What If You Have to Stop HRT (TRT)?

How Can You Stop Testosterone?
Today I found out that my testosterone was 111 (ng/ml).  Ouch!  Just as bad, my estradiol read was 12 (pg/ml).  Both numbers can cause classic hypogonadal symptoms as well as serious medical issues such as anemia and osteopenia.

That is the lowest testosterone reading I have ever had in my life and I’ve had some pretty low ones before.  This was obviously way below the standard hypogonadal thresholds out there for adults males:  280ish (non-LabCorp) or 350 (LabCorp).  Why was it so low?  Because I had stopped HRT (testosterone therapy) a few weeks before.  I often get asked what happens to a man when he stops testosterone therapy cold turkey and now you know!

Here are the dates and numbers, so you can get an idea as to exactly why I stopped HRT and how rapidly my testosterone fell:

  • Early December Blood Draw:
  • Two high PSA reads: 6.3 and 5.0.  (I was always less than 1.5 prior to these reads.)
  • –Total Testosterone (Trough):  719 ng/dl. (Peak testosterone probably around 1100 ng/dl.)
  • 12/10/2013:  Last injection.
  • –My clinic demanded that I have urological clearance before continuing with HRT.
  • 12/17/2013:  12-Point Prostate Biopsy.
  • 12/18/2013:  Began Prostate Nutraceuticals.
  • –Details of what I took are outlined in my page on High PSA But No Cancer.
  • 12/27/2013:  Results Back from Pathologist.
  • –Urologist explained that results showed no cancer or precancer but some inflammation.
  • 1/3/2013:  Retested for Total Testosterone, Estradiol and PSA.
  • 1/6/2013:  Results Back from 1/3 Blood Draw
  • –Total Testosterone = 111 ng/dl; Estradiol = 12 pg/ml; PSA = 3.6 ng/ml

What this means is that in 24 days my total testosterone dropped from a weekly average of about 900 ng/dl to 111 ng/dl!  Before I began HRT – admittedly years ago – my testosterone levels were always in the low 300’s, so this 111 read was very likely a rebound effect.  I talked to my clinic director about it and he stated that, from what he has seen, the following rules usually apply for men quitting HRT cold turkey for whatever reason:

1.  Rebound.  There is a short term rebound affect where the man drops below his baseline for a few weeks or a couple of months.  Of course, usually the man was hypogonadal to begin with so this results in very low testosterone levels.  My clinic director said that this rebound typically occurs from about week 4 to week 8.

2.  Restoration of Baseline Testosterone Levels.  Recovery time usually takes 3-4 months.  Of course, baseline levels are usually quite low for men on HRT and, in some cases, it takes longer than 3-4 months. Yes, this is a long time, especially if you are in a relationship, but it’s survivable.

As a side note, I did surprisingly well during these last three weeks and did not notice the symptoms.  In fact, I actually had morning erections most nights, something I normally do not have unless my testosterone is > ~600.  I attribute this to the fact that I had started on POM pomegranate juice – no affilliation whatsoever – and a series of anti-inflammatories. which I discussed in my link How I Attacked my High PSA.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

Notice that my PSA did indeed fall appreciably from a high of 6.3 to 3.6 in about a month, which is a 43% reduction.  You might be thinking that my PSA dropped simply because my prostate shrank.  However, I have never had an enlarged prostate and, again, all my reads before a month ago were less than 1.5.  I feel certain that I have improved the inflammation or prostatitis that was likely causing the underlying problem.

I will also say that the last few days had become quite miserable though.  This is probably when my testosterone fell below 200.  I found my libido to be very low and I was having joint aches and terrible sleep.  (Libido has been found to be dose dependent on testosterone levels, which you can read about in my link on Testosterone and Libido.) In my low testosterone days I remember that that was one of the worst aspects of being hypogonadal:  miserable sleep and waking up feeling awful no matter how long I stayed in bed.  Also, I developed some venous leak from the years and years of low testosterone, so, needless to say, I was anxious to get back on HRT.

UPDATE:  I am officially back on HRT and what a difference!  Testosterone cypionate made a huge mental difference for me almost immediately.  I feel much more relaxed with minimal anxiety and slept much better last night.  (I got my shot yesterday afternoon.)

Stopping Testosterone with Less Pain
Does stopping testosterone have to be a very painful experience, where one loses sexual function?  The answer is probably not. Here are Four Ways to (Likely) Stop Testosterone Therapy With Less Pain. (Discuss with your doctor of course.)

1.  Clomid.  Now, first of all, do NOT consider this option if you are going off of HRT due to possible prostate cancer or a high PSA.  Clomid will very likely raise your testosterone and so you need to follow your urologist’s advice and, if he/she says to lower your testosterone levels, then go with that.  However, some men go off of HRT for different reasons, such as a) wanting to try to go natural or b) wishing to get their fertility back, etc.

These men can often consider Clomid as an option.  Clomid basically works on the hypothalamus and “tricks” your body into thinking it needs to signal for more testosterone.  This will work assuming that your pituitary and testes are functioning reasonably well.  However, clomid is notorious for working full strength for a month or two and then starting to lose its potency, i.e. testosterone levels begin to drop.  However, even if you fall into this category, you should get a couple of months of relief.  My impression from the Peak Testosterone Forum is that about 75% of men will respond to Clomid for at least 2-3 months reasonably well.

So Clomid will solve all your problems? Unfortunately, one of Clomid’s two active compounds is estrogenic and this fact causes men a lot of problems:  headaches, moodiness, depression and low libido are very common.  I would say that 80-90% of men have one or more of these symptoms.  And think how discouraging it is to see that you have nice beefy testosterone levels but your libido is almost nonexistent, a more-often-than-not occurrence on Clomid.  Also, Clomid has a number of rare, but serious side effects, so discuss with your doctor..

2. Boost Nitric Oxide (Assuming #1 Does Not Happen). Testosterone actually activates the eNOS enzyme and thus can increase nitric oxide in men (who have decent baseline NO). When those testosterone levels collapse, it’s beneficial to keep your nitric oxide levels up as much as possible. I have a lot of ideas in my link Increase Your Nitric Oxide Levels Naturally.

3. Increase Insulin Sensitivity (Assuming #1 Does Not Happen). As testosterone levels fall, insulin levels and insulin resistance rises as I document in my links on Testosterone and Insulin and Testosterone and Diabetes. To insure that elevated glucose levels do not cause you problems as your T slides downward, you will want to a) exercise more, b) eat more low glycemic foods and possibly c) add some supplements for protection (cinnamon, green coffee bean extract, carnosine, etc.).

4. Self-Monitor Your Glucose and Nitric Oxide. Your doctor will probably not care about #2 or #3 and so you may have to self-monitor. There are many labs who do extremely inexpensive lab testing: Reasonable Lab Testing. You can do a decent job of monitoring your nitric oxide levels with Nitric Oxide Test Strips.

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