Hi all,
I have been following the forum for quite a while already. I am wandering if I should go for TRT or not. I do have all the phenotypes of low T, including gynecomastia. It seems, however, that my testosterone values are really border line, and I was wandering if going for Nebido would be the best decision in 2022. I did use Nebido from 2017 to 2020, when a new endocrinologist said I had no need for it (after a LHRH exam and a few others) and removed me from it.
My results (and ranges) are the following:
Total Testosteron: 289.50 ng/dl (249 - 836 ng/dl)
Albumin: 4.60 g/dl (3.5 - 5.20)
SHBG: 18.45 nmol/L (18.30 - 54.10)
Calculated free testosteron: 7.3 nl/dl (2.52 %)
Calculated Bioavailable Testosterone: 183 ng/dL (63.1%)
Prolactine: 5.87 (ng/ml)
Knowing that I have been out of TRT for almost 2 years, would you say that these values (and symptoms) justify going back to Nebido?
This is kind of a subjective question… if you have low T symptoms, yeah - consider going on TRT. If you don’t have low T symptoms, then don’t.
If you felt like shit all the time but your labs said you’re good, would you pass on TRT or pursue treatment? I imagine the latter
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I’d go for it. I just started again 3 weeks ago. This time injections. Just make sure you’re getting labs every few months to dial in the dosage and watch the HCT.
Here in the US these T levels would easily qualify for TRT. There is no consensus for the lower Total T or Free T threshold defining testosterone deficiency.
A previously study published in JAMA in 2009 showed that men with total testosterone blood levels below 550 ng/dl had a significant increase in their risk of cardiovascular disease, while men with levels above 550 ng/dl reduced their risk by 30%.
Defining “Healthy” Testosterone
Multiple peer-reviewed papers state that “testosterone deficiencies” are more prevalent and "desirable testosterone" levels in men are actually much higher than what is currently being considered as “normal” in doctors’ practices across the country. Case in point: A cross-sectional study of Swedish men ages 69 to 80 years showed the risk for premature death from any cause and the risk for suffering a major cardiovascular event were inversely correlated with the total serum testosterone concentration (i.e., the higher the testosterone levels, the lower the risk of death).
Specifically with regards to cardiovascular events, men in the highest quartile of testosterone (at or higher than 550 ng/dL) had a lower risk of cardiovascular events compared with men with lower testosterone.
More importantly, details from this study show that it did not matter if a man’s total testosterone was very low (below 340 ng/dL ) or moderately low (up to 549 ng/dL ) – all men with T levels below 549 ng/dL had a similar increased risk for suffering a cardiovascular event. Only when total testosterone exceeded 550 ng/dL did cardiovascular risk drop.
This is truly alarming, as cardiovascular disease is the No. 1 killer of men in the United States and even more – this study was published in the Journal of the American College of Cardiology. These researchers documented a 30 percent reduction in cardiovascular events as well as a decrease in cerebrovascular disease incidence.
Men with the highest total testosterone had a 24 percent reduced risk of transient ischemic attack or full-blown stroke. Clearly, based on this study, the only target for “healthy testosterone” is to maintain total testosterone at or above 550 ng/dL.
Thanks everyone for the great technical answers. Special kudos to @systemlord, that I have seen valuable contributions in this forum for many years of archived posts. I think this makes clear that TRT is the only path to go.
I have a few extra questions regarding TRT:
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My understanding is that now there’s nothing better (so far) than Nebido for hypogonadism TRT. Is that the case? I am asking cause Nebido has multiple side effect on me - from hair loss and spots in the back to normally reversible infertility. I have the impression that low-t is actually a zero-sum game in terms of solutions, where we can only choose the losing side (e.g. either living with low-t, or going for clomid and having visual problems/zero libido, or going to TRT infections and having hair-loss/spots in the back and infertility).
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Is there any practical efficient way to avoid the hair loss effect caused by Nebido? In the past I took finasteride and it did stop the hair loss. However, I am aware that Finasteride has its own set of draw backs and ideally I would like to avoid it.
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Can HCG be used in the middle of a TRT process (e.g. a few years from now I decide to have kids and start taking HCG) or should it be applied in parallel since the beginning?
So far the most natural solution to substituting endogenous testosterone is with bioidentical exogenous testosterone. But why Nebido? My best guess is you are in Europe where that is all that’s offered by doctors with injections every couple of weeks. Maybe you could find a doctor that could give you a prescription for test cypionate or enanthate.
As for the hair thing - if you generally feel like shit with all the classic low t symptoms, I say - fuck the hair.
Balance My hormones treats men all across Europe with the more desirable short testosterone esters.
You can try to mitigate the hair loss using shampoos that help regrow hair, but the can be expensive.
Did you have any of those drawbacks? Most people don’t have the negative sides effects. Even less people have negative sides effects while on testosterone.
I use finasteride, haven’t had any negatives.
There are other things you can use that are more effective than the shampoo that was mentioned. Minoxidil is proven to grow hair, topical androgen blockers also work. RU58841 is pretty effective, but it’s a research chemical, so there isn’t long term data on it. You could try a low dose topical finasteride too.