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Quitting TRT: What to Expect and How to Manage the Transition

Stopping TRT: Challenges, Solutions, and the Road to Recovery

Testosterone replacement therapy (TRT) is a common treatment for men with low testosterone levels, helping to improve energy, mood, muscle mass, and overall well-being. Treatment for men has become popular as the understanding of hormone balance by qualified healthcare providers has led to a better understanding of the health benefits from a proper protocol. We have treated countless patients for testosterone therapy and the vast majority of our patients stay on testosterone therapy long term, however, there may come a time when you decide to stop TRT—whether it’s due to financial considerations, side effects, medical advice, or personal choice. Understanding what to expect when discontinuing TRT and how to manage the transition can be crucial for a smooth process of coming off TRT and mitigate and side effects from cessation of treatment. Here’s a guide on coming off testosterone therapy, including the symptoms you may experience, the steps to take, and tips for maintaining health and hormone balance. It should be noted that stopping any medically supervised treatment should be don’t in collaboration with your prescribing physician, and anyone stopping testosterone therapy that they are undergoing without physician guidance or prescription (which we strongly do not recommend) SHOULD seek out the expertise of a licensed physician.

Why Come Off TRT?

Whereas the majority of our patients stay on hormone therapy for a long period of time, sometime patients may decide to stop therapy. There are various reasons why someone might decide to stop TRT. These can include:

Unwanted Side Effects: Some men experience side effects on TRT like water retention, acne, increased blood pressure, or mood swings. While these are often manageable, they can sometimes prompt discontinuation. Usually these side effects can be managed with slight adjustments to the patients protocol however the mere presence of any side effects can be enough to dissuade a patient from continuation of treatment.

Health Concerns: Certain health risks are associated with long-term TRT use, particularly in individuals with pre-existing conditions. Patients that may have preexisting heart conditions or prostate cancer may not be good candidates for therapy.

Desire to Boost Natural Testosterone: Some men prefer to pursue lifestyle changes, supplements, or other therapies to boost natural testosterone production rather than rely on TRT. Things like diet, sleep, exercise and stress management may help increase testosterone and for some patients this may be a suitable course of action.

Fertility Considerations: TRT can suppress natural testosterone production and potentially reduce sperm count, impacting fertility. Often we have patients Discontinuing TRT is sometimes necessary for men looking to restore fertility, however there are medications that can help maintain fertility when on TRT like enclomiphene, FSH, LH and hCG.

Effects of Coming Off TRT

For those that do decide to stop hormone therapy there are a few issues that they may deal with, especially for the first few weeks after quitting treatment. Testosterone replacement therapy introduces exogenous synthetic or bioidentical testosterone into the body, often causing the body’s natural testosterone production to slow down or halt once the hypothalamus detects increased levels in the bloodstream. When you stop TRT, the endocrine system realizes that it needs to start making more of the hormone and thus your body needs time to recalibrate. The hypothalamus will begin releasing more GnRH which in turn causes the pituitary to secrete more LH and FSH which then triggers the testes to produce testosterone. Unfortunately, this process make take some time to “reboot the system” which can lead to several effects:

1. Drop in Energy Levels: A decrease in energy is common as the body adjusts. Many men report feeling sluggish, fatigued and there may be a decline in physical endurance and motivation to do things like hit the gym or exercise. This often can resolve itself however many men have stated they go back to feeling like they did PRIOR to starting TRT. Considering they started TRT because of how they felt, this often leads to feelings of frustration and many men will decide to restart treatment as a result.
2. Mood Changes: Testosterone influences mood regulation, so you may feel irritable, anxious, or even depressed while coming off TRT. It turns out that optimized hormones leads to men feeling better physically and this will influence their mood. When the benefits of TRT no longer exist, they may feel more irritable as a result.
3. Reduction in Muscle Mass and Strength: Testosterone supports muscle protein synthesis, so you may notice a decrease in muscle mass and strength without TRT. Men feel weaker, lose definition and motivation to workout. They may gain fat as well as lose muscle starting a cycle that accelerates testosterone depletion.
4. Lowered Libido: Testosterone plays a key role in sex drive, so you may experience reduced libido and sexual function initially.  Many men start TRT for specifically its role in increasing testosterone and improving erectile function.
5. Changes in Sleep: Some men find it challenging to sleep well when coming off TRT, often reporting insomnia or disrupted sleep patterns. There is a definite link between testosterone levels and sleep. Sleep is when men produce testosterone so when you cant sleep well, they cycle get exacerbated and levels decline even more. Better sleep equals better testosterone. Lower testosterone leads to poor sleep. It’s like being stuck between a rock and a hard place.
6. Possible Weight Gain: Without TRT, metabolism can slow down, leading to potential weight gain if dietary habits are not adjusted accordingly. Patients with low testosterone usually have higher estrogen and gain fat around their midsection. When you factor in a decrease in energy, and muscle synthesis, this can quickly spiral out of control.

Planning for the Transition Off TRT

Stopping TRT requires a planned and gradual approach, ideally under the supervision of a healthcare provider. Usually, they will come up with a “tapering off” protocol to ease the transition and mitigate side effects. Other physicians may decide to have a patient go off “cold turkey” to restart the natural production as quickly as possible. Each patient will have a different and unique approach. Here are some steps to consider when coming off of testosterone therapy, whether its injections, creams or pellets:

1. Consult with Your Healthcare Provider

Your doctor can provide guidance on the safest way to taper off TRT. Abruptly stopping testosterone can lead to a sudden drop in levels, causing more severe symptoms. A gradual reduction in dosage can help your body adjust more smoothly.

2. Consider a PCT (Post-Cycle Therapy)

Post-cycle therapy (PCT) involves medications or supplements that encourage the body to restart natural testosterone production. Common options include:

• Enlomiphene: Enclomiphene is a selective estrogen receptor modulator (SERM) that stimulates the body’s production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), promoting natural testosterone production in men. Sometimes doctors will prescribe Clomid, however enclomiphene has been shown to demonstrate fewer side effects and is a better option for most patients, though every patient is unique so it’s best to consult with an experienced physician or endocrinologist/urologist to determine which medication is best for you, enclomiphene of clomid when stopping TRT.
• Human Chorionic Gonadotropin (hCG): hCG mimics Luteinizing hormone (LH), a hormone released by the pituitary in response to the hypothalamus releasing GnRh. It works by stimulating the testes to produce testosterone and prevent testicular shrinkage for men who take exogenous testosterone injections. Its probably the best solution for this however recently it’s become more difficult to obtain and has increased in costs due to FDA regulatory changes in 2020, which limited compounding pharmacies and their ability to manufacture the medicine. As a result the demand and costs have increased while the supply has dwindled.
• Tamoxifen (Nolvadex): Like Clomid, tamoxifen is a SERM that can help restore hormone balance. Tamoxifen is a selective estrogen receptor modulator often referred to as a SERM. It’s commonly used to treat and prevent breast cancer by blocking estrogen’s effects on certain cells however in men it’s sometimes utilized in post-cycle therapy (PCT) for individuals who have used anabolic steroids in an effort to help restore natural hormone balance.

Your doctor may recommend one or a combination of these therapies based on your specific needs, but note that PCT may not be necessary for everyone as everyone will have different needs, results and goals.

3. Adopt Healthy Lifestyle Habits to Support Testosterone

This is kind of a no brainer and something that we should all do regardless of our HRT status, but especially after TRT, focusing on lifestyle choices can help to make a significant difference in your hormone levels and overall well-being. Key areas for people to focus on include:

• Exercise: Resistance training, such as plyometrics and weightlifting, has been shown to not only support testosterone levels, but actually increase them. Patients who engage in regular exercise, incorporating both strength training and cardiovascular exercise will see improved overall health as well as more optimized hormone levels as a result of their efforts.
• Diet: A diet that is rich in items such as lean proteins, healthy fats, and essential nutrients (like zinc and vitamin D) can help support testosterone production. Avoiding processed foods, excess sugar, and alcohol can also benefit hormone balance. Here’s a link to learn more about foods that can help increase testosterone levels. If eating healthy is an issue, then consider taking a multivitamin to ensure proper micronutrient supplementation into your diet.
• Sleep: Quality sleep is crucial for testosterone production. Men make testosterone overnight when they are sleeping. Aim for 7–9 hours per night to promote recovery and reduce stress. Even adding one extra hour of rest per night will potentially have a tremendous impact on testosterone production.
• Stress Management: This one is easier said than done. We all have stress whether it’s work or family related. Chronic stress elevates cortisol, a hormone that can suppress testosterone production in men. Practicing mindfulness, yoga, or meditation can be beneficial to reducing stress. Just finding time out to engage in activities that one enjoys is important for maintaining a healthy and happy lifestyle.

Managing Symptoms After Coming Off TRT

While adjusting off TRT, you may start to experience a range of symptoms that can be challenging and often overwhelming at first. Here are a few proven strategies for managing them while adjusting your body’s new hormone levels.

1. Fatigue and Low Energy

This is one of the biggest complaints we hear from patients after they stop TRT. Many times, [patients will call to ask why they feel so run down and we politely explain to them, that this is just how many patients feel with Low T. To combat low energy, focus on a balanced diet, regular exercise, and sufficient sleep. Avoid over-relying on caffeine, as it can lead to crashes later in the day. Instead, try natural energy boosters like green tea or B vitamins. After a period of time, these may help boost T levels and help increase natural testosterone production as well.

2. Mood Swings and Irritability

Mood swings can be difficult to handle but are often temporary. Men typically feel good with optimized hormone levels so when you come off of TRT, you may feel sluggish, down and the dumps and grumpy. This is hard for the man as well as his loved ones, friends,  and coworkers. Practicing stress management techniques like deep breathing or progressive muscle relaxation can help. Talking with a counselor or therapist can also be helpful if you experience significant mood changes or depressive symptoms.

3. Loss of Muscle Mass and Strength

A decrease in muscle mass is common after stopping TRT. However, resistance training can help you retain muscle and even stimulate some natural testosterone production but expect to lose size and strength as well as definition. Consistency with a structured workout routine is key in staying healthy but the reality is, without optimized testosterone levels, a patient is going to see a decrease is muscle mass.

4. Reduced Libido and Sexual Function

Libido quite often declines when coming off TRT, but it may improve as your body adapts.  Typically our patients notice a large increase in their sex drive when they start TRT and unfortunately a swift decline once they stop. Open communication with your partner and realistic expectations are essential when this occurs. Additionally, a healthy diet, regular exercise, and stress reduction can positively impact libido over time and may be needed to combat the lower suboptimal testosterone levels.

5. Weight Gain

Without TRT, metabolism may slow, leading to weight gain, especially in the abdominal area for men. Focusing on nutrient-dense foods, portion control, and regular physical activity can help you manage your weight especially after stopping TRT. A combination of resistance training and cardiovascular exercise is effective for maintaining a healthy body composition/BMI and will help maximize the body’s natural testosterone production. Avoiding processed foods, sugars and fast food is important during the transitional period to prevent rapid weight gain post HRT cessation.

Natural Supplements to Support Testosterone Levels

There are several natural supplements which may help to support testosterone levels during this transition, although the increase in T production may be slight, especially in comparison to prescription testosterone. There are many over the counter testosterone boosters on the market, however studies have shown that most of these are ineffective and in many cases actually can LOWER your testosterone levels. Some popular options of testosterone boosters include:

• Zinc: Zinc is an essential mineral known for its ability to help raise/optimize testosterone production. You can get zinc through various food sources, such as red meat, poultry, shellfish (like oysters), beans, nuts, whole grains, and dairy products. Zinc is also available in supplement form, either as standalone zinc tablets or in multivitamins and mineral supplements which can be purchase at most local pharmacies, supermarkets and sports nutritional stores like GNC.
• Vitamin D: Low vitamin D is associated with low testosterone. Vitamin D can be obtained by people through sunlight exposure, as the skin produces it when exposed to UVB rays but this may not be suitable or even possible for everyone. You can also get vitamin D from foods like fatty fish (salmon, mackerel), fortified dairy products, egg yolks, and by taking vitamin D supplements when needed, especially in areas with limited sunlight.
• Ashwagandha: Ashwagandha is an adaptogenic herb traditionally used in Ayurvedic medicine to help the body manage stress, promote relaxation, and improve overall well-being. Known for its potential to support cognitive function, energy levels, and hormone balance, ashwagandha may also have benefits for reducing anxiety, enhancing physical endurance, and supporting immune health all of which may have a positive impact of testosterone levels.
• Fenugreek: Fenugreek is commonly used in traditional medicine and cooking, known for its potential health benefits, including supporting hormone balance, digestion, and blood sugar regulation. Often taken as a supplement, fenugreek may also help enhance libido and testosterone levels in men, as well as support milk production in breastfeeding women. Fenugreek has shown some promise in supporting testosterone and libido, though more research is needed to fully understand its benefits towards this process.

Stopping TRT: Patience and Monitoring

For patients coming off TRT, it is a journey that requires patience and a strong commitment to lifestyle adjustments in order to prevent the potential side effects that are most likely to occur after ending treatment. Hormonal balance can take time to restore naturally, so allow yourself several months in order for your body to adjust fully back to natural pre-trt production, especially for older men who have been on long term testosterone therapy. It’s normal to experience fluctuations in energy, mood, and libido as your natural testosterone production resumes and be aware that they will usually only bounce back to pre-trt levels and often don’t even get to be that high. Everyone is different.

It's vital to schedule regular check-ups with your healthcare provider who can ensure your transition is progressing smoothly under their guidance. Blood tests can provide insight into your hormone levels and how quickly they’re rebounding and will help your doctor determine if additional support, like PCT or natural supplements, may be necessary to help restart your endocrine production.

While coming off TRT may present challenges for most men, focusing on a holistic approach to health—through diet, exercise, sleep, and stress management—can ease the process and is something that we should all be doing anyway. Over time, you may find a new balance that allows you to enjoy improved well-being without needing long-term testosterone supplementation, however it’s in everyone’s best interest to seek the care of an experienced healthcare provider to allow us to make the most informed decisions possible about our health.

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