How to stop TRT Safely?

Being on TRT has changed your life for the better and you're looking to get off now. Will low Test be a problem, and if so, let's learn how to stop TRT safely.

You have checked your hormones and figured out that you need testosterone replacement therapy to normalize your testosterone levels and get rid of the symptoms of testosterone deficiency.

Now a lot of questions pop up in your head. What course of treatment is right for me? Is it a life-long treatment? Need to know how to stop testosterone therapy? Can I stop it? And how?

All viable questions, and I’ve taken the time to learn how to stop TRT safely.

Key Takeaways

  • Testosterone replacement therapy (TRT) is used to treat testosterone deficiency.
  • If you stop Testosterone replacement therapy, your testosterone levels will go back to your baseline before starting Testosterone replacement therapy. Hence, you may experience symptoms of testosterone deficiency.
  • If you are considering stopping Testosterone replacement therapy because of high costs, side effects, or fertility issues, don’t stop treatment on your own and abruptly. Talk to your doctor first.
  • Talk to your doctor and discover your options. You may need to adjust your doses, find other treatment options, or if you decide to end Testosterone replacement therapy, he can help you gradually lower your dose safely to minimize side effects.

When Do You Need To Start TRT?

Hypogonadism in men is the clinical syndrome that results from failure of the testis to produce adequate levels of testosterone and sperm cells. [1]

Classical hypogonadism resulting in markedly reduced T levels due to identifiable congenital or acquired disorders at the testicular (primary hypogonadism), hypothalamic-pituitary (secondary hypogonadism) or combined levels is universally accepted indication for testosterone replacement therapy. [2]

Serum testosterone levels decline gradually with age at an approximate rate of 1% per year after the third decade of life. [4]

In 2018, the American Urological Association recommended the use of TRT in patients with total testosterone < 300 ng/dl. [3]

How Do You Know That You May Have Testosterone Deficiency?

  • Anemia.
  • Depressed mood.
  • Erectile dysfunction.
  • Decreased libido and sexual desire.
  • Reduced muscle mass and strength.
  • Reduced bone mass and osteoporosis.
  • Insomnia and a reduced sense of general well-being.
  • Forgetfulness, difficulty in concentration, and loss of memory.

Can You Stop TRT?

The short answer to this question is Yes! you can but you have to be aware of certain facts. These facts include:

how to stop trt safely
  • Never stop Testosterone replacement therapy abruptly.
  • Never stop Testosterone replacement therapy on your own without consulting your doctor first.
  • Be aware that when you stop Testosterone therapy, Your testosterone levels will be back to the baseline before you started TRT. So, you shoud expect symptoms such decreased lipido, anxiety, mood changes and irritability.

Why You May Think About Stopping TRT?

There are a lot of reasons that may exist behind your desire to stop TRT.

Feeling well

You feel well. You’ve been on TRT for awhile now and you feel you are finally back to your normal life. Your symptoms are under control and your sexual function is improved. So, now you feel that TRT paid off and you need to stop and just enjoy the benefits.

Just be aware that this “feeling well” is because you are on TRT and once you stop testosterone replacement therapy, your symptoms will appear again gradually and your testosterone levels will be back to the baseline when you strated TRT.

So, before making any decision to stop TRT, talk with your doctor first to find the best option and may be the best ulternative for you!

Costs

Financial burden may be one of the reasons that may make you think about stopping TRT. The costs of the initial and regular blood work for follow-ups, regular doctor visits, and most significantly the costs of TRT formulations.

This can range from as low as $20 to as high as $1,000 per month. So, it’s reasonable that costs may be an understandable reason.

Side Effects

Prostate Cancer 

TRT increases prostate volume and PSA. There is unequivocal evidence that TRT can stimulate growth and aggravate symptoms in men with locally advanced or metastatic prostate cancer.

Erythrocytosis

Erythrocytosis is a common adverse effect of TRT, particularly with testosterone ester injections and in older men. Middle-aged and older men on TRT are nearly four times as likely to have HCT > 50%.

Venous Thromboembolism

The known association between TRT and erythrocytosis and a report that demonstrated an increased risk of venous thromboembolism in men receiving TRT, especially in those with underlying thrombophilia, have led the FDA to require adding a general warning to testosterone products about the potential risk for venous blood clots. [3]

Therefore, it is crucial to obtain a careful personal and family history before initiating TRT. [5]

Cardiovascular Disease

Data regarding the cardiovascular safety of TRT have been conflicting and inconclusive. The use of injectable preparations is associated with a greater risk of myocardial infarction and stroke, but not VTE, compared with T gel use. [3]

However, more recent studies have shown that TRT is not associated with an increased risk of cardiovascular disease.

In general, testosterone treatment is contraindicated in men with severe heart failure as fluid retention may worsen the condition. [6]

Fertility Concerns

The Endocrine Society and American Urological Association (AUA) recommend against the use of testosterone for treatment of hypogonadism in men who desire fertility in the next 6 to 12 months. [7]

Exogenous testosterone suppresses LH secretion and thereby decreases the high intratesticular testosterone levels essential for spermatogenesis.

Therefore, hypogonadal men who are being considered for TRT should be told of the suppressive effect of testosterone on spermatogenesis and asked if they desire fertility. [5]

What Should You Expect When You Stop TRT?

The short answer is “Back to your baseline before starting TRT”.

You are going to experience the same symptoms you used to have before starting TRT such as mood changes, decresed lipido, erectile dysfunction, anxiety, etc.

You should also expect your serum testosterone levels to be back to its baseline.

How Do You Stop TRT?

Now you are considering ending your TRT, What is next?

  • Set an appointment with your doctor.
  • Discuss with your doctor the reasons behind your decision. Whether it’s side effects or costs or fertility and desire to conceive. Just be upfront and honest about your reasons.
  • Discuss with your doctor the most suitable plan for you. Gradual withdrawal, and/or finding other alternatives.

Alternative Plans After Stopping TRT

You met with your doctor and made a decision to stop TRT. Now, it is crucial to know what is your plan. Based on the reasons behind your decision, there are several alternatives to TRT. These alternatives may include drugs or lifestyle modification such as regular exercise or both.

Let’s introduce you to some of the options you may need to discuss with your doctor regarding natural testosterone production.

Non-medical Alternatives

Stress Control

While it may not always be possible to live a completely stress-free life, you can do some things to lower stress levels and therefore boost testosterone levels.

Try somethings like meditation, yoga, listening to music, or even reading. This is totally on you. Do whatever makes you feel relaxed.

Exercise

A previous study showed that serum testosterone, glycated hemoglobin (A1C), fasting glucose, high‑density lipoproteins (HDL), triglycerides (TG), and waist circumference were significantly improved after 52 weeks of supervised diet and exercise without testosterone treatment. [11]

Weighted Vest Benefits

There is epidemiologic evidence that frequent vigorous exercise is associated with a 30% lower risk of erectile dysfunction. [11]

Moderate physical activity reduces the risk of ED by two‑thirds, and in men with high physical activity, erectile dysfunction. is reduced by over 80%. [11]

The serum testosterone levels of obese men have been reported to be significantly increasing following a 12‑week course of regular aerobic exercise and dietary regulation. They explained that the aerobic exercise and dietary regulation reduced the insulin levels of obese males, leading to increased serum testosterone levels. [11]

Quality Sleep

Aside from maintaining a healthy weight, sleep quality has been associated with symptoms of testosterone deficiency. [12]

Most studies suggest a correlation between sleep quality and symptoms of testosterone deficiency. [12]

Pastuszak et al. noted a linear relationship between self-reported sleep quality and symptoms of testosterone deficiency as quantified by the Androgen Deficiency in the Aging Male (ADAM) questionnaire. [13]

BMI and Low Testosterone

Low levels of testosterone can negatively affect body composition, and as people age, reduced testosterone levels can also cause weight gain.

Studies have shown that both low testosterone and obesity increase the risk of major adverse cardiac events. [12]

Recent preliminary data have shown that low endogenous testosterone levels are associated with lower high-density lipoprotein (HDL) cholesterol and higher low-density lipoprotein cholesterol, triglyceride, and total cholesterol levels. [12]

As such, the AUA recommends counseling men with testosterone deficiency to increase physical activity and maintain their weight within the recommended range to reduce the signs and symptoms of testosterone deficiency and increase serum testosterone levels. [12]

Previous study reported on 68 men participating in a weight-loss diet. Men lost a mean of 10.3–10.8±1.2 kg over the 52-week study period and experienced significant increases in total and free testosterone (P<0.001 and P=0.002, respectively). [12]

Additionally, men with moderate to severe baseline erectile dysfunction had significant increases in the International Index of Erectile Function (IIEF) erectile function domain following weight loss. [12]

More recently, Rigon and colleagues evaluated 29 men with a mean baseline weight of 155.26±25.88 kg preoperatively and 6 months postoperatively following bariatric surgery. [12]

BMI improved to a mean of 37.82±5.94 kg following surgery, with improvements in total testosterone levels from 229.53±96.45 ng/dL to 388.38±160.91 ng/dL (P<0.001). [12]

Medical Alternatives

Clomiphene Citrate

Clomiphene citrate or Clomid is a selective estrogen receptor modulator. It has been primarily used for infertility treatment in both genders for over 50 years. [8]

It selectively blocks estrogen receptors in the hypothalamus and pituitary, thereby increasing gonadotropin-releasing hormone, luteinizing hormone, and follicle-stimulating hormone release. This boosts endogenous testosterone levels. [8]

A previous study reported that clomiphene achieved testosterone levels comparable to those of testosterone gels. [9]

Another study found that clomiphene significantly increased testosterone levels without changing prostate-specific antigen or hematocrit values. [10]

Clomiphene is a less expensive alternative to testosterone replacement with the added benefit on fertility. [8]

Human Chorionic Gonadotropin (hCG)

Human chorionic gonadotropin or HCG is used to promote the endogenous production of testosterone without compromising spermatogenesis. [3]

It is FDA approved alternative therapy for males with low testosterone and wish to preserve their fertility. [3]

It is also efficacious in inducing spermatogenesis. It is even effective in helping with the recovery of spermatogenesis in men who were on TRT. [7]

Clinicians generally agree on using 2,000 IU of hCG administered subcutaneously 3 times per week as defined by the 2002 American Association of Clinical Endocrinologists guidelines. [7]

HCG may help maintain natural testosterone levels and keep your testicles in good health, both of which are important for maintaining natural testosterone production and fertility, respectively.

Bhasin, S., Cunningham, G. R., Hayes, F. J., Matsumoto, A. M., Snyder, P. J., Swerdloff, R. S., Montori, V. M., & Task Force, Endocrine Society (2010). Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. The Journal of clinical endocrinology and metabolism, 95(6), 2536–2559. https://doi.org/10.1210/jc.2009-2354

Nieschlag E. (2015). Current topics in testosterone replacement of hypogonadal men. Best practice & research. Clinical endocrinology & metabolism, 29(1), 77–90. https://doi.org/10.1016/j.beem.2014.09.008

Park, H. J., Ahn, S. T., & Moon, D. G. (2019). Evolution of Guidelines for Testosterone Replacement Therapy. Journal of clinical medicine, 8(3), 410. https://doi.org/10.3390/jcm8030410

Yabluchanskiy, A., & Tsitouras, P. D. (2019). Is Testosterone Replacement Therapy in Older Men Effective and Safe?. Drugs & aging, 36(11), 981–989. https://doi.org/10.1007/s40266-019-00716-2

Snyder PJ (2012) Testosterone treatment of male hypogonadism. UpToDate, Matsumoto, AM (Ed), UpToDate, Waltham, MA

Isidori, A. M., Balercia, G., Calogero, A. E., Corona, G., Ferlin, A., Francavilla, S., Santi, D., & Maggi, M. (2015). Outcomes of androgen replacement therapy in adult male hypogonadism: recommendations from the Italian society of endocrinology. Journal of endocrinological investigation, 38(1), 103–112. https://doi.org/10.1007/s40618-014-0155-9

Patel, A. S., Leong, J. Y., Ramos, L., & Ramasamy, R. (2019). Testosterone Is a Contraceptive and Should Not Be Used in Men Who Desire Fertility. The world journal of men's health, 37(1), 45–54. https://doi.org/10.5534/wjmh.180036

Francisco, R., Jaroudi, S., Murtaza Ali, M., Frost, J., Chemitiganti, R., & Peiris, A. N. (2019). Clomiphene for hypogonadism complicated by polycythemia. Proceedings (Baylor University. Medical Center), 32(1), 75–77. https://doi.org/10.1080/08998280.2018.1526570

Ramasamy, R., Scovell, J. M., Kovac, J. R., & Lipshultz, L. I. (2014). Testosterone supplementation versus clomiphene citrate for hypogonadism: an age matched comparison of satisfaction and efficacy. The Journal of urology, 192(3), 875–879. https://doi.org/10.1016/j.juro.2014.03.089

Chandrapal, J. C., Nielson, S., Patel, D. P., Zhang, C., Presson, A. P., Brant, W. O., Myers, J. B., & Hotaling, J. M. (2016). Characterising the safety of clomiphene citrate in male patients through prostate-specific antigen, haematocrit, and testosterone levels. BJU international, 118(6), 994–1000. https://doi.org/10.1111/bju.13546

Cho, D. Y., Yeo, J. K., Cho, S. I., Jung, J. E., Yang, S. J., Kong, D. H., Ha, J. K., Kim, J. G., & Park, M. G. (2017). Exercise improves the effects of testosterone replacement therapy and the durability of response after cessation of treatment: a pilot randomized controlled trial. Asian journal of andrology, 19(5), 602–607. https://doi.org/10.4103/1008-682X.184269

Krzastek, S. C., & Smith, R. P. (2020). Non-testosterone management of male hypogonadism: an examination of the existing literature. Translational andrology and urology, 9(Suppl 2), S160–S170. https://doi.org/10.21037/tau.2019.11.16

Pastuszak, A. W., Moon, Y. M., Scovell, J., Badal, J., Lamb, D. J., Link, R. E., & Lipshultz, L. I. (2017). Poor Sleep Quality Predicts Hypogonadal Symptoms and Sexual Dysfunction in Male Nonstandard Shift Workers. Urology, 102, 121–125. https://doi.org/10.1016/j.urology.2016.11.033

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