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How to come off TRT and possibly reset your HPTA Axis

Jasen Bruce

May 16, 2019

During the previous years large surge in testosterone prescriptions and TRT clinics there are unfortunately many men who have been misdiagnosed with low testosterone, yet placed on TRT when it may not have been needed in the first place. If you are one of these men and you are considering the discontinuation of testosterone treatments there is a protocol that can help restore your own hormone axis.

You do not want to stop testosterone "cold turkey", this will lead to unnecessary symptoms that could last for many months. This is an example of just one protocol, since there really is no "one way" to do it. This has proven a very effective protocol for Defy, but of course every patient is different and therefore treatments are individualized as needed. A good TRT doctor will customize the approach based upon the patients response.

TRT: Endogenous Restoration protocol for Men Discontinuing TRT

Male patients who have been taking any form of exogenous Testosterone long term, longer than 12 weeks, will have secondary hypogonadism induced by the negative feedback response to the exogenous testosterone use. The purpose of this protocol is to stimulate the testes using HCG so that they are able to produce testosterone once again,while also preparing them to respond to endogenous LH/FSH(gonadotropins).

Tamoxifen is taken beyond the HCG as it is shown, as aSERM, to stimulate the pituitaries release of LH/FSH whole suppressing the negativeeffects of excess estradiol. Clomid is also commonly used as a SERM. Estradiol can elevate in men who discontinue TRT, so it is important to run the SERM for some time after discontinuing TRT to mitigate E2 rebound.

Meds needed:

  • HCG 12,000iu+mixing kit
  • Clomiphene 50mg #30-#60 tablets
  • Tamoxifen 20mg #30-#90 tablets
  • Syringes and supplies for HCG Basic Protocol

Begin protocol 5 days after the last T injection (Cyp/Enanth). If the patient is taking a T cream than begin the protocol one day following the last application of T cream.

  • First 30 days: HCG 350iu daily sq Tamoxifen 20mg- 1 tablet POQD DHEA 50mg- 1 capsule QHS (Optional) Request Sildenafil (Viagra) or Tadalafil (Cialis) for any ED. Many patients experience ED during initial recovery.
  • 30 day blood work follow up draw the following labs
    • Testosterone F&T
    • Sensitive Estradiol
    • CBC
    • CMP
    • Physician can order additional labs at his/her discretion. After 30 days of HCG+Tamox

After the initial 30 days of HCG+Tamox; If the total Testosterone is elevated at the follow up blood test, then it can be assumed that patient is responding well to HCG. Discontinue HCG and titrate tamoxifen dosage to 10mg after last dose of HCG. Continue the Tamoxifen 10mg for 30 more days. Add Clomid 50mg QHS for 30 days. Set lab reminder for follow up labs 2 weeks after last dosage of Tamoxifen/Clomid. Levels should remain elevated from there. If not, at the physicians discretion the above protocol can be repeated until labs reflect a desired response.

Symptomology (the study of your symptoms) must also play a role in determining desired response.

Labs Needed:

  • Testosterone Free and Total
  • Sensitive Estradiol
  • LH
  • CBC
  • CMP-14
  • DHEA
  • PSA

If the patient does not respond to the HCG+Tamoxifen after 90 days (3 cycles), then it can be assumed there is possible primary hypogonadism. This would not have been caused by the TRT, more than likely it has developed naturally with age or has been present for a long time. In this case it is best to suggest continuing TRT so that T levels remain optimal and the patient’s life quality and health also remain optimal. Educate the patient on the importance of maintaining good levels of T, even if that means being treated with TRT.

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