The Testosterone Restart
STEP 7: Can You Restart Your Testosterone?
One fairly common question on the Peak Testosterone Forum is whether or
not one's low testosterone levels can be restarted. Of course, some of us feel that we have always had low testosterone since puberty and thus there is nothing to restart. However, the majority of hypogonadal men coming to this site feel that they once had solid T levels, but something unknown happened and their testosterone dropped for one reason or another. These men can actually consider seeking out a restart, i.e. a methodology to actually restore naturally their old testosterone levels.
Will it work? The answer is simple: there is no way to know unless you try. The reason is that there are three
types of true hypogonadism (clinically low testosterone): a) primary or testes-based, b) secondary or pituitary-based and c) tertiary or hypothalamus-based. Of course,
if you are primary, i.e. your Leydig cells are actually damaged or genetically malformed, etc., then you cannot restart. This could happen if a man contracted
adult-onset mumps and his testes were damaged. He simply will not be able to be restarted. Perhaps in the future we will have some way to
generate new Leydig cells via stem cell therapy or some other miraculous means. But, as it stands now, that is out of our reach.
Now let's jump to the case of pituitary damage. There are cases, admittedly
quite uncommon, of men losing their testosterone through what is called empty
sella syndrome and part of the responsiveness of the pituitary being damaged.
 In this case the hypothalamus would send the signal to the pituitary for
more testosterone, but the pituitary would not respond correctly in its
signaling to the testes. Again, in this case, a testosterone restart
cannot truly happen. However, it should be pointed out that something
called HCG Monotherapy can do a quasi-restart. HCG is an LH analog that
will trigger the testes to produce testosterone. However, the HCG must be continued indefinitely in this case, because
the pituitary cannot self-heal. The good news is that one's testes are actually being stimulated to start working again and one
can quite often experience an actual increase in the size of the testicles along with a boost in testosterone. For many, this
seems like a much more natural approach. We have a number of men on the Peak Testosterone Forum that
have been this type of treatment and you can read their comment by using the Search feature there.
However, one should not that HCG Monotherapy does shut down some pituitary function however, so it is not a true restart of the entire HPT axis.
What about the case of tertiary hypogonadism? Well, this is where it gets
interesting. Again, if the hypothalamus is actually damaged, then there is
little that can be done for a true restart. That said, sometimes you can
give a man Clomid, a SERM that acts upon the hypothalamus, and a man can be
successfully restarted. By this I mean that you can back off his Clomid
dosage and then his entire HPT axis will work just fine with decent testosterone
levels resulting. In fact, this very situation happens all the time with
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Steroid users take their testosterone levels to 2500+ ng/dl and usually end up
with their body's own natural production shut down. However, steroid users
are usually young guys and their hypothalamus, pituitary and testes are all
fine. It's just that somehow the "switch" got turned off. And in
their case, they can restart using Clomid.
But what about the typical non-steroid hypogonadal male, who wakes up one morning
and realizes he's not feeling good. His libido is down; his morning
erections are subsiding; he's starting to get a little erectile dysfunction and
is experiencing increased fatigue and anxiety. He goes in one day to the
doctor's office and finds out he has low testosterone. Can he restart?
Based on what I have seen the answer is usually not. I have been running
the Peak Testosterone Forum for a few years and no one has restarted his testosterone
successfully to date. A couple of guys have had a restart
that seemed to last for a couple of months, but then their testosterone dropped
down to their old hypogonadal levels.
That said, it is probably worth a try. Dr. Crisler is one of the early
pioneers and apostles of this technique and he has restarted some men using Clomid.
Again though, from all I have heard, it is a low percentage of men that
succesfully restart under these circumstances, but you have little to lose other
than a little time and money, assuming you can find a reasonably priced doctor
to work with you.
So what is the general protocol? One of our posters gave a nice summary:
"Start at 12.5mgs Clomid per day. After 3 weeks, run these labs (which you ran
before you started, BTW): TT LH FSH SHBG E2 (sensitive only) If you feel much
better--the goal of therapy--you are all set. Even if your T levels don't look
great; that would mean you happened to catch your new production level at a
trough. If you don't feel much better, have your LH and FSH levels risen
substantially? If not, increase the dose to 25mgs. A couple weeks later, the
same labs again. You can go to 37.5mgs, then 50mg per day if necessary. Notice
we are employing 1/4 tab increases, for convenience. If LH/FSH rose
substantially, and T did not, and you still don't feel well, look to testicular
failure as your issue. Of note, some have gotten great results on only 12.5mgs
every other day." 
Again, this is not something you want to try on your own: I encourage you
to find a good doc to work with.
So has anyone on our forum successfully restarted? Not really. We had
one man who went on Clomid and two months after quitting has raised his
testosterone from 428 to 545 ng/dl, a 27% increase.  Of
course, that's just one guy and it was only two months afterward.
Nevertheless, it at least gives some hope, eh? Well, unfortunately, that is
not necessarily the case. Look at the description from this young man who
was okay for a couple of months but then drifted back down to his old levels
shortly thereafter: 
"I have also tried clomid restarts which have lasted for about 6 weeks at 50 mg
per day. My Free testosterone went from 11.3 pg/ml 9 AM to 16.5 pg/ml 5 PM.
That's pretty impressive if you figure the 16.5 pg/ml evening draw might have
been roughly 30% lower than what an AM reading typically is. My levels like most
men who are secondary also drop back down into the problem areas and I
experience all the same symptoms. I will say though I have had levels
stay elevated for close to two months once the SERM use is discontinued
and thought "could it be possible my body has normalized" but the levels
fall back again eventually. Symptoms once again reappear and the
bloodwork confirms this."
"This really sucks for many secondary men who respond to clomid but the clomid
fails to reset the HPTA. However this points out some important factors that
should be addressed. We know that our pituitaries will secrete LH in response to
GNRH and we know our testicles still work, but it seems the hypothalamus isn't
sending adequate GNRH pulses without the pituitary being fooled by blinding it
to estrogen detection with a SERM. There seems to be a malfunction between the
hypothalamus and pituitary. I'm leaning more towards a damaged
hypothalamus as being the culprit for many of us."
And what if you get a big testosterone increase? Is this a positive sign
that a restart is likely? Well, not according to the story of this young
man who actually went supraphysiological with his Clomid dose but plummeted back
down to earth almost immediately:
"I took clomid back in july. 50 mg every day. Shot my levels up (1550), but 3
months being off clomid, everything crashed back down and total testosterone is
back in the 300s." 
NEWS FLASH w PROTOCOL UPDATE: Some of our users have been looking at the latest protocols out there and are attempting a restart as I write this. They are doing to some of the smarter and most experienced doctors out there, and here is what is being tried according to their description:
1. Pretty Low Dose HCG at First: One of our men was put on 350 IU of HCG daily for a month to appearently fire up the testes and was told that Clomid would follow after that.  Still another poster said the usual was 100 IU MWF. 
2. Clomid Next and Fairly Low Dose As Well. One of moderators was put on a protocol of 12.5 mg of Clomid every day. He has oly been doing this for a month, so results are still pending for his situation. 
One of our othe posters, who is on the steroid boards a lot, has pointed out that the steroid men use much higher dosages of everything, which seems a bit risky to me, because that much Clomid could cause side effects in some men. (See below.) But then steroid users probably have a much more severe hormonal profile and shutdown and may need hire dosages. He claimed that this type of protocol was common in Europe and worked well for them. It is always better to go to a physician who works with these kind of things day in and day out.
"STEROID USER PROTOCOL (NOT RECOMMENDED): First stop all Testosterone (and other stuff he takes) Week 1
- 3 x 50mg Clomid daily, 1,000 IU HCG EOD. Week 2
- 2 x 50mg Clomid daily, 1,000 IU HCG EOD Week 3
- 1 x 50 mg Clomid daily 1,000 IU HCG EOD."
After that, back to his cruise dose for 6 weeks and get new blood work. It seems that in Europe, this is the recommended way to do a reboot." 
1) Recenti Prog Med, 1992 Feb, 83(2):73-6, "Primary empty sella syndrome and hypogonadotropic hypogonadism in young male patients"