Re: Nebido injections for low testosterone in type two diabe
EricTCat,
I disagree with you - Nebido has by your testament made a difference to you. Both physiologically and psychologically you have manifested some of the medications side effects and desired effects. You mention that you're seeing a Consultant Endocrinologist for your diabetes, why didn't he/she initiate Nebido treatment? They don't just specialise in dibetes treatment. Your GP sounds like he/she is periodically assessing, monitoring and I assume titrating the Nebido dose. Injected testosterone can be likened to being on an emotional roller coaster, because you experience all the peaks and troughs which can make you feel at times, hard done by. Topical testosterone i.e. Testogel can be an option which seems to be tolerated better if compliance is not an issue.
The fact is that diabetes is insideous it must be managed. Your doctor is managing your diabetes because it isn't currable. Low testosterone levels have been found to be a common factor in men with diabetes. Diabetes is still receiving a great deal of attention from medical researchers because the disease is not completely understood. Men with diabetes who have symptoms of low sex drive, weak erections, chronic fatigue, depressed mood, or osteoporosis are likely to benefit from testosterone therapy. In the case of comorbidity with diabetes, T therapy is benificial because it may slow some of the ravages of diabetes, this will be a primary concern of your clinicians. They have objectivity and you don't that's why no matter how knowledgable you are, you are the patient.
You must be monitored closely during testosterone treatment for the duration of its use. From the outset of treatment you should have been receiving regular 3 monthly reviews of your free and total testosterone levels until stable, full lipid profile, monitoring of LH and FSH, PSA, electrolytes, and glucose monitoring. Periodic digital examination by the GP and your report of symptoms confirms prostate enlargement, not just serum PSA. The whole point of administering testosterone is to get you back to a more acceptable serum testosterone value, which will be in the mid to higher end of the normal range. Quantification and trend are only apparent through periodic blood testing.
Synthetic esters of testosterone at best mimic natural testosterone. HRT is a crude application of a complex housekeeping molecule. The hormonal processes are subtle within the human body and while medical understanding is getting better, there is a lot that it doesn't know. The testosterone molecule produces psychological effects and physiological effects. Low testosterone males tend to be meek and retiring, lack lustre and unmotivated, fatigued and easily distracted. You sound like you have more purpose and steel these days, that's a positive!
You must read the patient information brochure that accompanies your medication. If you did you would know that increased irritablility (moodiness) and quickening anger are part of the hormone's activating effects (motivating). This too has to be monitored because frequent impulsive disinhibited and explosive anger is not normal. This is likely to be manifested with testosterone misuse, i.e. males with normal mid to high testosterone levels taking inappropriate doses of testosterone without medical supervision.
It's simplistic to assume that erectile dysfunction is driven purely by low testosterone levels, there are other causes and these have to be investigated too. Instead of getting frustrated and blue look at your options, why not go to another GP for a second opinion? If you're suffering recent leg cramps/weakness, new onset fecal or urinary incontinence then you should tell your GP because this requires further investigation.
If your GP has told you that your testosterone serum levels are not stable (decreasing), then was this discussed or referred on? Has a strategy been discussed with you? You sound like you're in the dark. These are questions that you should be asking your GP, not casting doubt on his competency to practice. If you are so dissatisfied and you attribute all the problems that you listed to Nebido, then why are you continuing to use the medication? You must remember that diabetes is a disease that inflicts damage to your body that isn't reversable. Treatment is unlikely to give 100% benefit and consequent total satisfaction. Diabetes is a slippery pole carefully discuss/consider your treatment options before you refuse any therapy.
I wish you all the best.
