Have you been on testosterone replacement therapy and wondering how to safely come off TRT? Are you worried about high estrogen levels, whether your testosterone levels will come back into normal range, etc? In this article, we will look at how to safely come off TRT (testosterone replacement therapy) safely. We will address luteinizing hormone, estrogen, and if you need to take things like HCG or Clomid, etc. We will also look at some of the questions surrounding testosterone replacement therapy and shutting off the natural production of testosterone when you stop replacement therapy.
If you want to know how to safely come off TRT, keep reading.
How To Come Safely Come Off TRT?
Once you decide to stop TRT you may ask if it's safe to stop it abruptly or if there's something specific you need to do to reset your body. Do you need to do something to make sure everything is working the way it was prior to starting, for instance? The main reason people ask this question is because of the feedback loops between the testes, the pituitary, and the hypothalamus. These feedback loops can get interrupted when you are taking testosterone from external sources. This is true whether it is an injection, something you take by mouth, a pellet, or even a topical cream. That outside source of testosterone will actually interrupt the feedback loops between your brain and your testes. Sometimes it will just turn down or dampen that loop or it will shut it off completely. This is a dose dependent phenomenon.
First we want to look at the feedback loop itself, then we will look at what happens with testosterone replacement therapy. Finally, we will look at the things you can do to mitigate the interrupted feedback loop when you stopping TRT.
Testosterone is produced from specific cells in the testes called the Ledig cells. Those cells are stimulated to produce the testosterone by a hormone that comes from the pituitary gland in your brain called luteinizing hormone. When your pituitary gland receives high levels or sufficient levels of testosterone (and to a lesser extent estrogen) it will decrease or dampen the amount of luteinizing hormone it produces. So when the Ledig cells produce the testosterone, it feeds back and shuts off or decreases the amount of luteinizing hormone that's produced there. In addition, there is another feedback loop higher in the brain called the hypothalamus. This gland produces gonadotropin releasing hormone (GnRH). This hormone stimulates the pituitary to produce luteinizing hormone (and other hormones). The production of GnRH is partially influenced by the luteinizing hormone which feeds back to the hypothalamus to tell it there is enough. This will then cause a decrease in the amount of gonadotropin releasing hormone that it produces.
The hypothalamus also has an internal pulsatile stimulus of GnRH too. So that there is not a constant stream of gonadotropin releasing hormone, it is done in a pulsatile manner. When the the overall feedback loop is interrupted that pulsatile stimulation of gonadotropin releasing hormone is also interrupted.
Pituitary Feedback Loop While On TRT
When you are taking an exogenous source of testosterone, the amount of luteinizing hormone goes down. As that luteinizing hormone decreases, you will have less stimulation to the testes to produce that testosterone. In this case, it's okay given that you are taking it exogenously. The moment you stop, it will take some time for your pituitary to reset and produce that luteinizing hormone again. Keep in mind this is not a light switch it is more like a dimmer switch. The more testosterone present in your body the less luteinizing hormone you will produce. If you are doing injections, day one after the injection the luteinizing hormone production will be very low and stay low for several days after. It may start to kick five days after or so depending on the dose you are taking. By the end of seven days, you might have more. The more saturated your body is with the testosterone, the less LH you will produce. If your free testosterone is up above 200 ng/ml, you probably will not produce much luteinizing hormone. If however you are on testosterone replacement therapy and your free testosterone is down at around 100 ng/ml you are probably still producing luteinizing hormone. This is especially true the further away from the injection or the dosing of testosterone. The same principal is true when you stop testosterone completely.
Many people have commented to me that they don't want to go on testosterone replacement therapy because they don't want their testosterone production to completely shut off. The signaling does not really work that way in my experience. It's more of a dimmer switch and it does come back when you stop taking it. There seems to be some suggestion that once you start testosterone therapy you have to continue taking it because it shuts off the internal production completely. Testing many people that have been on testosterone replacement therapy for six months and six years, they still come back to what their baseline was. While this may be true in some extreme cases I have never seen this clinically. This doesn't mean it won't happen but it seems to be more extreme cases. I wouldn't know because i've never seen it.
How To Come Off TRT Safely
My first tip is, if you want to come off TRT, you can just stop taking it. You may feel tired and you may feel like all your old symptoms come back. However, if you really didn't have any symptoms to begin with and you didn't get any benefit from taking the testosterone replacement therapy you're not really going to notice when you stop it. There is no real internal danger or problem that is going to happen from stopping the testosterone. You will just have all your old symptoms coming back. Some people have moderate depression that does come back when they stop testosterone. Whatever you're using for is treatment those symptoms may return.
The next option you can take for a more soft landing to safely come off TRT, is to decrease the dose that you inject. You can decrease the dose you take over the course of one week to two weeks by about twenty five percent. If you typically inject 0.5 cc's of a 200 milligrams per ml once a week, you take 100 mg per week. In this case you would decrease it to 80 milligrams (not quite 25% but close enough) once a week. You will then take this 80 milligrams for two weeks and then drop down again to 50 milligrams etcetera. There is no strict rule about how quickly or how slowly you are supposed to come off the testosterone. If you want an even more smooth landing, you can go down even more slowly and you will notice it less. As your dose is decreasing, your body's luteinizing hormone is starting to kick in more and more.
The third tip to safely come off TRT is to start some kind of luteinizing hormone analog. An analog is something that is similar in molecular structure. HCG is an analog to luteinizing hormone. HCG stimulates the testes to make testosterone just like luteinizing hormone does. This can be taken at 250 units twice a week. Some people even do it more often and in higher doses. 250 units is a more standard dose. You can take this for three weeks after stopping the testosterone replacement therapy. After this just discontinue the HCG all together. You can do HCG in conjunction with tapering off testosterone as well. In this case, as you decrease the dose of testosterone you start the HCG. As the dose of testosterone goes down the dose of HCG goes up. As you can see, there are many different ways to approach this. When there are concerns about fertility you are you better off using something like HCG. Clomid is another option that can increase the amount of luteinizing hormone production. It can be used similarly to HCG.
There is sometimes a legitimate concern about increases in estradiol or estrogen levels as you're coming off of TRT. I prefer to check estrogen levels rather implement a blanket treatment. If you are someone that already has higher insulin levels, you are more likely to have higher estrogen levels to begin with. In this case you may want to be a little more cautious. Remember estradiol comes from testosterone. If you are putting less testosterone in your body, you are less likely to have estrogen as well. It will naturally just go down. Your body will not make higher amounts of estrogen if it doesn't have the raw material. As your body is stimulating the production of LH or if you're taking HCG, these can increase aromatization. This is going to be a temporary thing though. You should be checking your estradiol levels to see if that's a problem for you. You can address that appropriately once you know what the levels of your estradiol are. Things will change as you get further away from the testosterone replacement therapy or TRT.
That should give you a better understanding of how to safely come off TRT. If you have questions about the content in this article, please ask it in the comment section below.
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