Coming off of TRT after two years

Medical Q&A [Moderated]
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Hi Docs,

I’ve just finished listening to both of the testosterone podcasts and found them extremely informative! I did, however, find a lot of the information quite concerning within the context of my own situation.

I want to come off of testosterone replacement therapy after being on for two years at only 21 years of age. I started treatment due to a number of symptoms which arose following a testicular torsion surgery I had at 17. Despite blood work showing I was well within the physiological range (levels were between 320 - 400 ng/dL) and my symptoms being quite general (fatigue, inability to concentrate, decreased sex drive), I was told by my doctor that I was a good candidate for therapy given my symptoms and past history of surgery.

I had done minimal research when I had my first appointment with the doctor and trusted his advice that I should start therapy - he was considered a specialist by many online. At this time, I was unaware of the vast amount of malpractice and misinformation spread by TRT providers. The man was a doctor, I trusted him and had no inclination of potential ulterior motives (I.e. just wanting my money). The blood work he conducted was extremely limited, containing only total testosterone and SHBG; LH, FSH, Estradiol, Thyroid, Prolactin etc. were never tested before initiating therapy.

I stayed under that doctors care for a year, and as you can imagine, things did not go well. He rarely responded to my emails containing blood work updates and the cohort of side effects I was experiencing, and when he did, it was usually a couple of words max. As a result, I had to do extensive research into how to manage a TRT protocol and spent a whole year essentially self medicating. Overall, I ended up much worse than when I started. I saw no improvement in my pre-treatment symptoms while experiencing a number of adverse effects including a decrease in cognitive function, accelerated male pattern baldness, erectile dysfunction and severe anxiety.

I’ve since moved to a new doctor who is much more competent. Although I feel much better, I still have a number of persistent side effects that were not present prior to treatment. With my current knowledge gained from the likes of yourselves and other great sources, I would have never started therapy with minimal blood work and without first trying to implement the appropriate lifestyle changes.

As a result, I want to come off of therapy and conduct a complete workup of my natural hormonal function. I will be working closely with my doctor throughout this process, but I have a couple of questions I would like to ask you:

1.) Given the context outlined above, does coming off of treatment seem like the best course of action?

2.) Do you know the statistics on the chances of recovering back to my pre-TRT levels after being suppressed for two years? I’m not sure if being young impacts this in either a positive or negative way. I will not be using a SERM to restart my HPTA during this process (not sure if you would recommend that anyway).

3.) I’m currently eating at a caloric surplus trying to gain weight/strength. Should I continue to eat at a surplus while coming off of treatment or drop to maintenance calories? There’s going to be a period where the exogenous testosterone is out of my system, but my endogenous production/HPTA is still suppressed. I’m worried that eating at a surplus during this time will just result in excessive fat gain without much muscle or strength.

4.) Are there any training variables I should consider adjusting? I’m assuming my recovery is going to be impaired while waiting for my endogenous production to be restored. I’m currently two weeks into the bridge, would you recommend adjusting the volume or any other training variable preemptively, or should I run the program as it is and adjust if I feel I am no longer recovering?

Thanks in advance for the answer and all of the great content BBM produces.

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Hi there,

Sorry to hear about this. We’re glad our podcasts were helpful.

  1. I think it’s a reasonable thing to try.

  2. I cannot quote you specific data on this, unfortunately.

  3. I would probably go to a maintenance calorie intake during this period of time (though, to be clear, this isn’t necessarily based on specific evidence)

  4. I would actually not assume that your recovery is going to be significantly impaired (this psychological effect could actually be more potent than any true physiologic effect). I would train normally, aim to hit the prescribed volume, and adjust the absolute loads according to the prescribed RPE targets (i.e., exactly the way you would do it in any other situation).

1 Like
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Just want to update this post encase it might be valuable to others.

I ended up using 100iu HCG every morning whilst the testosterone cleared my system. After three weeks on HCG only, I stopped the HCG too and waited for my own testosterone production to come back online, without the use of a SERM like climid.

After two weeks of no meds, my testosterone levels came back at 15.6 nmol/L (450 ng/dL). Happy with my levels, and just goes to show i probably shouldn’t have been placed on TRT in the first place. My energy levels and gym performance has taken a hit, as has my body composition, but sexual function and mental health actually improved.

Just want to say thank you to both Austin and Jordan. Without your two testosterone podcasts, I would have likely continued injecting myself with a medication I didn’t need for the rest of my life.

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Have you been able to adjust your libido?