What Happens When You Stop Testosterone Therapy

Physical Changes After Testosterone Therapy Ends

One of the reasons why working with a qualified hormone replacement therapy specialist is so important is the protocol that follows the end of the TRT cycle. The body is going to go through physical changes when supplemental testosterone is no longer being administered. An HRT doctor understands the treatment that must follow to stimulate the testes to increase natural testosterone production after stopping testosterone therapy.

Following the last day of testosterone injections, the body will be put through a 14 day rest cycle. Vitamin B-12 will be the only thing administered during this time. It will be injected subcutaneously beneath the skin.

In order to avoid any unwanted effects of stopping testosterone replacement therapy, our doctors at Kingsberg Medical prescribe HCG injections and Clomiphene capsules to encourage the body to produce testosterone. This helps to maintain the weight loss, muscle tone improvement, stronger bones, and other benefits that were received by correcting Low T with testosterone therapy.

Side Effects Of Testosterone Therapy

Risks and side effects of testosterone therapy may be reasons not to have the treatment or be reasons to stop if you’ve started. Make sure to ask your doctor about them. They include breast enlargement, acne, and skin reactions related to the testosterone gels, patches, and injections.

If you can get by the risks and side effects of testosterone therapy, your doctor will still need to make sure you are safe on testosterone. Most men can tolerate treatment well, and many men do get benefits, but you need to keep watch, Gilbert said.

Monitoring and screening should include periodic blood tests to monitor your testosterone levels, digital rectal exams to check your prostate, testing your blood for prostate-specific antigen to check for prostate cancer, and blood tests to check your red blood cell level, called a hemoglobin and hematocrit.

Finally, even if you do everything right, testosterone just does not work for some men,” Harris said. “If you dont feel any better after a trial of testosterone therapy, thats another reason not to take it.

Recognizing The Signs Of Low Testosterone

When your body starts producing less testosterone, its common to notice a lower sex drive and difficulty getting or maintaining an erection. But low testosterone can cause additional issues that include:

• Weight gain
• Hair loss, both on your body and face
• Lack of energy and endurance
• Fatigue
• Loss of muscle mass and bone density
• Problems falling and staying asleep
• Emotional changes, like irritability and depression
• Memory issues and difficulty focusing

When you have less than 300 nanograms of testosterone per deciliter or symptoms affecting your quality of life, Dr. Kelly might recommend hormone therapy.

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Is It Safe To Just Stop Taking Testosterone Replacement Therapy

Abruptly ceasing any medical treatment without the advice of your doctor is not recommended. In the case of TRT, you also need to bear in mind the role hormones play in almost every function of your body. While its unlikely that going cold turkey on TRT will place you at imminent risk of death, it will make you feel extremely uncomfortable. Suddenly depriving your body of testosterone will result in a massive shock to your system. This is something you will need to be prepared for if you wish to end the treatment, however as always, you should consult your doctor before making any drastic changes.

Cold Turkey Vs Tapering

How did you stop your testosterone? Did you gradually taper down the amount you were receiving or did you abruptly discontinue? Simply discontinuing without gradually tapering down the amount of hormone you received may lead to more severe withdrawal effects. This is because your nervous system becomes dependent on the amount you were receiving for functioning.

If you immediately stop the testosterone therapy without giving it any time to adapt to changes, your nervous system may be somewhat shocked at the significant drop-off in production. In most cases, doctors will work with you to gradually reduce the testosterone therapy so that you can minimize any unwanted discontinuation effects.

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What Are The Risks Of Testosterone Therapy

A relatively small number of men experience immediate side effects of testosterone treatment, such as acne, disturbed breathing while sleeping, breast swelling or tenderness, or swelling in the ankles. Doctors also watch out for high red blood cell counts, which could increase the risk of clotting.

Men on long-term using forms of testosterone therapy long term appear to have a higher risk of cardiovascular problems, like heart attacks, strokes, and deaths from heart disease. For example, in 2010, researchers halted the Testosterone in Older Men study when early results showed that men on testosterone replacement therapy had noticeably more heart problems. “In older men, theoretical cardiac side effects become a little more immediate,” Dr. Pallais says.

Some physicians also have a lingering concern that testosterone therapy could stimulate the growth of prostate cancer cells. As with the hypothetical cardiac risks, the evidence is mixed. But because prostate cancer is so common, doctors tend to be leery of prescribing testosterone to men who may be at risk.

So, keep risks in mind when considering testosterone therapy or other therapies . “I frequently discourage it, particularly if the man has borderline levels,” Dr. Pallais says.

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Factors That Influence Testosterone Withdrawal

There are many factors that will influence the withdrawal process from testosterone. These include things like: how long youve been taking testosterone / receiving boosters, how much you have been increasing it, how abruptly you tapered off of it, as well as other individual factors such as: diet, whether you exercise, etc.

Understand The Potential Risks And Consider Alternatives Before Boosting Your Hormones Indefinitely

Millions of American men use a prescription testosterone injection or gel as forms of testosterone replacement therapy to restore normal levels of the manly hormone. The ongoing pharmaceutical marketing blitz promises that low T treatment can make men feel more alert, energetic, mentally sharp, and sexually functional. However, legitimate safety concerns linger. For example, some older men on testosterone replacement therapy could face higher cardiac risks.

“Because of the marketing, men have been flooded with information about the potential benefit of fixing low testosterone, but not with the potential costs,” says Dr. Carl Pallais, an endocrinologist and assistant professor of medicine at Harvard Medical School. “Men should be much more mindful of the possible long-term complications.”

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Take A Cautious Approach

A large, definitive trial for hormone treatment of men is still to come. Until then, here is how to take a cautious approach to testosterone therapy.

Take stock of your health first

• Have you considered other reasons why you may be experiencing fatigue, low sex drive, and other symptoms attributable to low testosterone? For example, do you eat a balanced, nutritious diet? Do you exercise regularly? Do you sleep well? Address these factors before turning to hormone replacement therapy for men.

• If your sex life is not what it used to be, have you ruled out relationship or psychological issues that could be contributing?

• If erectile dysfunction has caused you to suspect “low T” as the culprit, consider that cardiovascular disease can also cause erectile dysfunction.

Get an accurate assessment

Be mindful of unknown risks of testosterone replacement therapy

• Approach testosterone therapy with caution if you are at high risk for prostate cancer have severe urinary symptoms from prostate enlargement or have diagnosed heart disease, a previous heart attack, or multiple risk factors for heart problems.

• Ask your doctor to explain the various side effects for the different formulations of testosterone. The different treatments include testosterone injections, gels and patches. Know what to look for if something goes wrong.

Who Should Not Take Trt

Dr. Welliver cautions men with an untreated heart problem, sleep apnea or a history of elevated red blood cell counts to not take TRT, as testosterone could worsen these conditions. Men with prostate or breast cancer should carefully use TRT for the same reason, he said. “Men planning on having children should avoid TRT, because it can decrease sperm count and fertility,” said Dr. Welliver.

Do not take TRT for non-medical reasons, such as body building, preventing aging changes or performance enhancement. Men who have normal testosterone levels will not be helped by TRT. “Some men buy testosterone-boosting products at the gym or online, and that can be dangerous,” he warned. “You don’t know what’s in those products as they are not regulated by any governing body.”

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At What Age Should You Stop Bioidentical Hormone Replacement Therapy

Men and women of all ages successfully treat a range of symptoms with regular BHRT treatments. Thanks to the natural sources of and identical match to your bodys hormones, most patients enjoy therapy without side effects or adverse reactions. As for treatment length, the average is under five years our team will work with you to determine the correct time period as it pertains to your unique needs.

Keep in mind, however, you can continue treatment as long as you are happy with the results. For women, BHRT helps them navigate the complexities of menopause so that most patients are between the ages of 40 and 55. We can adjust your therapy as you age to continue addressing the symptoms of hormonal imbalance, meaning the number of years behind you should not be seen as an impediment to treatment.

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How To Wean Off Testosterone Injections

Stopping testosterone therapy is generally safe, but depending on your approach it can cause symptoms of withdrawal and endocrine dysfunction.

The withdrawal symptoms are usually short-lived and last 2-4 weeks until your body restores normal testicular function or adapts to your new T levels

Certain medications can be used to provide symptomatic relief against testosterone withdrawal. According to scientific literature, the most effective ones include antidepressants such as selective serotonin reuptake inhibitors .

Furthermore, the endocrine symptoms are also usually reversible and may last from 2 weeks to a few months. If there are persistent clinical symptoms of endocrine dysfunction, your doctor may prescribe you medications that stimulate the HPG axis and kick-start the natural production of testosterone. Studies suggest that the best options are human chorionic gonadotropin , clomiphene, tamoxifen, and anastrozole.

Another strategy to reduce the risk of side effects is tapering off the dose of injections as opposed to stopping it abruptly.

Know The Health Warnings Of T Supplementation

When it comes to treatment, there are a variety of forms of testosteronefrom gels to adhesive pellets to injectionsthat can be administered to men.

However, you should be aware that patients who use transdermal gels to restore normal T levels should be careful to avoid any risk of transferring testosterone gels to women and children.4 Covering the shoulders or upper arms where the gel has been applied is sufficient to protect against accidental exposure of this hormone to others.

From a reproductive standpoint, both professional organization guidelines note that men who are trying to conceive should not receive testosterone treatments because it impairs sperm production.

Even when testosterone replacement is stopped, there will be a period of time during which it will take sperm production a while to recover, says Dr. Mulhall.

Theres no magic to diagnosing or treating testosterone deficiency, says Bhasin. Like any other condition its really important to have accurate measurements and be rigorous in the diagnosis and a major concern has been starting treatments without an appropriate diagnosis.

The result has been that half the people never refill their prescriptions and about three quarters of men given a testosterone prescription will not be using testosterone after the first year, he said. It’s a bona fide condition that is under diagnosed and over treated.

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How Will I Be Monitored While On Testosterone Replacement Therapy

Your doctor will measure your testosterone levels at the 3- and 6-month marks after treatment begins. After that you’ll be tested once a year. If your levels are OK you’ll stay on your current dose.

If your testosterone levels are too low, your dose may be adjusted. At the same time, your doctor will check your red blood cell levels.

Within 1 to 2 years of TRT, your doctor will measure your bone density if you had osteoporosis when treatment began. Your doctor will evaluate your prostate cancer risk at the start of treatment and may do more tests at the 3- and 6-month marks, and then annually.

Patients taking TRT should call 911 immediately if they have symptoms which include:

• Shortness of breath or trouble breathing
• Weakness in one side of the body
• Slurred speech

When Testosterone Is Not The Answer

Testosterone therapy comes with risks, and it’s not appropriate for all men. Certain situations and certain health conditions make testosterone therapy less than a good idea and worthy of a talk with your doctor. These include:

If you have low T only. A mans testosterone level starts to fall naturally after age 40. There’s a difference between a natural decline, which often accelerates after age 60, and actual low T. We measure testosterone with a blood test,” said Dr. Gilbert. Still, having a low number without symptoms is not enough reason to treat low testosterone, he added.

If you have symptoms only.Symptoms of low testosterone may include low energy, low mood, loss of your sex drive, and poor erections. About 25 percent of men take testosterone without ever having a blood test,” Dr. Harris said. “Symptoms alone tell you nothing. You need to have low testosterone proved by blood tests along with symptoms to benefit from treatment.”

If you have prostate cancer. Testosterone therapy does not cause prostate cancer, but it can make prostate cancer grow,” said Gilbert. “It might be like adding flame to the fire.” According to guidelines from the Endocrine Society, you should not take testosterone if you have prostate cancer. If you have been successfully treated, you may be able to take testosterone, but you need to talk with your doctor. Although rare in men, breast cancer is another reason not to take testosterone.

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Effects Of Intermission And Resumption Of Long

Clin Endocrinol. 2016 84:107-114

Purpose:

In addition to primary and secondary hypogonadism, hypogonadism occurring in middle-aged and elderly men has been recognized. There is evidence that restoring testosterone levels to normal improves body weight, serum lipids and glucose levels.

Participants:

In an ongoing registry study in a urology clinic, 262 hypogonadal men received testosterone for a maximum of 11 years. They were younger than most of the other patients . All subjects had sought urological consultation for erectile dysfunction. A deficient testosterone serum testosterone level and the presence of symptoms as assessed by the Aging Males’ Symptoms scale were used for the definition of hypogonadism. All men received treatment with injectable testosterone replacement therapy.

What Happens when you Stop Testosterone Replacement Therapy :

Body weight, Body Mass Index and waist circumference increased significantly. Fasting glucose and serum HbA1c returned to baseline levels or were even higher. Similar patterns were observed for serum cholesterol, LDL cholesterol, triglycerides, HDL cholesterol, total cholesterol/HDL ratio and non-HDL cholesterol, as well as systolic blood pressure.

Results of Restarting TRT:

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Physiologic Changes In Testosterone Levels

Testosterone levels in adult men decline at an average rate of 1 to 2 percent per year.4 This change can be caused by the normal physiologic changes of aging, testicular dysfunction, or hypothalamicpituitary dysfunction.5 By 80 years of age, more than 50 percent of men have testosterone levels in the hypogonadal range.6 Hypogonadism is defined as a low serum testosterone level coupled with any of the signs and symptoms outlined in Table 1.7 The presentation varies from person to person.

Signs and Symptoms of Hypogonadism in Men

Anemia

Adapted with permission from Rhoden EL, Morgentaler A. Risks of testosterone-replacement therapy and recommendations for monitoring. N Engl J Med 2004 350:483.

Signs and Symptoms of Hypogonadism in Men

Anemia