again in the US! I was just tired of the weekly shots...I was injected about 150-165-mg Testeviron 250 weekly...been doing that for about eight months. In the US, i was taking weekly depot-testosterone 200 shots....tried the gel, patches, etc. I just can't seem to get a good balance without feeling like crap or not getting the best I can from the HRT. I first started on Androgel in 2001....six months on that was the best I've felt in years! Then everything fell off, couldn't keep my levels up, etc. My job has kept me on the move alot....I can sympathize with all the people having trouble finding physicians who understand HRT! I have had my share! I think I have tried them all...just can't get things exactly right. My libido is suffering...think it could be much better! I don't have much punch when I unload during sex! The amount of semen is nothing like it should be!
> How do you tell if your estrogen is high....do you feel bloated.....water weight? Do you think .25 EOD arimidex could help?I have access to HCG ...5000.......not sure how to break that down in small amounts given the water to mix it with?
> Give me a routine you think will help me with the Nebido...please. I'm 45..5'10", 220lbs, not fat, but need to loose about 20 lbs. 
> Thanks,
> Marty


What I mean by frontload is how are you loading the Nebido? are you doing one injection then again in 6 wks then every 12 wks? what loading protocol did your endo advice?

You need to get bloodwork done after you have loaded the nebido and see what Test/estrogen levels your at.

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## martyjack

Yes, that's exactly right....first injection, then six weeks, then 12 weeks. The endo didn't want to do any lab work until about a week before my 3rd injection.

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## marcus300

> Yes, that's exactly right....first injection, then six weeks, then 12 weeks. The endo didn't want to do any lab work until about a week before my 3rd injection.


Yes i guess he is right, just wait till you get bloodwork, he will adjust the injections closer if you need it and he will tell you if your estrogen balance is out, the low libido could do with the transition from the one therapy to another

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## marcus300

*December, 2010*

*Testosterone replacement therapy for the treatment of male hypogonadism – results from the largest international study 1493 patients from 23 countries joined this study; of these 1123 completed a series of five injections of supplementary testosterone.*

All patients had lower than normal levels of testosterone at the start of treatment. The average age of men taking part was just over 49 years. Some suffered from other conditions such as hypertension (high blood pressure) and diabetes.

The findings of this study were presented to the Men’s Health World Congress, 2010 held in France.

*Key findings*Increasing testosterone levels to normal levels by a series of injections improved the symptoms of testosterone deficiency 
The percentage of patients who reported “low” or “very low” levels of sexual desire/libido fell from 64% at the start of treatment to 10% by the end 
Before treatment 67% of patients said they had moderate, severe, or extremely severe erectile dysfunction (ED). This decreased to 19% after treatment with 61% of patients with some degree of ED reporting an improvement 
Treatment also improved patients ability to concentrate as well as their mood 
The average waist measurement of the patients fell from 100 cm to 96 cm 
Some patients (6%) reported side effects which were mostly mild to moderate in severity 
Overall 89% of patients said they were “satisfied” or “very satisfied” with their testosterone replacement treatment 

*Source:* IPASS: Final data from the worldwide largest study of the tolerability and effectiveness of injectable testosterone undecanoate (TU) for the treatment of male hypogonadism involving 1493 patients. M Zitzmann, JU Hanisch, A Mattern, M Maggi. A presentation to the Men’s Health World Congress 2010.

*Background information*
Testosterone is an essential male hormone, produced in the testes in a man, which helps to keep our minds and bodies functioning properly. In particular, testosterone enables a man to have erections and experience sexual desire (libido). It also helps to maintain:

Muscle strength and function 
Healthy bones 
Positive mood 
Physical energy 
Male hypogonadism is a condition associated with low testosterone (T) levels.
The impact on men’s health of low testosterone can include:

Lack of energy 
Depression 
Loss of libido 
Loss of facial and body hair 
Changes to body composition (for example, low muscle mass and increased fat mass)
Men with low testosterone are also at increased risk of:

Cardiovascular disease 
Diabetes and metabolic syndrome 
Osteoporosis 
Restoring testosterone levels in men (with lower testosterone levels than normal) can potentially lead to some beneficial effects. Researchers found that patients experienced some of these benefits in this large international study.

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## trix8

Marcus do you take an AI or HCG ? Also any other hormones like dhea with it because from reading your different posts it sounds like you just use the one compound compared to most of us on all kinds of things to calibrate our hormones.......It would almost seem too perfect if all my hrt routine was to go to the doctor 4-5 times a year and have no ups and downs.

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## marcus300

> Marcus do you take an AI or HCG? Also any other hormones like dhea with it because from reading your different posts it sounds like you just use the one compound compared to most of us on all kinds of things to calibrate our hormones.......It would almost seem too perfect if all my hrt routine was to go to the doctor 4-5 times a year and have no ups and downs.


I use to use hcg but I dont anymore, size doesnt bother me and I dont have any issues,

I dont use an AI or DHEA and all my levels are within range,

I use Nebido every 12 weeks (1000mgs 4ml TU) and thats it, nothing else.

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## marcus300

*October, 2010*
*Boosting testosterone improves mood and other 'quality of life' measures in older men
A Russian study, published in the Journal of Sexual Medicine in July 2010, looked at how men with metabolic syndrome (Met S) and hypogonadism responded to treatment with either a placebo (safe, dummy medicine) or testosterone (Nebido®) injections.*Key findings

Following treatment with additional testosterone (Nebido®) to reach 'normal' testosterone levels , men in the trial (average age 51) reported feeling and functioning better. They also lost weight. These improvements to quality of life measures were significantly better than the results achieved by the placebo.

The most significant improvements to quality of life scores were reported by those men who had the lowest levels of testosterone at the start of the study.

Patients felt better and functioned better when they lost weight and the more weight they lost, the more they improved.

The study suggests that testosterone supplementation alone may improve depression in men with Met S and hypogonadism.

There were no health issues associated with the testosterone therapy .

Source: “Effects of testosterone supplementation on depressive symptoms and sexual dysfunction in hypogonadal men with the metabolic syndrome.” Giltay EJ, Tishova YA, Mskhalaya GJ, et al. J Sex Med. 2010 Jul;7(7):2572-82. 

Background information
Metabolic syndrome (Met S) is a group of conditions linked to being overweight or obese: three or more of these conditions together is sufficient for a diagnosis of Met S. These conditions or characteristics are:

A large waistline 
A higher than normal fat level in the blood – the so-called 'triglyceride level' 
A lower than normal HDL ('good') cholesterol level 
Higher than normal blood pressure 
Higher than normal blood sugar 
People with Met S are at greater risk of heart disease and diabetes. It is also associated with poor sexual and personal well-being.

Hypogonadism (or low testosterone ) occurs when the testes produce little or none of the hormone testosterone, or sperm. Low testosterone is associated with Met S as well as with depression, low energy and sexual problems, (ie poor quality of life indicators).

Testosterone levels naturally fall over the age of about 40, but hypogonadism is not only associated with older men.

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## The Toad

Has anyone heard anything on when this will be available in the US

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## Spartans09

The FDA reviewed it about a year and a half ago and put it on hold. The oversimplified reason was a couple of people in the trial out of hundreds or more had shortness of breath or coughing for a couple of minutes because they injected part of the 4 cc load into a vein which runs it to the lungs and causes those symptoms for a couple of minutes. Gotta love the fvcking government.

----------


## Times Roman

> Ive recently had a few questions regarding the new HRT therapy Nebido whats available, hopefully this thread will answer some of those questions I keep getting asked. Nebido is a 1000mgs 4ml amp of testosterone undecanoate set in castor oil.
> 
> When I was put on HRT a few yrs ago my Endocrinologist tried various therapies to bring my Testosterone levels back up to a level were I was feeling better, eventually we got this from Test E which was shot every 12-14 days, my life completely changed and the demons what I use to fight everyday finally went.
> 
> Over 18 months ago my Endocrinologist started to tell me about this new therapy what he wanted to try because it was claiming remarkable results, he quoted me study after study and told me this product is getting alot of headline news and many Endo's are talking about how this kind of application will out date every other method when its available world-wide.
> 
> i've been using this product now for over 12 months and ive found it to be far superior than any other HRT therapy i've ever used. My blood values are more stable than ive ever had and i feel like 21yrs old again,
> 
> There is a loading phase for the first 6 wks and then its one injection every 12 wks or in some case's 10 wks depending on how your BW comes back and what protocol your doctor use's.It has a very long half life which is why your doing a loading phase to bring blood values up and then a maintenance dose to keep them there, at first I wasn't convinced but after using it and reading the studies I cant recommend this product highly enough, its simply remarkable and definitely worth trying.
> ...


cool! I just emailed my kaiser endo so let's see if he is open to new ideas?

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## marcus300

Not sure when it will become worldwide available but I'm sure it will be coming soon, FDA were concerned about painful injection sites and slight other concerns but hey what do you expect when your sticking needles in you  :Smilie:

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## zaggahamma

marcus...how long were you injecting with weekly doses before you went the nebido route and do you endorse it over weekly 100% or are there any pros/cons to consider?

----------


## marcus300

I was on Test E for around 12 months before going on Nebido and the Test E was great, no issues what so ever only slight dip in libido when the next injection was due but could of been in my head  :Smilie:  but once I started Nebido I could tell a huge difference, I felt like 21yr old again with a sex drive to match, I could maintain some good size on it and I felt the best ive ever have since going on HRT. Without doubt for me Nebido is the king of HRT and with only 4 injection a year it cant be matched. I cant see any con's only pro's for Nebido.

If you check out the studies ive posted some going on for 8yrs and 7yrs you will see what its capable of doing when its up against Test E or other HRT treatments, but like anything you have to try it and see if you prefer it or not, for me its No1 treatment 100%.

----------


## blacksmoke

Do you know if it is available in Canada?

----------


## streeter

Call me a pessimist but I bet all those HRT clinics in Florida (Like the one I use) will not like this new drug unless they can charge an arm and a leg for it because they will not like loosing money on 4 injections a year. Or they just won't carry it. But I think they will they will just make it very expensive so it equals what you would have paid for a year of Test Cyp or E

----------


## marcus300

> Call me a pessimist but I bet all those HRT clinics in Florida (Like the one I use) will not like this new drug unless they can charge an arm and a leg for it because they will not like loosing money on 4 injections a year. Or they just won't carry it. But I think they will they will just make it very expensive so it equals what you would have paid for a year of Test Cyp or E


I am sure some politics will come into it somewhere along the line , shame if it does

----------


## marcus300

> Do you know if it is available in Canada?


Not sure, why don't you ask about at your doctors.

----------


## Times Roman

> Ive recently had a few questions regarding the new HRT therapy Nebido whats available, hopefully this thread will answer some of those questions I keep getting asked. Nebido is a 1000mgs 4ml amp of testosterone undecanoate set in castor oil.
> 
> When I was put on HRT a few yrs ago my Endocrinologist tried various therapies to bring my Testosterone levels back up to a level were I was feeling better, eventually we got this from Test E which was shot every 12-14 days, my life completely changed and the demons what I use to fight everyday finally went.
> 
> Over 18 months ago my Endocrinologist started to tell me about this new therapy what he wanted to try because it was claiming remarkable results, he quoted me study after study and told me this product is getting alot of headline news and many Endo's are talking about how this kind of application will out date every other method when its available world-wide.
> 
> i've been using this product now for over 12 months and ive found it to be far superior than any other HRT therapy i've ever used. My blood values are more stable than ive ever had and i feel like 21yrs old again,
> 
> There is a loading phase for the first 6 wks and then its one injection every 12 wks or in some case's 10 wks depending on how your BW comes back and what protocol your doctor use's.It has a very long half life which is why your doing a loading phase to bring blood values up and then a maintenance dose to keep them there, at first I wasn't convinced but after using it and reading the studies I cant recommend this product highly enough, its simply remarkable and definitely worth trying.
> ...


Marcus,
My California Endo just emailed me and explained that Nebido is not FDA approved, and therefore not available in the US. FYI

----------


## marcus300

> Marcus,
> My California Endo just emailed me and explained that Nebido is not FDA approved, and therefore not available in the US. FYI


Yes I know,

----------


## Times Roman

But I'm not in the US no more, and I'm going pharm shopping tomorrow, so maybe I'lll add it to my list

----------


## BeastintheSheets

Marcus, are your balls exhibiting any negative feedback? Are they shrunken in comparison? Mine don't even shrink on my TRT doses really. How are your lipids on the Nebido? Sex drive? Appetite? It seems cool and convenient as I pretty much deal with a 2 day spike and then 2 days of normal and then nothing. lol

----------


## optionsdude

> Call me a pessimist but I bet all those HRT clinics in Florida (Like the one I use) will not like this new drug unless they can charge an arm and a leg for it because they will not like loosing money on 4 injections a year. Or they just won't carry it. But I think they will they will just make it very expensive so it equals what you would have paid for a year of Test Cyp or E


I asked my clinic about Nebido and you are right they don't like it. The rep told me its just a long acting ester no better than the test cyp. I am currently using. Less injections are better in my book.

----------


## marcus300

> Marcus, are your balls exhibiting any negative feedback? Are they shrunken in comparison? Mine don't even shrink on my TRT doses really. How are your lipids on the Nebido? Sex drive? Appetite? It seems cool and convenient as I pretty much deal with a 2 day spike and then 2 days of normal and then nothing. lol


Ive been on hrt for many years so my testicles have shrunken but thats the normal on hrt unless you apply a hcg protocol.

Ive never been healthier, like ive stated many times my sex drive is like when i was 21yrs old and my blood work is fine, i have no issues what so ever and its far the best hrt ive ever used or tried.Read the whole thread and studies it make interesting reading.

----------


## marcus300

> I asked my clinic about Nebido and you are right they don't like it. The rep told me its just a long acting ester no better than the test cyp. I am currently using. Less injections are better in my book.


If your happy with your hrt then no need to change but your clinic will put you off it because they wont make as much money from it. But trust me imho nebido is far better than cyp or test e but guess you would have to use it to find that out but you can read the studies on it what ive posted in this thread to give you more knowledge on it.

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## GotNoBlueMilk

My doc gives me the vial and needles for my TRT. He won't lose any money if I switch to this since I only see him once every 3-4 months anyway now. In fact, he probably would make more money because of the extra monitoring during the switch from cyp to this.

----------


## marcus300

> My doc gives me the vial and needles for my TRT. He won't lose any money if I switch to this since I only see him once every 3-4 months anyway now. In fact, he probably would make more money because of the extra monitoring during the switch from cyp to this.


If your happy with your current therapy stick with it, but once its available in your Country I am sure your endo will tell you more about it.

----------


## Morrille

Hey Marcus!
I wonder. Would it have a positive effect on building muscles if U take 1 amp of 1000 mg every 2 weeks? Or is it not possible because of the slow release?

----------


## JimmySidewalk

It has a very slow release, thus needing only 4 injects per year after frontloading is done. It test undecanoat, the slowest ester.
Because of this, i dont think it would be ideal in muscle building purposes.

BTW 1 amp=4ml

----------


## marcus300

> Hey Marcus!
> I wonder. Would it have a positive effect on building muscles if U take 1 amp of 1000 mg every 2 weeks? Or is it not possible because of the slow release?


Yes of course taking 1000mgs every 2 wks will have a positive effect on building muscle tissue. If your using Nebido for your therapy why dont you just blast with Test E or similar.

----------


## Shol'va

Be prepared to pay some mighty big bucks for this here in the States as it will only be available in name brand and not generic so they will charge out the ying yang just like they do on Androgel .....

----------


## JimmySidewalk

edit, no price talk, pls read the rules  Dont know the situation in US but if you get a prescription order it via internet or on your next european vacation buy a hefty supply of nebido cheaper than US.
The one i'm talking about is a brand from Germany, wont name it because of the rules, though i think its the only one that produces it.

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## zaggahamma

who edit/edited...confused

----------


## JimmySidewalk

Um.. didnt know that prices are also forbbiden. I thought saying a price with no source is ok, just for informative reasons really.
Well, i guess you will find out for yourselves when you buy  :Big Grin:

----------


## Shol'va

> Um.. didnt know that prices are also forbbiden. I thought saying a price with no source is ok, just for informative reasons really.
> Well, i guess you will find out for yourselves when you buy


I think that legal prescription pharmacy prices can be talked about, as they are well, legal but not the unconventional ways. I will need to reread the rules myself to verify this though. Maybe Marcus or some other monitor will chime in on this.

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## marcus300

Rule 10. There is to be no price discussions of steroids . Price discussions often lead to source discussions, both are not permissible.


Sorry but lets move on from, there is no need to talk about prices.

----------


## JohnnyVegas

^^^^ Curious about this as well. A few of us on the TRT forum have talked about pharmacy prices and even HCG prices and got away with it. I thought it was because we were talking about totally legit things. Hell, anyone can call CVS pharmacy and get a price quote for a 10ml amp of Cyp 200mg/ml. But, maybe it is against the rules and it just slipped by because no one noticed?

----------


## JimmySidewalk

Well if marcus grants permission i will re-post the price. Without sources or anything like that of course. Maybe sincer its about TRT and a lot of you use it, you'll succeed in convincing him. Afterall, its just for informative purpose.

Fine by me either way.

----------


## zaggahamma

> Well if marcus grants permission *i will re-post the price.* Without sources or anything like that of course. Maybe sincer its about TRT and a lot of you use it, you'll succeed in convincing him. Afterall, its just for informative purpose.
> 
> Fine by me either way.


 no need...noone was asking about price anyway...as j vegas stated, ANYONE can call ANY pharmacy and get their local prices

----------


## marcus300

It's against the rules pls read rule 10. 

Let's move on from price

----------


## Nofinshline

Hello Marcus, good thread! I'm thinking of switching from 100mg Test E x week to Nebido. My question is, do I have to wait until TE clears, say 2 weeks, then do bloodwork and then start nebido?

----------


## marcus300

> Hello Marcus, good thread! I'm thinking of switching from 100mg Test E x week to Nebido. My question is, do I have to wait until TE clears, say 2 weeks, then do bloodwork and then start nebido?


No need to wait for your TE to clear, go straight into the Nebido therapy you just wont need to do the loading phase

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## greyingwolf

I have 4x4ml amps. Was thinking of using it as base of cycle. From what ive seen it would need to look something like this:

Week 1 12mls 3000mg
Week 2 2mls 500mg
Week 3 2mls 500mg

This first phase should keep levels around 80nmol/l + for first 6 weeks. Then add in Test E:

Week 7 100mg
Week 8 150mg
Week 9 200mg
Week 10 250mg
Week 11 300mg
Week 12 350mg
Week 13 400mg

Test E should take up the slack as TU wears off

Thinking of running Primo at 400mg/wk along side this.

Week 16 begin PCT - 13 weeks after last TU. Maybe PCT would not be needed considering the long "tail" of the TU. I read somewhere that it allows Natty production to begin slowly without PCT, but would need that confirmed.

I have not seen anyone post a cycle using TU. Front loading is the only way I can see to make use of the length of the ester, but a 3000mg shot on the outset, although clinically sound regarding release rates and nmol/l, feels a bit hairy.

Comments please.

----------


## toddbo01

Marcus,

Can you tell me what your doctor had you on prior to the Nebido? What was the hormone and weekley dose? 

I have been on HRT for 2 years now. I take Test cyp twice a week, 100mg per shot. 

I did have great improvement once I went on it. My memory came back, better libido etc. I had a bone density issue in my left hip and that is how I found out I was low test. I was 46, now 48.

I still don't get morning wood frequently unless I use HCG , which I use from time to time. I only take .5mg Arimidex per week but was told by another Endo I don't need it.

I am getting ready to go to a new doctor. I believe he is much more experimental as he mentioned me being on Test E for better levels. He can't tell me more till he sees me in 2 weeks. 

Any suggestions on what you think I should ask him etc. I am still trying to add size, so like being at the high end. My current doctor has let my total test stay around 1400 since I have better sexual response at this level. When I was around 1100 I could not always maintain but now I can. My free is high now per the lab test (marked high) I just don't remember the number. 

One thing I have not been able to overcome on this is my energy level. I get tired frequently but not sure this is test related or something else. Thus my reason for changing doctors, my current one is not doing anything. He just says all your levels look really good etc. 

Also, if on HRT and doing a cycle, is there really a need to to give the receptors a rest via a pct? I am getting conflicting input from two individuals. Thoughts?

Thank You

----------


## Brohim

Marcus 1000mg per 12 weeks is only 83mg per week. It would seem this would be too low. However you seem to say you even retain good muscle mass with this at the gym? The lowest ive seen is 100mg per week with E and CYP and a study I read says UNDEC is lower that cyp or E. I guess everyone is different.

When you were on E how many mg per week were you taking? 

For frontloading, it would seem easier if the docs would just give test E 100mg/week for four weeks then start the long ester test. They could "tune" you up faster on this. 


Todd if you want help post up your blood work. That is the only way to tell where your Thyroid levels are (you feeling tired) and also if you aren't getting wood at 1100 that is the top level of test. Try taking 500 iu of HCG two day's before your shot split into 250iu the two day's before. Also look into your estrogen level's.

----------


## Brohim

> Did you do the loading phase for the first 6 wks?
> 
> Did your have bloodwork done?
> 
> I know including myself around 5 people who are using Nebido and 4 of us are doing 1 every 12 wks and one is doing 1 every 10 wks, strange your having a rollercoast ride unless you didnt load correctly, but if for some reason your different than most 8 wks is still great but your the only one ive seen under 10 wks.



Marcus what was your test levels with Nebidio?

----------


## BigIce

I had been on gel for a year and was suffering badly, did not really understand just how bad I had been feeling until I started Nebido.

It has only been a few weeks now but I feel SO GOOD, it is like a brand new me. And my girlfriend is over the moon, I am like a 21 year old again like you Marcus.

I think the power of test is underrated when it comes to men´s well being, lets hope more and more doctors will start to understand that, because I met a lot of resistance when I started my quest. I even got "testosterone is useless to men and only abused by bodybuilders" yeah really !

I will have my second shot in a couple of weeks (@ week 6) and I can´t wait

----------


## marcus300

> Marcus,
> 
> Can you tell me what your doctor had you on prior to the Nebido? What was the hormone and weekley dose? 
> 
> I have been on HRT for 2 years now. I take Test cyp twice a week, 100mg per shot. 
> 
> I did have great improvement once I went on it. My memory came back, better libido etc. I had a bone density issue in my left hip and that is how I found out I was low test. I was 46, now 48.
> 
> I still don't get morning wood frequently unless I use HCG , which I use from time to time. I only take .5mg Arimidex per week but was told by another Endo I don't need it.
> ...


I was on Test E before Nebido and was taking 125mgs weekly,
I dont think you will need arimidex unless your bloods show elevated estrogen levels,
You dont run a pct when on hrt if you go on cycle, just drop back down to your hrt dose,








> Marcus 1000mg per 12 weeks is only 83mg per week. It would seem this would be too low. However you seem to say you even retain good muscle mass with this at the gym? The lowest ive seen is 100mg per week with E and CYP and a study I read says UNDEC is lower that cyp or E. I guess everyone is different.
> 
> When you were on E how many mg per week were you taking? 
> 
> For frontloading, it would seem easier if the docs would just give test E 100mg/week for four weeks then start the long ester test. They could "tune" you up faster on this. 
> 
> 
> Todd if you want help post up your blood work. That is the only way to tell where your Thyroid levels are (you feeling tired) and also if you aren't getting wood at 1100 that is the top level of test. Try taking 500 iu of HCG two day's before your shot split into 250iu the two day's before. Also look into your estrogen level's.


Nebido therapy is the no1 therapy for hormone repla***ent or it is in my eyes and with all the studies ive posted in my first post you will see it outshines them all. Please read the studies if you require numbers and its performance when its up against Test E.





> Marcus what was your test levels with Nebidio?


My numbers are within mid range but ive not had them done for sometime now, I dont require any AI and I feel like when I was in my 20's and it maintains my size really well.




> I had been on gel for a year and was suffering badly, did not really understand just how bad I had been feeling until I started Nebido.
> 
> It has only been a few weeks now but I feel SO GOOD, it is like a brand new me. And my girlfriend is over the moon, I am like a 21 year old again like you Marcus.
> 
> I think the power of test is underrated when it comes to men´s well being, lets hope more and more doctors will start to understand that, because I met a lot of resistance when I started my quest. I even got "testosterone is useless to men and only abused by bodybuilders" yeah really !
> 
> I will have my second shot in a couple of weeks (@ week 6) and I can´t wait


You will experience more changes as you go through the therapy, once the nebido is up and running at peak your life would of changed for the better  :Smilie:

----------


## marcus300

Due to the pm's I've recently had, bump

----------


## marcus300

My Doctor has changed my protocol from every 12 weeks to every 11, I was feeling a slight dip around wk 10 so we compromised

----------


## pugster

my protocol for nebido is now every 8 weeks , my last bloods at the end of week 8 showed TT at 17/nmol , hopefully this will go over 20 n/mol once ive had a few at the 8 week interval.

----------


## dec11

> My Doctor has changed my protocol from every 12 weeks to every 11, I was feeling a slight dip around wk 10 so we compromised


i squeezed the 10wk interval hehehe

----------


## dec11

> my protocol for nebido is now every 8 weeks , my last bloods at the end of week 8 showed TT at 17/nmol , hopefully this will go over 20 n/mol once ive had a few at the 8 week interval.


holy shit, how'd you manage to talk 'em into that??!!!

----------


## pugster

> holy shit, how'd you manage to talk 'em into that??!!!


my doc said at the start he wanted to aim for low/mid 20's , tbh 8 weeks after my injections i started to feel a dip and by 10 weeks i felt as rough as hell , after telling him this he moved me to 8 weeks.
tbh i think the lead time of 10-12 weeks by bayor for nebido is overstated and this time scale should be dropped to 8-10 weeks , i think a few docs know this now and are being more flexible with injection timescales , at 8 weeks its still by far the best treatment on the market atm (imo) as marcus says.

----------


## marcus300

> my doc said at the start he wanted to aim for low/mid 20's , tbh 8 weeks after my injections i started to feel a dip and by 10 weeks i felt as rough as hell , after telling him this he moved me to 8 weeks.
> tbh i think the lead time of 10-12 weeks by bayor for nebido is overstated and this time scale should be dropped to 8-10 weeks , i think a few docs know this now and are being more flexible with injection timescales , at 8 weeks its still by far the best treatment on the market atm (imo) as marcus says.


Thats remarkable to get your Doctor to go outside the guidelines of the medication, never heard of that especially in the UK were I would say our doctors are behind the times with hormone therapy, well done.
My dip use to come on around week 10 but it wasn't really bad just that I felt a slight dip so the 11 wk protocol should be just fine with me.

----------


## milky01623

I don't think he's going to be on his own when I spoke to the doc he mentioned every 8-10 weeks and I think we share the same doctor

----------


## pugster

> I don't think he's going to be on his own when I spoke to the doc he mentioned every 8-10 weeks and I think we share the same doctor


naw i dont think we share the same doc as i get treatment on the nhs, tho it was me that recommended dr savage to you as ive spoken to him on the phone in the past (my own research led me to him when i was first looking into low testosterone and its symptoms), tho i get the impression a few TRT docs are becoming more flexible with dosage times so hopefully they will go on symptoms rather than fixed injection timing.

----------


## marcus300

Sounds all good guys

We have a nice Nebido gang here now lol

----------


## milky01623

> naw i dont think we share the same doc as i get treatment on the nhs, tho it was me that recommended dr savage to you as ive spoken to him on the phone in the past (my own research led me to him when i was first looking into low testosterone and its symptoms), tho i get the impression a few TRT docs are becoming more flexible with dosage times so hopefully they will go on symptoms rather than fixed injection timing.


Sorry I got you mixed up with plunn lol
Thanks for the info on leger clinic and what's more is because of dr savage I'm in the process of arrangeing an appt with an endo on the nhs
I hope our little nebido gang doesn't want Xmas cards I'm skint and we're in recession lol

----------


## devildog1967

Yes good gang and very informative..

----------


## dunder

Hi guys. I have been lurking here for awhile and have learned a lot about TRT! 
Got my first Nebido injection today and I have been on Testogel with good results buy my endo and I decided to step up the game with injections.
Looking forward to learn some more and to the second injection in six weeks...

----------


## Shol'va

> Hi guys. I have been lurking here for awhile and have learned a lot about TRT! 
> Got my first Nebido injection today and I have been on Testogel with good results buy my endo and I decided to step up the game with injections.
> Looking forward to learn some more and to the second injection in six weeks...


Well your going to like no more bathing in the gel every day! And if your squeamish with a needle, then you are good to go with seeing your doc every 2 or 3 months for follow up injections for nebido. There are a lot of men I would estimate that want to be on injections but are scared, afraid, or just plain squeamish on doing it themselves, or even having someone else do it for them. So they stick to gels and creams to rub on them. One thing now though is that you won't need to worry about the transference factor of gels, where it can rub off on your wife or prepubescent children causing them to go into puberty early. That is if you have young children. But with the wife, she could have ended up with a fuller beard and lower voice than you over time. So now those possible worries are out the window. As they say in Australia..No Worries Mate!

----------


## dunder

> Well your going to like no more bathing in the gel every day! And if your squeamish with a needle, then you are good to go with seeing your doc every 2 or 3 months for follow up injections for nebido. There are a lot of men I would estimate that want to be on injections but are scared, afraid, or just plain squeamish on doing it themselves, or even having someone else do it for them. So they stick to gels and creams to rub on them. One thing now though is that you won't need to worry about the transference factor of gels, where it can rub off on your wife or prepubescent children causing them to go into puberty early. That is if you have young children. But with the wife, she could have ended up with a fuller beard and lower voice than you over time. So now those possible worries are out the window. As they say in Australia..No Worries Mate!


I have no problem with needles and I actually looked forward to get the shot. The nurse that gave it to me was experienced with giving Nebido shots and I didn't felt any pain. However she complained a little about the thick oil and that she has to push the syringe so hard that she almost breaks her fingers...

----------


## marcus300

_Source: Testosterone Treatment and Mortality in Men with Low Testosterone Levels. Shores MM, Smith NL, Forsberg CW, et al. Testosterone. J Clin Endocrinol Metab 2012; Published ahead of print April 11, 2012_



Observational cohort study examined the association between testosterone replacement therapy and mortality in men with low testosterone levels compared with no testosterone treatment.
This large retrospective observational cohort study of 1031 men with low testosterone (also known as hypogonadism) from seven Veteran Affairs medical centres in the US was the first to look for a link between testosterone treatment and mortality (death rate) in men with low testosterone. During the three and a half year study, 39% of the men received testosterone replacement therapy (intramuscular injections, testosterone patches or gel), and 61% did not. The mortality of treated men was compared with that of untreated men. The men in the study were aged 40 years or older (average age 62 years), with no history of prostate cancer, but they had a high number of other medical conditions, including diabetes (38%), sexual dysfunction (low libido; 36%) and heart disease (21%).Key Findings
Overall during the study, one in ten men who received testosterone replacement therapy for low testosterone died, while one in five of those who had low testosterone but did not receive treatment died 
Treated men had a 39% lower risk of dying than untreated men when all the factors such as age, initial testosterone level, body characteristics and medical conditons, were taken into consideration 
Testosterone treatment appeared to be most beneficial in younger men, men with diabetes, and men without heart disease 
Source: Testosterone Treatment and Mortality in Men with Low Testosterone Levels. Shores MM, Smith NL, Forsberg CW, et al. Testosterone. J Clin Endocrinol Metab 2012; Published ahead of print April 11, 2012.

Background information
Low testosterone levels are common in older men, and have been linked to a number of conditions, including diabetes, obesity, cardiovascular problems, loss of muscle mass and strength, poor bone density, and low libido. A number of studies have found that men with low testosterone tend to die at a higher rate than men with normal testosterone levels.

Although beneficial effects for testosterone treatment, including improvements in muscle mass and strength and increased bone density, insulin sensitivity and libido, have been shown in older men with low testosterone, this is the first study to specifically look at the link between testosterone treatment and mortality in middle-aged and older men with low testosterone. It is also interesting that men in this study often had a high level of other medical conditions that might make them more liable to harm or benefit from testosterone treatment.

An observational cohort study is used to explore the possible effect of a treatment on a group of similar subjects (cohort). It can either be prospective (following subjects over time) or retrospective (looking at the medical records of subjects who have already undergone treatment). The results of this retrospective observational study do not allow us to say for certain that testosterone treatment was the cause of the longer survival of the men who received treatment for their low testosterone, as there may have been other factors to explain the reduced mortality in men treated with testosterone. The results are very interesting, all the same, and are likely to encourage further research into the effects of testosterone treatment for men with low testosterone.

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## marcus300

Source: Low testosterone is associated with an increased risk of MACE lethality in subjects with erectile dysfunction. Corona G, Monami M, Boddi V, et al. J Sex Med 2010;7(4 Pt 1):1557-1564



Increased risk of dying from cardiovascular disease for men with erectile dysfunction and low testosterone 
Nearly 1700 men attending an andrology clinic for erectile dysfunction were monitored for an average of 4.3 years to find out whether those with low testosterone levels were more likely to suffer a major cardiovascular disease event, such as a heart attack or stroke.
Key Findings
At the start of the study, over 22% of the men had testosterone levels in the blood that were lower than the widely accepted lower limit for normal testosterone levels (the medical term for low testosterone is hypogonadism) 
Over the course of the study, 139 men had a major cardiovascular event, such as heart attack, stroke, sudden cardiac death or other major cardiac events 
For 15 of these men, the major cardiovascular event was fatal 
Although having a low testosterone level did not make men more likely to have a cardiovascular event, men with lower levels of testosterone who had a major cardiovascular event were seven times more likely to die than those with higher testosterone levels. 
Source: Low testosterone is associated with an increased risk of MACE lethality in subjects with erectile dysfunction. Corona G, Monami M, Boddi V, et al. J Sex Med 2010;7(4 Pt 1):1557-1564.

Background information
There is increasing evidence that erectile dysfunction may be a warning sign of a number of disease conditions, such as high blood pressure, metabolic syndrome, diabetes mellitus, depression and coronary heart disease.

This study is important as it is the first to show that low testosterone increases the risk of men with erectile dysfunction dying from cardiovascular events 
Low testosterone is often a contributing factor to erectile dysfunction 
Seeking advice or treatment for symptoms of erectile dysfunction gives an opportunity for both the patient and his doctor, as a check-up may uncover other health issues that would benefit from early treatment or lifestyle changes 
It is known that testosterone replacement therapy benefits sexual function and improves the effectiveness of common treatments for erectile dysfunction in men with low testosterone 
Testosterone replacement therapy may also have benefits in preventing or slowing the development of atherosclerosis 
Screening for low testosterone may also be a worthwhile way of discovering those men most at risk from heart disease 
However, more study is needed to find out if testosterone replacement therapy can help prevent unnecessary deaths from cardiovascular disease in men with erectile dysfunction.

----------


## RaginCajun

> _Source: Testosterone Treatment and Mortality in Men with Low Testosterone Levels. Shores MM, Smith NL, Forsberg CW, et al. Testosterone. J Clin Endocrinol Metab 2012; Published ahead of print April 11, 2012_
> 
> 
> 
> Observational cohort study examined the association between testosterone replacement therapy and mortality in men with low testosterone levels compared with no testosterone treatment.
> This large retrospective observational cohort study of 1031 men with low testosterone (also known as hypogonadism) from seven Veteran Affairs medical centres in the US was the first to look for a link between testosterone treatment and mortality (death rate) in men with low testosterone. During the three and a half year study, 39% of the men received testosterone replacement therapy (intramuscular injections, testosterone patches or gel), and 61% did not. The mortality of treated men was compared with that of untreated men. The men in the study were aged 40 years or older (average age 62 years), with no history of prostate cancer, but they had a high number of other medical conditions, including diabetes (38%), sexual dysfunction (low libido; 36%) and heart disease (21%).Key Findings
> Overall during the study, one in ten men who received testosterone replacement therapy for low testosterone died, while one in five of those who had low testosterone but did not receive treatment died 
> Treated men had a 39% lower risk of dying than untreated men when all the factors such as age, initial testosterone level, body characteristics and medical conditons, were taken into consideration 
> Testosterone treatment appeared to be most beneficial in younger men, men with diabetes, and men without heart disease 
> ...



interesting.......... i need to go get tested!

great work as always

i think that new guidelines need to be made about the levels of test in males. i think that 400-900ng is way too broad and it needs to be broken down into smaller sections (for example 300-400ng would be on the really low side). what do you think about that?

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## dunder

A week ago I had my second shot of nebido after six weeks from the first one. The last couple of days I've been feeling pretty great. 
I haven't been in such a good mood since I don't know when, maybe seven years ago.
I must say that I didn't feel much after the first shot and I was skeptical. But I aint no more.
I just hope this will last 12 weeks to the next shot. To be continued...

----------


## marcus300

*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*




Efficacy and safety of long-acting testosterone undecanoate in men with hypogonadism in daily clinical practice
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. Zitzmann M, Mattern A, Hanisch J, et al. J Sex Med 2012 [Epub ahead of print]. 

This Research News article reviews article available in full from The Journal of Sexual Medicine, via Wiley Online Library. 

This prospective, observational, post-authorization surveillance study investigated the safety and efficacy of intramuscular injections of testosterone undecanoate (TU) in men with testosterone deficiency syndrome (hypogonadism) in a clinical practice setting.1 The study, conducted in 23 countries throughout Europe, Asia, Latin America and Australia, enrolled 1493 men (mean age 49.2 ± 13.9 years) with a diagnosis of primary or secondary testosterone deficiency syndrome (serum total testosterone 8–12 nmol/L for newly diagnosed treatment-naïve patients). The men received up to five injections of TU during an observation period of 9–12 months. Between the first and second injections of the agent there was an interval of 6–10 weeks, and subsequent injections were given at intervals of 12 ± 2 weeks. 

The study aimed to assess treatment outcomes of male patients with testosterone deficiency syndrome who received TU under ‘real-life’ conditions, and to assess the treatment continuation rate in such patients and further confirm the safety profile of TU. Parameters of erectile function, libido, vigor/vitality, mood and ability to concentrate were assessed by physician interview using items and five-point Likert scales. Certain physical and circulatory parameters, as well as other laboratory parameters, were also measured at each injection visit. 

Of the 1493 men enrolled, 72.5% were Caucasian, followed by 19.7% and 7.5% of Asian and Latin American descent, respectively. A total of 1438 and 1140 men were evaluable at baseline and at the time of the fifth injection, respectively. At baseline, mean body weight was 86.8 kg, and 54% of those enrolled had previously received androgen therapy. Mean serum testosterone (T) was 9.6 ± 7.5 nmol/L, and comorbidities included erectile dysfunction (ED), hypertension and dyslipidemia. 


*Key Points 
Mean trough serum total T 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 


A total of 64% of patients at baseline experienced very low/low sexual desire/libido compared with 10% at injection 5 
The proportion of patients with a high/very high libido increased from 10% at baseline to 61% at injection 5 (overall p<0.0001) 
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) 


In those patients with some form of ED who did not receive concomitant phosphodiesterase type 5 (PDE5) inhibitor therapy, 56% reported a decrease from baseline in ED severity following TU therapy 
The proportion of patients reporting a high or very high response to PDE5 inhibitor therapy increased from 35.1% at baseline to 56.6% at injection 5 
Mean waist circumference decreased from 100 to 96 cm and the reduction was statistically significant whether or not patients had previously received androgen therapy (Figure 1) 
A total of 35.4% of patients each, reported being very satisfied or satisfied after treatment with TU 
Blood pressure, serum triglyceride, total cholesterol and LDL cholesterol levels were all significantly improved from baseline at injection 5 (p<0.02; Figure 2) whereas there was a slight increase in HDL cholesterol (not statistically significant) 
Adverse drug reactions (ADRs) related to TU therapy were rare (5.8%), and only 1 was considered serious (0.1%) 


The most common ADRs were increased hematocrit, increased PSA levels and injection site pain, all of which occurred in <1% of patients 
Overall, ADRs were associated with treatment discontinuation in 31 patients.*  

What is known
Hypogonadism (testosterone deficiency syndrome), which can be defined as serum total testosterone ≤12 nmol/L and a positive score suggestive of androgen deficiency on the AMS questionnaire, is increasingly recognized as a significant health problem in aging men.2-8 Testosterone deficiency syndrome adversely impacts physical health (including loss of physical strength, loss of muscle mass, increased visceral fat leading to a higher risk for metabolic syndrome and premature death), sexual function (loss of secondary sexual characteristics, decreased libido and erectile dysfunction) and psychological health (mood changes and sleep disturbances).5 Androgen replacement therapy is the principal treatment for testosterone deficiency syndrome, and involves the administration of T at doses which aim to reproduce normal blood T levels, in order to improve exposure of androgen-dependent tissues and organs to T. In general, the better the improvement in T levels after androgen replacement therapy, the better the clinical outcomes.1 TU is an intramuscularly administered, long-acting formulation of T used as an androgen replacement therapy for men affected by testosterone deficiency syndrome. As few large-scale post-marketing surveillance studies of TU have been conducted, and no large trials evaluating the agent in Asian and South American populations have been conducted at all, this trial aimed to confirm the safety profile of TU in men with testosterone deficiency syndrome, and to evaluate the efficacy of the agent in a ‘real world’ clinical setting throughout Europe, Asia, Latin America and Australia. 


What this study adds
This international, multicenter, one-arm, non-interventional, prospective, observational Post-Authorization Surveillance Study (IPASS) confirmed the safety profile of TU, and demonstrated its effectiveness in a large global cohort of patients, including those from Asia and South America.1 

Mental and psychosexual function scores (libido, vigor, overall mood and ability to concentrate) were all significantly improved over the course of the study, as were blood pressure and the majority of lipid parameters examined (Figure 1). After four injections of TU, the proportion of patients with low or very low sexual desire was significantly decreased, and 89% of patients declared themselves to be satisfied or very satisfied with TU therapy. The major limitation of this study was its potential for bias; however, the large sample size somewhat reduces the chance of this. 








top of page
References

1. Zitzmann M, Mattern A, Hanisch J, et al. 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. J Sex Med 2012 [Epub ahead of print].
2. Ullah MI, Washington T, Kazi M, et al. Testosterone deficiency as a risk factor for cardiovascular disease. Horm Metab Res 2011;43(3):153-164.
3. Wang C, Jackson G, Jones TH, et al. Low testosterone associated with obesity and the metabolic syndrome contributes to sexual dysfunction and cardiovascular disease risk in men with type 2 diabetes. Diabetes Care 2011;34(7):1669-1675.
4. Bassil N, Morley JE. Late-life onset hypogonadism: a review. Clin Geriatr Med 2010;26(2):197-222.
5. Wang C, Nieschlag E, Swerdloff R, et al. Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA, and ASA recommendations. Eur Urol 2009;55(1):121-130.
6. Kazi M, Geraci SA, Koch CA. Considerations for the diagnosis and treatment of testosterone deficiency in elderly men. Am J Med 2007;120(10):835-840.
7. Traish AM, Miner MM, Morgentaler A, et al. Testosterone deficiency. Am J Med 2011;124(7):578-587.
8. Saad F, Aversa A, Isidori AM, et al. Onset of effects of testosterone treatment and time span until maximum effects are achieved. Eur J Endocrinol 2011;165(5):675-685.

----------


## fm2002

Need to cover a few things here;

1)I'm currently taking 150mg of Test E every 10 days. My level at this amount is between 900-1000. Marcus you refer to your levels being mid range at your protocol. Do you mind sharing exactly what Total Testosterone level you are?
2)I will be traveling to California in 2 weeks to get a complete BW and than have my HRT doc evaluate the results. I will definitely be asking him about Nebido. However since it's not FDA approved and the economic angle I'm afraid I won't get a straight answer. Coupled with the fact that I currently live in a very remote place, I'll be on my own if I decide to switch over. I can get my blood tested to monitor my levels. Can you help me out with a protocol? Basically would like to stay in the 900-1000 range.
3) would love to stop;
a. having to do injections every 10 days
b. taking arimidex 
c. eventually not having to worry about my Estrogen levels

Thanks

----------


## marcus300

> Need to cover a few things here;
> 
> 1)I'm currently taking 150mg of Test E every 10 days. My level at this amount is between 900-1000. Marcus you refer to your levels being mid range at your protocol. Do you mind sharing exactly what Total Testosterone level you are?
> 2)I will be traveling to California in 2 weeks to get a complete BW and than have my HRT doc evaluate the results. I will definitely be asking him about Nebido. However since it's not FDA approved and the economic angle I'm afraid I won't get a straight answer. Coupled with the fact that I currently live in a very remote place, I'll be on my own if I decide to switch over. I can get my blood tested to monitor my levels. Can you help me out with a protocol? Basically would like to stay in the 900-1000 range.
> 3) would love to stop;
> a. having to do injections every 10 days
> b. taking arimidex 
> c. eventually not having to worry about my Estrogen levels
> 
> Thanks


1, My levels were around 600 mark at a 12 week protocol, which was fine for me had no isses what so ever. Since them Ive been dropped down to 11 weeks but haven't had bw done since. The protocols are from 8 weeks to 12 weeks, so I am sure you will get a good solid range.

2,Nebido isn't approved in the USA yet so doubt you will be able to get hold of it but around the 8 week protocol would get your levels at high range.

3, I take one injection every 11 wks, I also don't take no AI, its not needed.

----------


## fm2002

Thanks Marcus !

Since I'm already a long time Test Ethanate user and will confirm soon, but sure my levels are between 900-1000, would I skip the front loading and just do 4ml ? Than wait how long; 6 weeks or 12 weeks for the next injection?

Than I suppose to adjust your level you would toggle between 9-12 weeks of a 4 ml injection?

Lastly if one wanted to do hcg when would you do this?

----------


## marcus300

Every 11 weeks now and feeling good, estrogen in check and levels between 600-700mark

----------


## DelTurco

hello Marcus; I read all of your posts about Nebido ,.Just want to ask about LOADING PHASE.Can you explain how should it be?

----------


## marcus300

> hello Marcus; I read all of your posts about Nebido ,.Just want to ask about LOADING PHASE.Can you explain how should it be?


It tells you on the first page of this thread, thanks

----------


## marcus300

Product Name: Nebido® (Reandron® in Spain, Reandron®1000 in Australia, Nebid® in Italy) 

Indications: hypogonadism 

Disease or condition: Typical signs of testosterone deficiency, known as hypogonadism, may include: Increased irritability or depression, fatigue, decreased concentration, noticeable decrease in lean body mass and increase in fat mass, particularly abdominal fat, decreased libido and sex drive, erectile dysfunction and decreased frequency of morning erections, reduced muscle mass and strength, loss of body hair, osteoporosis. 

Drug mechanism: Nebido® provides testosterone to men whose testes do not produce enough testosterone. 

More detailed: Nebido® is the first registered testosterone undecanoate preparation for intramuscular injection. One ampoule contains 1000 mg of testosterone undecanoate in 4 ml of oily vehicle and is available in a corresponding individual packaging. 

Nebido® is an intramuscularly administered depot preparation of testosterone undecanoate. Following intramuscular injection of testosterone undecanoate as an oily solution, the com-pound is gradually released from the depot and immediately cleaved by serum esterases into testosterone and undecanoic acid. An increase in serum levels of testosterone above basal values may be seen immediately after administration. The muscle serves as a depot for the sustained release of testosterone into the systemic circulation. 

Circulating testosterone is chiefly bound in the serum to sex hormone-binding globulin (SHBG) and albumin. The albumin-bound fraction of testosterone easily dissociates from albumin and is presumed to be bioactive. The portion of testosterone bound to SHBG is not considered biologically active. The amount of SHBG in the serum and the total testosterone level will determine the ratio of bioactive and non-bioactive androgen. SHBG-binding capacity is high in prepubertal children, declines during puberty and adulthood, and increases again during the later decades of life. Approximately 60 % of testosterone in plasma is bound to SHBG, 2 % remains unbound (free) and the rest is bound to albumin and other proteins1.

Product characteristics (package/color/durability/dosage): 
Nebido® Ampoule vergrößern Nebido® is the first registered testosterone undecanoate preparation for intramuscular injec-tion. One ampoule contains 1000 mg of testosterone undecanoate in 4 ml of oily vehicle and is available in a corresponding individual packaging. 

As stability tests have shown that Nebido® is stable at a temperature of 30°C for at least 24 months and at a temperature of 40°C for at least 6 months, there are no particular precau-tions for storing the product. It is recommended to store the product at room temperature. Shelf life is 5 years in most countries. The medicinal product must be used immediately after first opening. 

Nebido® is injected in intervals of 10-14 weeks. It is advisable to reduce the first interval to six weeks in order to reduce the time until steady state conditions are reached. (During the initial time of treatment the mean concentration of testosterone is slowly increasing with each injection. Steady state is reached when the amount of testosterone supplied with an injection replaces exactly what has been metabolized from the intramuscular depot). Individualization of therapy is required and should be based on serum testosterone levels achieved under Nebido® treatment and clinical symptomatology.



For what is Nebido® licensed?
Nebido® Packshot vergrößern In the countries where it is licensed, Nebido® is authorized for testosterone replacement therapy of primary and secondary male hypogonadism, i.e., if testosterone deficiency has been confirmed both by clinical and by laboratory tests. Nebido® is licensed in more than 80 countries worldwide.

----------


## ctenosaura

"Product Name: Nebido® (Reandron® in Spain, Reandron®1000 in Australia, Nebid® in Italy)"

Does this mean it is available in the US now?

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## bass

*"Product Name: Nebido® (Reandron® in Spain, Reandron®1000 in Australia, Nebid® in Italy)"*

what from this statement says anything about US?!

----------


## FRDave

> "Product Name: Nebido® (Reandron® in Spain, Reandron®1000 in Australia, Nebid® in Italy)"
> 
> what from this statement says anything about US?!


I was thinking the exact same prior to reading your comment lol.

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## ctenosaura

Duhhhh............your right.

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## marcus300

> "Product Name: Nebido® (Reandron® in Spain, Reandron®1000 in Australia, Nebid® in Italy)"
> 
> Does this mean it is available in the US now?


No it doesn't otherwise it would state available in the US

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## 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

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## marcus300

Bump for someone  :Wink:

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## 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?

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## 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  :Smilie:  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  :Wink:  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  :Smilie: 

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 :Smilie:

----------


## 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  :Smilie:

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## 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  :Smilie:

----------


## clarky.

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

----------


## 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?

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## 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 :Smilie:

----------


## 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  :Smilie:

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## 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.

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## 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.

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## 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.

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## 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.

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## 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  :Smiley:

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## 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

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## 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.

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## 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

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## 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  :Frown: 

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

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## 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.

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## 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.

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## 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?

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## 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

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## MuscleScience

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

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## 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.

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## 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?

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## 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  :Wink: 
*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.

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## 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...

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## 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.
> ...









> 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

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## 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.

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## 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  :Smilie:

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