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How to come off TRT and possibly reset your HPTA Axis

Jasen Bruce

Dec 3, 2014

We have published an updated version of this article with the latest research and protocol guidance (as of 2020). Read our new article on discontinuing HRT and resetting your HPTA axis.

During the previous years’ large surge in testosterone prescriptions and TRT clinics, there are unfortunately many men who have been misdiagnosed with low testosterone, yet placed on TRT when it may not have been needed in the first place. If you are one of these men and you are considering the discontinuation of testosterone treatments, there is a protocol that can help restore your own hormone axis.

You do not want to stop testosterone "cold turkey", because this can lead to unnecessary symptoms that could last for many months. Below is an example of just one protocol, since there really is no "one way" to do it. This has proven a very effective protocol for some patients, but of course every patient is different and therefore treatments are individualized as needed. Defy’s expert care team develops unique protocols based on each patient’s needs and responses.

TRT: Endogenous Restoration protocol for Men Discontinuing TRT

Male patients who have been taking any form of exogenous testosterone long term (longer than 12 weeks) will likely have significant secondary hypogonadism induced by the negative feedback response to the s testosterone supplementation. The purpose of this protocol is to stimulate the testes using HCG so that they are able to produce testosterone once again, while also preparing them to respond to endogenous (natural) LH/FSH (gonadotropins).

Beyond HCG, Selective Estrogen Receptor Modulators (SERMs) are shown to stimulate the pituitary to release LH/FSH while suppressing the negative effects of excess estradiol resulting from the testosterone to estrogen ratio being out-of-balance after discontinuing hormones. a SERM is often prescribed for some time after discontinuing TRT to mitigate estradiol rebound and negative feedback. Tamoxifen and Clomid are commonly used SERMs.

Medications typically used when discontinuing TRT:

  • HCG – 5,000iu to 50,000iu
  • Clomiphene – 12.5mg to 50mg
  • Enclomiphene – 12mg to 50mg
  • FSH – 1,500 units
  • Tamoxifen – 10mg to 40mg
  • Supplies for HCG Basic Protocol

Protocols vary depending on the individual patient’s needs, and on the type of testosterone delivery system the patient has been using. With testosterone cypionate or enanthate injections, for example, a patient may begin the discontinuation protocol 5 days after the last injection. If the patient is using a testosterone cream, the protocol may begin one day following the last application of the cream. Defy Medical’s experienced providers can guide you through the right discontinuation protocol for you.

Here’s an example of a potential protocol:

During the first few weeks, a patient may take HCG daily either aling with or followed by  Tamoxifen, Clomiphene, Enclomiphene, or another SERM until testosterone and other hormone levels are at adequate levels. Because men discontinuing hormones often experience erectile dysfunction, Sildenafil (Viagra®) or Tadalafil (Cialis) may be prescribed, as well.

Blood work will typically be evaluated every few weeks to see how the body is responding to the stimulation  therapy. Lab work may include:

  • Testosterone F&T
  • Sensitive Estradiol
  • CBC
  • CMP

Your physician can order additional labs at his or her discretion.

If the patient’s total testosterone is elevated after the initial 30 days of the initaial HCG and continued SERM protocols, then it’s likely the patient is responding well. At this point, the physician may decide to have the patient discontinue HCG or SERM, or in some cases continue for longer to ensure symptoms remain non-existent. weeks. All decisions depend on the patient’s individual reaction to the treatment protocol. Once the patient stops the SERM, the physician will typically order more labs to see if the hormone levels remain elevated without outside support. If not, the physician will guide the protocol from there until the labs reflect the desired response.

Symptomology (the study of your symptoms) must also play a role in determining the desired response.

Additional labs needed may include:

  • Testosterone Free and Total
  • Sensitive Estradiol
  • LH
  • CBC
  • CMP-14
  • DHEA
  • PSA

If the patient does not respond to HCG stimulation protocol after a reasonable period of time, it’s possible that the patient is experiencing primary hypogonadism, or the inability to produce natural testosterone. At this time, the physician will likely provide a more comprehensive and thorough evaluation to determine the cause of the hypogonadism.

 Men with primary hypogonadism typically benefit greatly from continuing hormone replacement therapy. If you think you may have primary hypogonadism, Defy Medical’s experienced care team can help guide you into the optimal protocol to maintain your health and quality of life.

*This article is intended to provide general information for these considering making a change. For best results, schedule a consultation with an experienced practitioner to discuss your individual health and goals to determine the most effective protocol for you.

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