Primary Hypogonadism: Doctor wants to put me on 25mg of Testosterone enanthate per week

[PrimaryHypogonadismHell]

Hi everyone,

I have primary hypogonadism and need your help, i am less than 35 years old and no children so i would like to preserve the little sperm production i have.

My numbers for the 2 last years are similar to my last bloodwork and sperm test which are:

Total testosterone at 170 ng/dL
LH: 30
FSH: 24
Sperm count: 5 millions/ml

The doctor wants to start me at 25mg of TE per week, which i think is extremly low.

He says that since i am primary, this dosage will "add up" to my low natural production while preserving the remaining fertility. He says LH and FSH levels will much likely remain high even with low dose exogenous testosterone.

His goal is to improve metabolic health and bones/heart health while not hurting the residual fertility i currently have

He believe this low dosage will probably increase my test level to 300-400ng/dl while preserving fertility. He says that if 3 months after starting injections, my lh and fsh levels are still high enough and if sperm count has not decreased, we can increase the dosage to 37.5mg per week and aim for 500-600ng/dl test level. But he said that according to his experience, 50mg per week can decrease lh and fsh too much even in primary hypogonadism.

What do you think of this protocol? I am lost because i have never heard of this.Can you confirm that low dose exogenous testosterone will not decrease fsh and lh much for primary hypogonadism?

Thank you for your help!

 

[Cataceous]

You have a wise doctor. It's not common for guys with primary hypogonadism to get such good advice. All I would add is that dividing the dose into 2-3 injections per week is a good idea—if he didn't already suggest that.

It is correct that with primary hypogonadism, exogenous testosterone adds to natural production until you get close to normal levels of testosterone. You use LH/FSH measurements to tune your dose, just like he says. You're aiming to bring them down to normal from over-range/high-normal. The latter is a prominent feature of primary hypogonadism: It means that your brain is yelling at your testicles to make more testosterone, but they can't do it.

 

[PrimaryHypogonadismHell]

You have a wise doctor. It's not common for guys with primary hypogonadism to get such good advice. All I would add is that dividing the dose into 2-3 injections per week is a good idea—if he didn't already suggest that.

It is correct that with primary hypogonadism, exogenous testosterone adds to natural production until you get close to normal levels of testosterone. You use LH/FSH measurements to tune your dose, just like he says. You're aiming to bring them down to normal from over-range/high-normal. The latter is a prominent feature of primary hypogonadism: It means that your brain is yelling at your testicles to make more testosterone, but they can't do it.

Thank you for your answer, it awesome to know that this protocol is not stupid! He did not talk about increasing injection frequency for TE, but it is something i could do.

He also talked about another testosterone, Nebido, which has very long half life and is very popular in my country. But the issue is that it only comes in 4ml single usage , for a total 1000mg every 3 months. He suggested that we could split it in 25mg per week, but i dont understand how i could do split it since it is a single usage vial from what i have seen. Also, it does not seem to have any preservatives in it

Thanks again for your message, i am relieved that my doctor is not crazy. I looked on the web for such protocols, but i could not find anything

 

[Cataceous]

Nebido—testosterone undecanoate—is viable, but it's not ideal when you are still planning to make dose adjustments. Either testosterone cypionate or testosterone enanthate would be better, although these should be injected at least three times a week or every other day to smooth out levels. Once you have determined the correct dose—that yields good subjective results and normal testosterone/LH/FSH—then you could switch to testosterone undecanoate and cut the injection frequency to once a week or even once every 10 days. The shorter half-lives of cypionate/enanthate mean that dose changes stabilize over a period of a few weeks. With undecanoate, the stabilization period may be extended to months.

An advantage of injections is that you have a lot of precision in dose adjustments. For example, if the best dose for you happens to be 35 mg of testosterone enanthate per week then that is simple to achieve with EOD injections of 10 mg. You doctor undoubtedly understands how to convert this to injections of testosterone undecanoate, but here's the explanation: The enanthate is 72% testosterone, while the undecanoate is 63.2% testosterone. So the equivalent of 35 mg T enanthate per week is 35 * 72 / 63.2 = 40 mg T undecanoate per week.

It is not too difficult to split Nebido, even if it comes in a single-use ampule instead of a multi-dose vial. Nebido contains a preservative, so you don't need to be too worried about microbial growth as long as you use good aseptic techniques. All you have to do is transfer the Nebido from the single-use container to a new sterile vial of suitable size, e.g. 5-10 mL. You would use a sterile syringe to do this transfer. Even better is to divide the 4 mL of Nebido into a few separate sterile vials so that no one vial is used/punctured excessively over time.

For subcutaneous administration your doses are then drawn from the reusable vial(s) with U-100 insulin syringes.