how to manage estradiol on testosterone undecanoate (nebido?

[adpower91]

I just got my shot of Nebido about 5 days ago (4th shot and I get it every ten weeks 1000mg/4ml). By the end of my third shot I got labs done and my total T was at 520 ng/dl. My estradiol was at 63 pg/ml which I know is high.

After getting this shot I feel horrible. I mean I can't even describe it. I can't function. Extremely tired, my eyes are black and sunken and I can't think straight or remember what I did ten minutes ago. I imagine that if my estradiol was at 63 ten weeks after my shot then right now (during the week where T is peaking) my E levels must be through the roof.

I have read the estradiol threads but my question is how do you treat estradiol when you are on aveed/nebido and your levels are non linear? I can't switch to cypionate as it isn't available where I'm from. Also would splitting the shot into two (every 4-5 weeks get 500mg/2ml?). I'm going to call my endo tomorrow also and ask to be put on an AI. Would .5ml twice a week make a big difference?

 

[ERO]

Low dosing of Anastrozol should work fine to control your E2, but from what I understand it's near impossible to get a doc to prescribe it in Europe or Canada - what country are you in? Anastrozol is very powerful, typically 0.25 mg twice a week will control E2 for anybody except for the very high converting guys that use higher doses like 0.5 twice a week. Its best to check E2 with the Ultra Sensitive test though, which I also understand to be difficult to do in Europe and Canada. Since you are on a long-term declining dose, perhaps you could start with 0.5 twice a week for the first 4 weeks and then go to 0.25 twice a week until your next shot. Without accurate testing though, its going to be trial and error and some guesswork.

Nelson and some of the other guys here know more about what is available in countries other than the US and I am sure they can chime in as well.

 

[CoastWatcher]

I'm writing from Canada, and sympathize with your situation. I have an excellent doctor and I have to travel to the States for routine E2 monitoring via the sensitive test - it simply is not offered here. Have you asked your doctor about this? Should he/she not be familiar with the theory behind, and the reason for, sensitive testing, there is a great deal of information on the Forum you could present. Message me if you would like copies of some things my own doctor prepared on this topic when we were hunting a Canadian lab that might help me.

 

[adpower91]

ERO I will ask him to allow me to try that so. Thanks.

Coastwatcher there are only two doctors in all of Ireland that will even prescribe trt that i know of. I brought up an AI with my doc before and he didnt like the idea but didnt say no. Il push it tomorrow. As for the sensitive tests i highly doubt I have any hope of getting that done here if you cant get it done in Canada. We are years behind with that sort of stuff here. How inaccurate is the non senstive test? Does it give a false low or false high?

 

[ERO]

The non-sensitive test typically give a false high reading, which for docs here in the US that are not up to speed, causes them to prescribe too much AI, which tanks your E2. Having your E2 too low is just as bad as having it too high.

If you cannot do the sensitive test, I'd recommend going slow with Anastrozole, providing your doc will prescribe. They typically come in 1 mg pills (from the manufacturer - compounding pharmacies can do any dose). Get a pill cutter and cut them in quarters and start with 1/4 pill (0.25 mg) twice a week and see how you feel after 3-4 weeks. if you still have high E2 symptoms go to 0.5 twice a week. Like I say though, this drug is almost surprisingly strong. 0.25 mg twice a week sounds like a tiny dose, but it is more than I can even use at a dose of 200 mg of T weekly. Everybody is different, but I'd start low and work up slowly rather than start too high and tank your E2. Do that and it takes weeks to recover. Tanked E2 typically means joint pain and ED that cannot be helped by Viagra or Cialis or any PDE5 inhibitor. Its not a fun place to be.

 

[CoastWatcher]

ERO I will ask him to allow me to try that so. Thanks.

Coastwatcher there are only two doctors in all of Ireland that will even prescribe trt that i know of. I brought up an AI with my doc before and he didnt like the idea but didnt say no. Il push it tomorrow. As for the sensitive tests i highly doubt I have any hope of getting that done here if you cant get it done in Canada. We are years behind with that sort of stuff here. How inaccurate is the non senstive test? Does it give a false low or false high?

I know of private clinics in Ireland that practice in the area of men's health (including TRT). I can provide names if you are interested.

 

[adpower91]

That would be brilliant for future reference. I could only find two online. An update.. I spoke to my endo on the phone and it went great. He agreed that it needs to be treated and that he will sort it. I asked what medication he would go with and all that but he said he will wait until he looks over my file and stuff before deciding. I was worried he would not agree with me so Im very pleased.

 

[CoastWatcher]

That would be brilliant for future reference. I could only find two online. An update.. I spoke to my endo on the phone and it went great. He agreed that it needs to be treated and that he will sort it. I asked what medication he would go with and all that but he said he will wait until he looks over my file and stuff before deciding. I was worried he would not agree with me so Im very pleased.

Imwill mesaage you, and post the names of the Irish clinics on the Forum (which may be the ones you already know). Excellent news about the conversation with your current doctor.

 

[adpower91]

:am having a tough time finding an amoratase inhibitor licensed in Ireland. Clomid of course is another and perhaps safer option. There is little point in my writing a prescription if it is not mentioned in Mims. What are your thoughts?"

This is what my doctor just sent me. Anyone have any suggestions on what to do? I dont have any clue about clomid.

 

[CoastWatcher]

:am having a tough time finding an amoratase inhibitor licensed in Ireland. Clomid of course is another and perhaps safer option. There is little point in my writing a prescription if it is not mentioned in Mims. What are your thoughts?"

This is what my doctor just sent me. Anyone have any suggestions on what to do? I dont have any clue about clomid.

The drug you need is Anastrozole. It has never been approved for management of high estradiol in men. That means your doctor will have to prescribe it "off-label." This is a perfectly legal procedure in which your doctor prescribes a medication that, in his/her professional opinion, you need. That being said, some doctors are hesitant to engage in off-label prescribing for liability issues. Should that be what you encounter with your doctor, there is material posted here on the Forum you can present to him that indicates the utility of Anastrozole as an AI.

 

[adpower91]

I called my pharmacist who told me exactly what you just said. I emailed my doctor and asked him to call my pharmacist. My doctor will do it off license for sure which is great. He would actually have to get clomid off license too. He is good and actually lets me have an input which I never had with any other doctor before. I'm looking forward to getting it sorted out... I feel horrible and just started an engineering masters yesterday so need to be able to function physically and mentally properly ASAP. Thanks for the help coastwatcher.

 

[CoastWatcher]

I called my pharmacist who told me exactly what you just said. I emailed my doctor and asked him to call my pharmacist. My doctor will do it off license for sure which is great. He would actually have to get clomid off license too. He is good and actually lets me have an input which I never had with any other doctor before. I'm looking forward to getting it sorted out... I feel horrible and just started an engineering masters yesterday so need to be able to function physically and mentally properly ASAP. Thanks for the help coastwatcher.

Clomid and exogenous testosterone at the same time? Why???? It makes no sense at all. Clomid stimulates production of LH, while the testosterone you are receiving suppresses that same production. You are putting a drug into your system you don't need, and sending contradictory signals to your body. No well-trained practitioner would do that.

 

[adpower91]

No he said I could use it instead of the nebido shots if I wanted. That clomid will stimulate endogenous testosterone production and it can help get a better T to E ratio. I told him I'd like to stick with nebido and go for arimidex.

Normally clomid (apparently) will help stimulate LH and FSH in the pituitary but I don't think it will help me because my pituitary gland doesn't work properly... most likely down to the head trauma I experienced when I was 4 years old and fell off a wall and decided to break my fall with my head.

 

[CoastWatcher]

No he said I could use it instead of the nebido shots if I wanted. That clomid will stimulate endogenous testosterone production and it can help get a better T to E ratio. I told him I'd like to stick with nebido and go for arimidex.

Normally clomid (apparently) will help stimulate LH and FSH in the pituitary but I don't think it will help me because my pituitary gland doesn't work properly... most likely down to the head trauma I experienced when I was 4 years old and fell off a wall and decided to break my fall with my head.

OK, Clomid monotherapy. What does he suggest about monitoring E2? He seems to be an odd mix openmindedness, his willingness to prescribe off-label, and stubborn - refusal to consider any other form of TRT (weekly injections). I recall the issues we wrote about, the challenges you face, but how does he balance it all?

 

[adpower91]

Well he will do the topical but I know how low its success rate it is also I don't want to put it on every day. I know I'l forget and also I don't want the risk of passing it to my girlfriend. Nebido is the only injectable form available in Ireland. I had started out on cypionate in the US. I was working there for a year and had good health insurance so got checked out there.

 

[adpower91]

Got the go ahead for arimidex! Should be starting next Friday! very pleased.

 

[skaman007]

I self med trt nebido trt at 2ml..500mg every 3 weeks..only 6 wks in..have bloods done week 11..feel great