Nebido vs Testosterone Enanthate in Malaysia: Which TRT Protocol?

When you decide to start TRT in Malaysia, one of the first questions is: which testosterone formulation? The two most common injectable options are Nebido (testosterone undecanoate) and testosterone enanthate (or its near-identical cousin, cypionate).

Each has trade-offs. This guide compares them head-to-head so you can have an informed conversation with your doctor.

The Two Options at a Glance

Feature	Nebido (Testosterone Undecanoate)	Testosterone Enanthate/Cypionate
Injection frequency	Every 10–14 weeks	Every 3.5–7 days (weekly or split)
Injection volume	4 mL (large, intramuscular)	0.3–0.5 mL (small, subcutaneous possible)
Needle size	21G × 1.5" (large, deep IM)	25–29G × 0.5–1" (small, minimal pain)
Self-injection	Not recommended (clinic visit required)	✅ Easy to self-inject at home
Cost per month	RM150–250 (RM400–600 per injection ÷ 10–14 weeks)	RM200–400
Blood level stability	Moderate — peaks then gradually declines	Good to excellent (with frequent dosing)
Half-life	~21 days (in castor oil depot)	~4.5 days (enanthate) / ~5 days (cypionate)
Dose adjustment	Difficult (committed for 10+ weeks per injection)	Easy (adjust weekly dose up or down)
Estrogen management	Harder (large bolus = more aromatization at peak)	Easier (smaller, frequent doses = less peak aromatization)
Polycythemia risk	Similar	Similar (may be slightly lower with subcutaneous)

Nebido: Deep Dive

What It Is

Nebido is the brand name for testosterone undecanoate 1,000 mg in 4 mL castor oil. Manufactured by Bayer. It's a long-acting depot injection designed for infrequent dosing.

How It Works

The castor oil creates a slow-release depot in the muscle. Testosterone is released gradually over 10–14 weeks. The loading protocol is typically:

1. First injection: Day 0
2. Second injection: 6 weeks later (loading dose)
3. Subsequent injections: Every 10–14 weeks (adjusted based on blood work)

Pros of Nebido

• Convenience: Only 4–6 injections per year. Set it and (mostly) forget it
• No self-injection: Done at the clinic by a nurse/doctor. Good for needle-phobic men
• Compliance: No daily or weekly routine to maintain
• Established in Malaysia: Available at most urology departments and hospitals
• Cost-effective per injection: RM400–600 every 10–14 weeks works out to RM150–250/month

Cons of Nebido

• Painful injection: 4 mL of thick oil through a large needle into the gluteal muscle. Many men report significant discomfort and soreness for days
• Peak-and-trough pattern: T levels spike in the first 1–2 weeks, then gradually decline. Some men feel great for weeks 1–6 and then feel low T symptoms returning in weeks 8–12
• No quick adjustment: If you're having side effects, you can't easily reduce the dose mid-cycle
• Higher estrogen spikes: The large bolus dose creates a testosterone peak that aromatizes more heavily to estrogen
• Castor oil reactions: Some men develop injection site reactions or oil cysts (rare but reported)
• Requires clinic visits: Can't self-administer at home

Blood Level Pattern (Nebido)

Typical testosterone levels on Nebido follow a saw-tooth pattern:

• Week 1–2: Peak (often 800–1,200 ng/dL or higher)
• Week 4–6: Optimal range (600–800 ng/dL)
• Week 8–12: Declining (may drop to 400–500 ng/dL before next injection)
• The "trough crash": Some men feel fatigue, low mood, and reduced libido in the final weeks before their next injection

Testosterone Enanthate/Cypionate: Deep Dive

What It Is

Testosterone enanthate and testosterone cypionate are nearly identical esters with half-lives of 4.5 and 5 days respectively. Available as multi-use vials (typically 250 mg/mL in 1 mL or 10 mL vials).

How It Works

Injected into muscle (intramuscular) or fat tissue (subcutaneous). The ester slowly cleaves off, releasing free testosterone. Shorter half-life means more frequent injections but more stable levels.

Typical Protocols

Protocol	Dose	Frequency	Stability
Standard	100–200 mg	Every 7 days	Good
Split dose (preferred)	50–100 mg	Every 3.5 days (twice weekly)	Excellent
Every other day (EOD)	25–40 mg	Every 2 days	Optimal
Biweekly (outdated)	200–300 mg	Every 14 days	Poor (large peaks and troughs)

Pros of Testosterone Enanthate/Cypionate

• Stable blood levels: With twice-weekly or EOD dosing, testosterone stays remarkably stable — no roller coaster
• Easy dose adjustment: Feeling side effects? Reduce by 10–20 mg next injection. Instant fine-tuning
• Less estrogen spike: Smaller doses = less peak aromatization = less need for aromatase inhibitors
• Self-injection at home: Small insulin syringes, subcutaneous into belly or thigh. Takes 2 minutes
• Painless: With 29G insulin needles subcutaneously, most men feel nothing
• More control: You manage your own protocol (with doctor guidance)

Cons of Testosterone Enanthate/Cypionate

• Frequent injections: 2–4x per week is the optimal protocol. Some men don't want this commitment
• Self-injection required: You need to be comfortable with needles
• Supply management: Need to source vials, syringes, and store properly
• Less available in hospitals: Malaysian hospital urologists typically prefer Nebido. You may need to go to a specialized men's health clinic
• Slightly more expensive monthly: RM200–400/month depending on source and dose

Blood Level Comparison

The biggest practical difference is in blood level stability:

Metric	Nebido (10–12 week cycle)	Enanthate (twice weekly)
Peak T level	800–1,200+ ng/dL	700–900 ng/dL
Trough T level	400–600 ng/dL	600–750 ng/dL
Variation	~50–60% swing	~10–20% swing
How you feel	Great → good → declining → wanting next shot	Consistently good
Estrogen peaks	Higher spikes (may need AI)	Lower, more stable (usually no AI needed)

Which Malaysian Clinics Offer Which?

Setting	Typical Protocol	Why
Government hospitals	Nebido (or Sustanon)	Standardized formulary; less frequent clinic visits
Private hospital urologists	Nebido (primarily)	Established brand, Bayer-backed, doctor-administered
Men's health / hormone clinics	Testosterone enanthate or cypionate	Optimization-focused; prefer stable protocols
Anti-aging clinics	Enanthate/cypionate + HCG	Comprehensive protocols with fertility preservation

For clinic recommendations, see our best TRT clinics in KL guide.

Switching Between Protocols

It's common to switch, especially from Nebido to enanthate:

Nebido → Enanthate

• Start enanthate injections ~4 weeks after last Nebido injection (as Nebido levels decline)
• Blood work at 4 weeks to check levels and adjust enanthate dose
• Most men report feeling more stable within the first month of switching

Enanthate → Nebido

• Less common but sometimes desired for convenience
• Stop enanthate, get Nebido injection within a few days
• Expect an adjustment period as you get used to the less stable levels

Which Should You Choose?

Choose Nebido If...	Choose Enanthate/Cypionate If...
You hate needles and don't want to self-inject	You want the most stable blood levels possible
Convenience is your top priority	You want to fine-tune your dose easily
You travel frequently and can't maintain a weekly schedule	You're sensitive to estrogen and want to minimize aromatization
Your doctor only offers Nebido	You also want to add HCG (already injecting, so adding another is no big deal)
Budget is tight (slightly cheaper monthly)	You want maximum control over your health

The Bottom Line

Both Nebido and testosterone enanthate/cypionate effectively treat hypogonadism. The "best" protocol depends on your lifestyle, preferences, and willingness to self-inject.

If you value convenience and don't mind some level fluctuation, Nebido is a solid choice. If you value stable levels, easy dose control, and a more optimized approach, testosterone enanthate with twice-weekly self-injection is what most modern hormone optimization protocols use.

Whatever you choose, make sure you're getting regular blood work, monitoring for side effects, and working with a doctor who understands both options. And don't forget to discuss fertility preservation if it matters to you.