Ask a doctor on the topic of Urology

Decreasing testosterone levels despite Nebido

August 2, 2020 | 40,00 EUR | answered by Dr. Med. Thomas Kreutzig

Good day,

My problem concerns the topic of testosterone substitution. Since December 2018, I have been receiving the medication Nebido injected every 12 weeks. Due to the testosterone deficiency, I have a low libido and very weak and irregular erections. Initially, I had better libido and erections with the medication, but unfortunately, I now feel hardly any effect. Recently, I received the new lab values and was shocked to see that my testosterone level has decreased despite the substitution.

Here are my values for comparison in 2019 and now in 2020:

06.06.2019:
Testosterone 2.56 ng/ml low, SHGB 13.8 nmol/l and FAI 64.3 within normal range.

07.07.2020:
Testosterone 1.36 ng/ml low, SHGB 15.5 nmol/l FAI 33.4.

There is a peripheral testosterone deficiency.

Now, I have the following questions:
1. Why is my testosterone level dropping despite Nebido?
2. What does a peripheral testosterone deficiency mean?

Thank you in advance, I hope you can help me.

Dr. Med. Thomas Kreutzig

The testosterone replacement therapy must above all replace your own production. When determining the level, the time since the last injection is crucial. If the level is not sufficient, the intervals between Nebido injections can be shortened. Combining it with morning gel is also an option.

The total testosterone level is crucial. A testosterone deficiency is always also "peripheral," which is why the term is somewhat misleading.

For erectile function, a low-dose therapy with Tadalafil (5mg daily or every 2 days) can be excellent!

Good luck!

Best regards,

Dr. T. Kreutzig-Langenfeld