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 steroid users.
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 successfully 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: 
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“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 apparently 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 only 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
– Very High dose Clomid daily and 1,000 IU HCG EOD. Week 2. NOT RECOMMENDED: Clomid can have side effects.
– High dose Clomid daily, 1,000 IU HCG EOD Week 3. NOT RECOMMENDED: Clomid can have side effects.
– 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”