Hematocrit: How Doctors Respond

[DragonBits]

@DragonBits , thank you for that very informative post about the differences of HCT rises via different Testosterone delivery systems. I live outside the US and I've tried both Nebido and transdermal gel but as I have low SHBG the T gets quickly flushed out of my system. What enables me to sustain continuous high T levels is bi weekly SUBQ T enanthate injections, which are absorbed slower via the SUBQ tissue. However the T enanthate does raise my HCT, requiring me to donate blood three times a year.

I wonder if the Nebido 1000mg/4ml dose can be split up used in bi weekly SUBQ injections of say 50mg each, thus lasting 10 weeks, similar to what I do with my T ethanoate ampule. The Nebido instructions state:

"As with all oily solutions, Nebido must be injected strictly intramuscularly and very slowly (over two minutes). Pulmonary microembolism of oily solutions can in rare cases lead to signs and symptoms such as cough, dyspnoea, malaise, hyperhidrosis, chest pain, dizziness, paraesthesia, or syncope. These reactions may occur during or immediately after the injection and are reversible. The patient should therefore be observed during and immediately after each injection in order to allow for early recognition of possible signs and symptoms of pulmonary oily microembolism. Treatment is usually supportive, e.g. by administration of supplemental oxygen.

Suspected anaphylactic reactions after Nebido injection have been reported."

The question is given the above warning of Pulmonary microembolism is would it be safe to home administer Nebido via SUBQ. Unless a medical authority says it is safe I would not attempt it. Perhaps @Dr Justin Saya MD can chime in?

Basically, you want a higher level of total T than you can get with Nebido alone.

I was wondering how Nebido might work with low SHBG, I take it you have measured T levels after a month (or some other short period of time) and found your T too low for you? With Nebido you do get fairly high T levels of ~1200 ng/dl for 2-3 weeks. What did you measure and how long after injection? You must have done a blood test else how did you know T was flushed out?

The slow release is because of the ester and deep IM which should have nothing to do with SHBG levels, but maybe you don't get enough T/FT, especially after a few months? You could shorten the time between injections which would give you higher levels, and like all esters, it does build up over time, it takes I think 6 month with Nebido.

Or after a month you could add in a smaller amount of transdermal gel using the Nebido level as a base and boosting T even more with the daily gel/cream. BUT I am pretty sure combining Nebido with a gel/cream would somewhat raise your chances of raising your HCT too high, what the odds would be, who knows for sure?

I am not really sure, I think the microembolism reaction is possible anytime you do a deep IM injection with any testosterone ester, it means you injected into a vein. Which is why when you do IM injections, they recommend you aspirate to see if there is any blood in the syringe.

Nebido at first came in an ampule, then it came in a vial, if you got an ampule you would have to draw it all out and inject it into an empty vial in order to only use a partial injection. I am not sure if they still distribute in ampules or how to specify.

Obviously you can't inject 4 ml subq.

Doing a subq injection would change how Nebido was absorbed, not sure how much it would change. You might well get more HCT. I thought raising HCT was caused by the numerous spikes you get from injecting shorter esters like T enanthate, while with Nebido you get a spike up, but I don't think it's as sharp and it gradually falls off over 3 months. People do get HCT from Nebido, it just doesn't happen that often, 7%.

I would think you could also inject a smaller amount of T enanthate more frequently to reduce your odds of HCT. And some people have reported they had to donate blood at first but then after a few years they didn't get as much of a rise in HCT.

You should ask Dr. saya those questions.

 

[Dr Justin Saya MD]

@DragonBits , thank you for that very informative post about the differences of HCT rises via different Testosterone delivery systems. I live outside the US and I've tried both Nebido and transdermal gel but as I have low SHBG the T gets quickly flushed out of my system. What enables me to sustain continuous high T levels is bi weekly SUBQ T enanthate injections, which are absorbed slower via the SUBQ tissue. However the T enanthate does raise my HCT, requiring me to donate blood three times a year.

I wonder if the Nebido 1000mg/4ml dose can be split up used in bi weekly SUBQ injections of say 50mg each, thus lasting 10 weeks, similar to what I do with my T ethanoate ampule. The Nebido instructions state:

"As with all oily solutions, Nebido must be injected strictly intramuscularly and very slowly (over two minutes). Pulmonary microembolism of oily solutions can in rare cases lead to signs and symptoms such as cough, dyspnoea, malaise, hyperhidrosis, chest pain, dizziness, paraesthesia, or syncope. These reactions may occur during or immediately after the injection and are reversible. The patient should therefore be observed during and immediately after each injection in order to allow for early recognition of possible signs and symptoms of pulmonary oily microembolism. Treatment is usually supportive, e.g. by administration of supplemental oxygen.

Suspected anaphylactic reactions after Nebido injection have been reported."

The question is given the above warning of Pulmonary microembolism is would it be safe to home administer Nebido via SUBQ. Unless a medical authority says it is safe I would not attempt it. Perhaps @Dr Justin Saya MD can chime in?

Nebido is not approved in the US for home administration, not sure outside of the US. With that said, the reason for requiring injection in office is primarily due to the above-mentioned risk. In theory the risk of pulmonary microembolism should be far less (if any at all) with a subcutaneous vs intramuscular injection, especially if proper technique including aspiration is followed. Another consideration is the large volume of the Nebido injections in relation to subcutaneous injections, which typically are much smaller volume.

 

[Simon7]

@DragonBits , thank you for your elaborate response.

I tried Nebido twice - both times it was completely out of my system within 3 weeks of the injection, i.e. a blood test showed that T levels returned to the (very low) level they were prior to the injection. I have the same problem with transdermals - when I take a blood test 12 hours after application the T level is in the upper 4th quarter, but when I check 22 hours after application the result is that the T level has returned to the very low subnormal value.

It's not a problem for me to transfer the content of the ampule to a sterile vial in order to split the dose to several small doses. That's what I do today with the Testoviron enanthate 250mg 1ml ampule, splitting it to five shots of 50mg each.

I've only seen the risk of pulmanory microembolism mentioned in respect to Nebido/Aveed, not with other Testosterone oil esters.

BTW, what is the source for the data you quoted on % of users who experienced an increase in HCT per T delivery system?

 

[Simon7]

Nebido is not approved in the US for home administration, not sure outside of the US. With that said, the reason for requiring injection in office is primarily due to the above-mentioned risk. In theory the risk of pulmonary microembolism should be far less (if any at all) with a subcutaneous vs intramuscular injection, especially if proper technique including aspiration is followed. Another consideration is the large volume of the Nebido injections in relation to subcutaneous injections, which typically are much smaller volume.

Dr. Saya, thank you for your response!

Nebido comes in 1000mg/4ml dose which is designed to last ten weeks, so if I were to split that up to 20 doses of 50gm each, they be 0.2ml, exactly the same volume as my Testoviron Enanthate 50mg dose that I use biweekly. AFAIK the instructions on all of the Testosterone oil esters say to inject IM, and it is only thanks to your doctors that we began injecting these T esters SUBQ with great results, especially us low SHBG guys who need the slow absorption via the SUBQ tissue.

Given the above, do you think that if folks like me who have good results with injecting Testosterone Enanthate 50mg SUB bi weekly would have similar results with Nebido 50mg SUBQ?

 

[MikeXL]

I use testosterone undecanoate in castor oil every 10-12 weeks, it doesn't cause a dramatic rise in HCT (but in 7& of men, it still happens). My HCT rose from a low of 40 to a high of 47.5.

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FYI. % of men that get a rise of HCT greater than 50% on different T protocols.

Testosterone cypionate or enanthate
(short-acting injectable)100-200 mg IM every week
67% get a rise over 50%

Testosterone undecanoate (long-acting injectable)1000 mg, 12 weeks
7% get a rise over 50%

Transdermal gel 50-100 mg every day(sachets)
Testosterone 20-80 mg every day (dosing pump)
13% get a rise over 50%

Pellets Crystalline testosterone 75 mg/pellet implanted, 10-14 pellets every 3-6 month
35% get a rise over 50%.
------------------------------------------------------

As you can see, HCT is most frequent in men that use either TC / TE. The forum suggest if you change your dose to more frequent injections of a smaller amount, you reduce your side effects.

This is very interesting. What is clear from the mode of administration and corresponding raise in HCT is that slow and steady seems to do better. Perhaps this is a reason for daily IM

 

[DragonBits]

This is very interesting. What is clear from the mode of administration and corresponding raise in HCT is that slow and steady seems to do better. Perhaps this is a reason for daily IM

If I were to inject TC, I would do every day subq. Subq isn't very difficult, I have done it, it's pretty easy. With my SHBG of ~40, I probably wouldn't need to inject every day, but why not?

Daily IM seems like a hassle, it might work marginally better, but I wouldn't want to bother.

 

[DragonBits]

@DragonBits , thank you for your elaborate response.

BTW, what is the source for the data you quoted on % of users who experienced an increase in HCT per T delivery system?

Hematocrit elevation following testosterone therapy – does it increase risk of blood clots? - Nebido - Testosterone Undecanoate

 

[Dr Justin Saya MD]

Dr. Saya, thank you for your response!

Nebido comes in 1000mg/4ml dose which is designed to last ten weeks, so if I were to split that up to 20 doses of 50gm each, they be 0.2ml, exactly the same volume as my Testoviron Enanthate 50mg dose that I use biweekly. AFAIK the instructions on all of the Testosterone oil esters say to inject IM, and it is only thanks to your doctors that we began injecting these T esters SUBQ with great results, especially us low SHBG guys who need the slow absorption via the SUBQ tissue.

Given the above, do you think that if folks like me who have good results with injecting Testosterone Enanthate 50mg SUB bi weekly would have similar results with Nebido 50mg SUBQ?

It would take much longer to “build up” with smaller/more frequent doses of Nebido, but you should eventually attain similar levels/results.

 

[Simon7]

Thank you Dr. Saya!