The side effects of Nebido can include those of an androgenic nature. The androgenic side effects of Nebido are, however, highly dependent on genetic predispositions and will not affect all men. The possible androgenic side effects of Nebido include accelerated hair loss in those predisposed to male pattern baldness, acne in sensitive individuals and body hair growth.
While by no means always necessary, some men may find the use of a 5-alpha reductase inhibitor to be useful. The testosterone hormone is metabolized by the 5-alpha reductase enzyme, which reduces the testosterone hormone to dihydrotestosterone (DHT). The DHT is what leads to the androgenic related effects. By incorporating a 5-alpha reductase inhibitor, you will reduce the hormones androgenicity. It will not be a complete reduction, but it will be significant. However, such inhibitors are not always recommended and should only be used as needed as they can hinder the potency of the testosterone hormone.
It should be noted that in theory if one was to consistently suppress your natural estrogen levels for a long period of time, this would negatively impact your health, including your cholesterol. Due to the ability of Letrozole- to inhibit estrogen so much, this should definitely be a concern to most users. However the research that has focused on the relationship between use of letrozole and cholesterol levels is rather inconsistent in it's findings. Many studies have concluded that the compound is detrimental to both a user's HDL and LDL cholesterol levels, while other research has found no link. Obviously individuals are best served to monitor their cholesterol while using any compound via blood tests however barring that, letrozole should simply not be run for extended periods of time if at all possible. Doing so could cause serious medical complications.
Along with the issues related to blood lipids is the fact that many users complain that their libido is dramatically reduced when using the compound. This is related to the fact that estrogen is partly responsible for the regulation of an individual's sex drive. Since Letrozole- is so potent it can often drive estrogen levels too low and this inhibits a user's libido. To avoid this users can lower dosages, but some anecdotally report that even extremely low doses of the drug can cause problems. If this is the case a less potent compound such as exemestane or anastrozole may be a more appropriate option.
Anticoagulants: Patients on anticoagulants such as warfarin should be carefully monitored during anabolic steroid therapy as anabolic steroids may increase sensitivity to oral anticoagulants which may require a concomitant reduction in anticoagulant dosage to achieve a desirable prothrombin time (PT). Anticoagulant patients should be monitored regularly during anabolic steroid therapy, particularly during initiation and termination of therapy. Warfarin patients should have INR and PT monitored throughout androgen therapy and warfarin dosages titrated to achieve the desired INR and PT. Such patients should be monitored for occult bleeding.