Testosterone replacement therapy (TRT) is commonly prescribed to symptomatic men with low testosterone. Let us ask the question: What happens when someone decides to discontinue treatment? What happens when stopping testosterone therapy?
Testosterone therapy supplies exogenous testosterone from outside the body, usually as a topical cream or gel. However, some men prefer injectable testosterone rather than topical creams, while some clinics offer testosterone pellets implanted under the skin. At TruemedMD Clinic, our testosterone therapy options include topical creams, gels, and injectable forms of testosterone. We do not currently offer testosterone pellets.
Any form of exogenous testosterone will suppress testicular testoterone production through suppression of the HPA axis. Normally, the pituitary makes LH (luteinizing hormone) and FSH (follicle stimulating hormone) which stimulates testicular production of testosterone and sperm. Exogenous testosterone will inhibit the pituitary production of LH and FSH. The net effect is suppression of natural testosterone and sperm production.
After stopping testosterone therapy, the HPA and pituitary is no longer suppressed, and the body gradually resumes its own testosterone production. The exact timing and recovery of testosterone production may vary.
The outcome after stopping testosterone therapy depends on your baseline testosterone levels. If your initial laboratory test showed very low testosterone, you may expect your levels to return to those same low levels after stopping treatment. This is especially true for men with low testosterone caused by testicular dysfunction.
What Happens to Your Body After Stopping Testosterone Therapy?
In 2016, Dr. Aksam Yassin studied 262 men with hypogonadism (low testosterone) who had been on TRT for up to 11 years. The average age was 59 years. While receiving TRT therapy, participants saw improvements in body composition, sexual function, and overall well-being. However, after stopping testosterone therapy for about 17 months, testosterone levels dropped back to baseline hypogonadal (low) levels, and symptoms of low testosterone returned. Once the men resumed TRT, their testosterone levels improved and symptoms were relieved. This suggests that for men with hypogonadism due to testicular dysfunction, continued treatment is required for symptom relief. The author concluded that some men may require life-long treatment. (1)
Testosterone production is regulated by a feed-back loop from the HPA (hypothalamis-pituitary axis) to the testicle. The hypothalamus releases gonadotropin-releasing hormone (GnRH), which stimulates the pituitary gland to release luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH stimulates testosterone production in the testicles, while FSH stimulates sperm production.
When testosterone is supplied externally, the brain detects this increased serum testosterone and reduces pituitary signaling with a reduction in LH and FSH. This in turn reduces testicular production of testosterone and sperm.
After stopping testosterone therapy, this HPA-testicular feedback loop is no longer suppressed, and baseline testosterone reproduction resumes. However, recovery is not immediate in every man. Men with underlying good testicular function will regain natural testosterone production, while others with poor underlying testicular function will continue to be symptomatic with low testosterone.
Common Symptoms to Know
Fatigue and Low Energy: Low testosterone can be associated with fatigue, reduced energy, and decreased physical stamina. If testosterone levels fall after discontinuing treatment, these symptoms may return.
Reduced Sexual Desire: Testosterone has an important role in male sexual function. After testosterone treatment is discontinued, if levels return to a low baseline state, this may result in reduced libido or a noticeable change in sexual interest.
Erectile Function Changes: Some men may notice return of erectile dysfunction after stopping testosterone therapy, particularly if testosterone deficiency was a contributing factor to to original symptoms erectile dysfunction and loss of libido before starting treatment.
Loss of Muscle Strength or Muscle Mass: Testosterone contributes to muscle development and maintenance. When testosterone levels decline, some men may notice loss of muscle mass, reduced muscle strength, exercise performance, or changes in body composition.
Mood and Concentration Changes: Low testosterone may be associated with irritability, low mood, reduced motivation, or difficulty concentrating. These symptoms can sometimes become noticeable after stopping treatment, when testosterone levels decline.
How Is Testosterone Evaluated After Stopping Therapy?
This usually requires a full evaluation by a physician with review symptoms, medical history, physical findings, previous testosterone results, and the type and duration of testosterone therapy. Laboratory testing is useful here to assess the HPA axis and testosterone production.
Depending on the individual situation, laboratory evaluation may include:
- Total and Free testosterone
- LH and FSH
- Estradiol
- Prolactin when indicated
- Complete blood count, Hemoglobin and hematocrit
- Thyroid testing with TSH, Free T3, Free T4, reverse T3, Anti-thyroid antibodies
- Other metabolic or nutritional testing based on symptoms and medical history
The timing of testing is also important, since testosterone levels are highest early in the morning.
Should You Restart Testosterone After Stopping?
If symptoms return after stopping testosterone therapy, a physician can reassess testosterone levels, review the original diagnosis, consider other possible causes of the symptoms, and take into consideration the patient’s current health and fertility goals.
For younger men who wish to preserve fertility while addressing low testosterone, alternatives such as HCG and Clomid may be considered instead of restarting exogenous testosterone (TRT). HCG and Clomid stimulate the body’s own hormone production rather than replacing it with exogenous testosterone from outside the body. For more information on Clomid see:
Clomid for Men with Low Testosterone Part One
Clomid for Men with Low Testosterone Part Two
Clomid for Men with Low Testosterone Part Three
Clomid for Men with Low Testosterone Part Four
For more information about HCG (human chorionic gonadotropin) see this article:
HCG for Males with Low Testosterone
For some men, continuing testosterone therapy may be appropriate. For others, further evaluation may identify an underlying issue that needs to be addressed.
When Should You Seek Medical Guidance?
If symptoms continue after stopping testosterone therapy, medical evaluation can help determine whether declining testosterone is responsible or whether another condition may be contributing.
At the TruemedMD Clinic, our medical director, Jeffrey Dach, MD, focuses on complete evaluation of each patient rather than treating a laboratory number in isolation. This includes a comprehensive medical history, review of symptoms, complete laboratory panel, and careful follow up after initiating treatment.
For men considering stopping testosterone therapy, this type of evaluation can help answer the question, can natural testosterone production resume, or will low testosterone persist? Another question to be answered is: Are there any other hormonal or metabolic factors that may be contributing to low testosterone symptoms?
Questions to Ask
What happens when you stop testosterone therapy?
Testosterone levels may decline after treatment is discontinued, and some men may experience symptoms such as fatigue, reduced libido, mood changes, or changes in muscle strength.
How long does it take testosterone to recover after stopping therapy?
Recovery depends on the age of the patient and underlying testicular reserve. It also depends on the original diagnosis of testosterone deficiency, whether primary hypogonadism (testicular dysfunction) or secondary hypogonadism (HPA dysfunction). The duration of treatment and status of the hypothalamic-pituitary-testicular axis (HPA) also plays a role.
Does Stopping Testosterone Therapy Restore Fertility?
Sperm production may recover after testosterone is discontinued, but recovery can take time and is not guaranteed to occur at the same rate in every man. Men who are actively trying to preserve fertility may want to discuss Clomid, HCG and other fertility-preserving alternatives with their physician before stopping.
Can you Stop Testosterone Therapy Suddenly?
Yes, this can be done since testosterone is not an addictive drug, and there are no withdrawal effects from stopping treatment. However, there may be a return of testosterone to baseline levels, and a return of low testosterone symptoms.
We Can Help
If you are considering stopping testosterone therapy, experiencing a return of low testosterone symptoms, or concerned about fertility after testosterone treatment, a comprehensive hormonal evaluation can help clarify what is happening. If you are in the younger age group, you may be a candidate for Clomid (clomiphene) therapy.
At TruemedMD, our medical director, Jeffrey Dach MD takes an individualized approach to hormone evaluation, considering your symptoms, medical history, laboratory findings, and health goals. For more information, contact us today.
Articles with Related Interest:
Testosterone Therapy Improves Life and Prolongs Survival
Low Testosterone is Associated with Increased Mortality
Male Testosterone Replacement, Benefits and Risks
Testosterone Reduces Mortality in Diabetic Males
References:
- Yassin, Aksam, et al. “Effects of Testosterone Replacement Therapy Withdrawal and Re-Treatment in Hypogonadal Elderly Men upon Obesity, Voiding Function and Prostate Safety Parameters.” The Aging Male, vol. 19, no. 1, 2016, pp. 64–69.
