Advice on Quitting TRT (VERY long read)

[PSFinAL]

Very long read! If you want to skip most of this, then read the paragraph starting with Dec 2011 and the paragraph immediately following and then the very last paragraph. I am seeking some advice as to the best way to proceed with quitting TRT and letting my body produce on its own (if it’s possible). I’m 33 years old and I would prefer to live a life without TRT unless absolutely necessary. I sought out this forum since it seems like there's knowledgeable people on here even though I don't take steroids per se for body building. So, here’s the story along with lab results mixed in.

As mentioned, I’m 33 years old and I used to exercise 3 to 4 times per week (cardio) and tried to eat healthy, relatively speaking. I’m 5’9” and based on my build and frame, I would like to weigh around 170 lbs. When I was 29 (see blood work below for Feb 2008), I weighed 185 and I was trying to reach 170 but never got there. I felt great, had endurance, could do yard work without getting tired, and had a good libido. Outside of becoming hypothyroid, low testosterone, vitamin D sufficient, and having an EBV flare-up, I have no known diseases or STDs. Since getting married to my second wife, I became sedentary, ate horribly, and got stressed out when I moved from Oklahoma to Alabama for a change in jobs in 2010. The stressed has been removed but I was under constant stress for about 4 months until my boss moved me to another area at the beginning of 2011. Since then I no longer have much stress as my wife and I try to live as much of a stress free life as possible. As far as history of known relevant family diseases: hypothyroidism, hyperthyroidism, and high blood pressure. There’s really nothing else major that I can think of.

In Feb 2008, I had a very minimal test for testosterone (results immediately below). The only reason I took this test was I didn’t want to have sex with my ex-wife because I was no longer in love with her and it was to appease her. She was convinced that I had a hormonal problem. Perhaps she may have been right as she thought I should go on an antidepressant so I was put on Wellbutrin to appease her. I refused to be on an SSRI as I tried Lexapro and I felt absolutely numb in every way. Man, I had no balls then LOL! However, during the good times together, I never had a single problem in the sex department. After falling out of love with her, I masturbated frequently…usually on the order of once a day, sometimes twice. I had an active sex drive, I exercised, and my diet was decent. So, the results below were taken when I had no known problems:

* Total Testosterone: 373 ng/dL (250 – 1100) -> In range percentage: 14.5%
* Free Testosterone: 47.2 pg/mL (35.0 – 155.0) -> In range percentage: 10.2%
* % Free Testosterone: 1.26 L (1.5 – 2.2)

Fast-forward to Dec 2009, already divorced, and met my wife-to-be. Of course we had a lot of sex, multiple times per day for the first few months. I did have the occasional issue of not being able to finish the job but it only occurred about once a month or so. Anyway, I stopped exercising, and started eating worse. I gained about 10 to 15 pounds but no major issues in the sex department. I was also happy so I came off of the Wellbutrin as my stress of being married to someone I didn’t want to be married to was gone. A this point, I was on Wellbutrin for probably about a 1 year.

Oct 2010 we moved from Oklahoma to Alabama for a career change. The job I was put in here and the people I was placed with put me under a high amount of stress for a good 4 months. During that time I decided to seek help from a psychiatrist and requested to be put on Mirtazapine. Again, I didn’t want an SSRI type medication for the stress. I was on this for 3 to 4 months and during that time, my boss moved me to another area. That was the best decision ever and I weaned off of the Mirtazapine.

Dec 2011 was awful. Up to this point in time, I had a pretty good sex drive. I would get burning desires to make love to my wife and always had burning desires. But, something happened at the beginning of Dec 2011 that I cannot entirely explain. Suddenly I started getting extremely exhausted, completely lost my sex drive, gained weight, very irritable, and had to sleep about 10 hours or so a day instead of my usual 8 hours. After battling this for the entire month, I did some research and suspected that I became hypothyroid and probably had low testosterone . I went to a homeopathic doctor at the end of DEC 2011. He ran some blood work, the results of which are below:

* Total Testosterone: 352.0 ng/dL (348.0 – 1197.0) -> In range percentage: 0.5%
* Free Testosterone: 9.0 pg/mL (8.7 – 25.1) -> In range percentage: 1.8%
* Estradiol: 22.1 pg/mL (7.6 – 42.6) -> In range percentage: 41.4%
* Prostate Specific Ag: 0.4 ng/dL (0.0 – 4.0) -> In range percentage: 10.0%
* Vitamin D: 15.7 ng/mL (30.0 – 100.0) -> In range percentage: -20.4%
* TSH: 2.43 iUI/mL (0.45 – 4.50) -> In range percentage: 48.9% (needs to be around 1 or a little less)
* T4: 8.5 ug/dL (4.5 – 12.0) -> In range percentage: 53.3%
* T3: 142.0 ng/dL (71.0 – 180.0) -> In range percentage: 65.1%
* Free T4: 1.35 ng/dL (0.82 – 1.77) -> In range percentage: 55.8% (mid range is ok)
* Free T3: 3.5 pg/mL (2.0 – 4.4) -> In range percentage: 62.5% (needs to be at top of range)
* TPO Ab: 7.0 IU/mL (0.0 – 34.0) -> In range percentage: 20.6%
* LDL-P: 2244 nmol/L (Very High > 2000) -> Off the charts high
* LDL-C: 151 mg/dL (High 160-189) -> Nearly off the charts but still high
* HDL-C: 33 mg/dL (>= 40) -> Low
* Triglycerides: 246 mg/dL (< 150) -> High
* Total Cholesterol: 233 mg/dL (< 200) -> High
* HDL-P (Total): 24.4 umol/L (>=30.5) -> Low
* Small LDL-P: 1686 nmol/L (<= 527) -> Very high
* LDL Size: 19.8 nm (> 20.5) -> Low
* LP-IR: 80 (<= 45) -> High

Obviously, my testosterone and free testosterone were tanked. I was also hypothyroid but it wasn’t terribly bad…TSH (worthless just for thyroid test…I know) was elevated and my Free T3 was lower than it should be. The doctor had no explanation but he immediately put me on 30 mg of Armour Thyroid and 100 mg of bio-identical testosterone…stating that it will supplement what my body is already making and should not cause me to stop producing my own. He also had me start taking a bolus dose once a week of 50,000 UI of Vitamin D as well as adrenal cortex.

Feb 2012 I had a follow-up appointment and I can’t find the blood work. Anyway, the doctor upped my Armour to 60 mg.

Mar 2012 was follow-up blood work. I was still extremely exhausted but doing a little better.

* Estradiol: 23.2 pg/mL (7.6 – 42.6) -> In range percentage: 44.6%
* Prostate Specific Ag: 0.4 ng/dL (0.0 – 4.0)
* TSH: 1.05 iUI/mL (0.45 – 4.50) -> In range percentage: 14.8% (very close to 1…looks way better)
* T4: 6.4 ug/dL (4.5 – 12.0) -> In range percentage: 25.3%
* T3: 130.0 ng/dL (71.0 – 180.0) -> In range percentage: 54.1%
* Free T4: 1.15 ng/dL (0.82 – 1.77) -> In range percentage: 34.7% (less than before, probably still needs to be mid-range)
* Free T3: 3.6 pg/mL (2.0 – 4.4) -> In range percentage: 66.7% (probably still lower than it needs to be…needs to be at top of range)
* TPO Ab: 10.0 IU/mL (0.0 – 34.0)
* Antithyroglobulin Ab: < 20 IU/mL (0 – 40)

I was starting to respond to the Armour and the bio-identical testosterone. I was still very tired and the doctor decided to up my Armour Thyroid to 90 mg. We were having sex once, maybe twice a week but it was more because it felt like habit…the desire wasn’t quite there and I completely lost the burning desire like I had before. There was no noticeable testicular atrophy. I mentioned this to the doctor and he upped my testosterone dosage to 150 mg. He also added 0.25 mg of Arimidex every 4 days. I was also tested for Hashimoto’s Disease…an autoimmune disorder where the immune system attacks the thyroid. It was negative.

Apr 2012 I had follow-up blood work:

* TSH: 0.076 iUI/mL (0.45 – 4.50) -> In range percentage: 14.8% (way too low)
* T4: 8.3 ug/dL (4.5 – 12.0) -> In range percentage: 50.7%
* T3: 205.0 ng/dL (71.0 – 180.0) -> In range percentage: 122.9% (way too high)
* Free T4: 1.46 ng/dL (0.82 – 1.77) -> In range percentage: 67.4% (a little higher than mid range)
* Free T3: 5.9 pg/mL (2.0 – 4.4) -> In range percentage: 162.5% (way too high)

I was still very tired…much of it I’m sure to being overmedicated on Armour. The doctor reduced my Armour back down to 60 mg. The doctor decided to test me for Epstein-Barr Virus (EBV). My numbers indicated that I *HAD* mono at one time but I recently had a “flare-up”. He recommended putting me on Hydrogen Peroxide Therapy to reduce my viral load. I had 8 sessions of this and my energy level and fatigue improved dramatically. I would say that I’m about 85% of what I used to be.

Jun 2012 I had follow-up blood work but I can’t find the paperwork. Basically, I was still overmedicated on Armour Thyroid so he lowered my dose down to 30 mg. The doctor thinks at this point that I can probably come off the thyroid medication all together. He has no explanation as to why thyroid seems to have “healed itself”. I asked the doctor about the testosterone stating that I still don’t feel like I used to but I didn’t press the issue.

Aug 2012 I had follow-up blood work and an upcoming doctor’s visit for the thyroid part. I anticipate that I can probably come off they Armour. I intend to ask a bunch of questions about quitting TRT on the following basis and assumptions: I honestly believe that there is a correlation between the EBV infection, low vitamin D, hypothyroidism, and low testosterone. Now that I have overcome the EBV, I think my body readjusted allowing me to come off the thyroid medication. If this is true, then I believe I should be able to quit TRT. Although my levels were low before, I felt great as far as sex drive and ability to finish back in 2008. I’ve started exercising again and eating a heck of a lot better (paleo). I also take 5,000 UI of Vitamin D3 as well as a good quality multi-vitamin. I still have no noticeable testicular atrophy either. I don't know if it matters but my testicles are about 2.25" long and 1.25" wide...not sure how to properly measure. Anyway, they've always been about this size. I don't know if my starting blood work was sufficient but I felt fine. Hopefully it was a good baseline to go back to.

So, my million dollar question regarding quitting TRT is, what tests should I ask the doctor to test for? What sort of regimen shall I ask the doctor for regarding PCT ? I plan on asking for:

* Total Testosterone
* Free Testosterone
* Estradiol (sensitive)
* DHEA
* DHT
* LH
* FSH
* SHBG
* Prolactin
* ACTH
* AM/PM Cortisol Test

Thanks in advance for your advice.

[kelkel]

Hi PS. Helluva first post btw. Very interesting diatribe and it's great to see you've done your homework. As you're still shutdown asking for LH/FSH right now is a waste of time IMO until after a period of time attempting to re-start. I'd also add in D to see where your at now as well as cortisol. With re-starts attempts you're never guaranteed you'll get back to where you were before, as you well know. It would have been helpful if you were on HCG throughout TRT. If you were, I missed it.

I would point you toward clomid/nolva pct in my opinion. They are both SERMS but work slightly different. Clomid will help the pituitary basically be more receptive to GnRH. Nolva works similar but different. Do a google search for Dr. Michael Scally Power PCT Protocol and do some reading. You may be a good case for this.

[Vettester]

One of the concerns I would have had is wondering why your testosterone was low to begin with? Your baseline labs were not all that good for the total serum (definitely low end for your age), but worse yet you had a 1.26% free test, indicating your SHBG must be highly elevated. Your free test should ideally be between 2% to 3%; right in the middle would be great!

This should have (IMO) prompted an MRI. Other pituitary related labs should have been taken (and still should be), including ACTH, prolactin, and at the time they should have also taken your LH/FSH.

Here's the problem as I see it ... If you come off and try to restart, say with a SERM like Clomid,
1) It's going to be "iffy" if your HPTA will have any response after this length of time.
2) Even if your HPTA responds, what does it do, go back to where it was before? I would only be guessing that you were slightly suppressed before starting, so all you might be doing is going back to that.
3) If your initial condition was primary hypo; meaning there's a problem with one or both testicles that's preventing you from producing an optimal level of endogenous testosterone, then some sort of restart, or PCT if you call it, will be ineffective with how the testicles respond.

You could essentially try a PCT, but you would need to measure your LH/FSH progress, as well as the total serum progress to see if it had any affect. I still think an MRI and complete testicle exam should be completed before trying to medicate in a region that's maybe not necessarily healthy for treatment of that nature. And, YES, the free test thing needs to addressed regardless if you stay on the TRT, or try to go back!! Your total serum could be 600 or 700, but at 1.26% you're going to be responding like a guy who is at 300ng/dl on total serum with a normal free test level. Your SHBG is probably in the 50's or 60's, it needs to come down, maybe in the 20's. Check your B12 as well, and a Cortisol AM/PM test. The ACTH lab will help give us an idea with the feedback of cortisol, and will also be a factor if there's a condition with the pituitary. Would also like to see your lipids and metabolic panels, and definitely want to know if your kidneys and liver enzyme functions are normal.

Thanks for sharing a little historical information about yourself. If you can also tell us a little more about yourself, stats, medications, any notable family predisposition for disease, and a little bit about your lifestyle and levels of stress.

[xtitan1]

Hey brutha welcome to forum. Sorry you're having these issues.

something happened at the beginning of Dec 2011 that I cannot entirely explain. Suddenly I started getting extremely exhausted, completely lost my sex drive, gained weight, very irritable, and had to sleep about 10 hours or so a day instead of my usual 8 hours.

That's exactly how I've been feeling so I somewhat understand what you're going through.

Now, remember that there's a relationship between thyroid and testosterone, as well as vitamin D. As I look over your numbers, it seems like your testosterone and vitamin D were more concerning than your thyroid. It could have been that if you got your vitamin D and testosterone back to optimal, your FT3 would have become more optimal on its own, but your thyroid wasn't really that off in the first place. I really do question the use of Armour in the first place instead of focusing on the testosterone and vitamin D and seeing if that would have relieved your symptoms and/or brought your FT3 further into the optimal range.

Now for the part that I'm not getting: you're wanting to quit TRT therapy after never re-testing your testosterone levels after starting. TRT is a dial-in process and it seems like your doctor keeps changing your testosterone dose without checking your levels (unless you didn't write them down in your post). What's with that?

Vette is right. The question here is why your testosterone is low in the first place. Is it because you are primary or secondary hypogonad? Now that you are on TRT, that's a lot harder to answer because LH and FSH tests are going to be useless (they will be suppressed due to the exogenous testosterone). I don't have enough experience to give you good advice on how to answer this 'cause' problem.

I suppose you could come off TRT, in which case you should listen to Kelkel, and then see how you do. If you are fine after that, then perhaps indeed it was EBV/mono, but remember almost all adults come up positive for EBV (though inactive, not active). I'm not well-read on/experienced with any relationship between EBV/mono and testosterone levels so I'm not comfortable commenting on that.

Disclaimer: I am new and not as experienced as the other posters here so take what I say with a grain of salt.

[kelkel]

Xtitan you're quickly becoming an asset to this board!

kel

[xtitan1]

Xtitan you're quickly becoming an asset to this board!

kel

Oh thanks man I appreciate that

[PSFinAL]

Thank you guys for answering so quickly and providing advice. Below is my follow-up:

From kelkel: It would have been helpful if you were on HCG throughout TRT. If you were, I missed it.

I wish I had found this forum before even being put on TRT but I was ignorant. I was unaware that HCG could be helpful so no, you didn’t miss it. I thought I read somewhere that HCG can be expensive too but I’ll look into it.

From Vettester: One of the concerns I would have had is wondering why your testosterone was low to begin with? Your baseline labs were not all that good for the total serum (definitely low end for your age), but worse yet you had a 1.26% free test, indicating your SHBG must be highly elevated. Your free test should ideally be between 2% to 3%; right in the middle would be great!

The reading of the results was by a urologist and his response regarding my numbers was something to the effect of “some men have high testosterone while some have less but you’re within range.” What else could explain the fact that I seemingly had a good libido still with such low values? Was it just enough to keep me sputtering along?

From Vettester: This should have (IMO) prompted an MRI. Other pituitary related labs should have been taken (and still should be), including ACTH, prolactin, and at the time they should have also taken your LH/FSH.

Sounds like good advice on the MRI and I’ll ask the doctor about it. Would you suggest an MRI following a blood test to include ACTH and Prolactin depending on the values?

From Vettester: 2) Even if your HPTA responds, what does it do, go back to where it was before? I would only be guessing that you were slightly suppressed before starting, so all you might be doing is going back to that.

I know that I need to determine first if I have primary or secondary hypogonadism but let’s assume that I can go back to where I was. Since I had no noticeable symptoms at the time, what’s the harm? Would I be teetering between feeling good and not so good? Would I be medically too low?

From Vettester: Your SHBG is probably in the 50's or 60's, it needs to come down, maybe in the 20's. Check your B12 as well, and a Cortisol AM/PM test. The ACTH lab will help give us an idea with the feedback of cortisol, and will also be a factor if there's a condition with the pituitary. Would also like to see your lipids and metabolic panels, and definitely want to know if your kidneys and liver enzyme functions are normal.

I’ve wondered if I was on the low end of normal and my SHBG was high if I could be treated to lower it and get the same effect. As mentioned, I’ll ask about ACTH as well as getting Cortisol AM/PM. As far as my lipid profile, I only had one and that was in Dec 2011 and it was off the charts awful! I updated my original post with the values. I attributed it to diet, lack of exercise, and a thyroid that seemed to go south. As I understood it, once properly medicated on thyroid, cholesterol usually normalizes. I probably should ask for another lipid panel again. Back to Cortisol, the doctor put me on Adrenal Cortex and stated that anyone being medicated for hypothyroidism needs to take it and mentioned that the test for it was a waste of money since he would put me on it anyway.

From Vettester: Thanks for sharing a little historical information about yourself. If you can also tell us a little more about yourself, stats, medications, any notable family predisposition for disease, and a little bit about your lifestyle and levels of stress.

No problem. See paragraph 2 in the original post as I updated it with this information.

From xtitan1: Now for the part that I'm not getting: you're wanting to quit TRT therapy after never re-testing your testosterone levels after starting. TRT is a dial-in process and it seems like your doctor keeps changing your testosterone dose without checking your levels (unless you didn't write them down in your post). What's with that?

I’m not sure why my doctor hasn’t looked at my numbers again except that he’s the type that will listen to the symptoms and make a judgment regarding whether or not to request blood work. I can see where this can be good and bad. He upped my testosterone because I told him that I was feeling better but I wasn’t my old self so he increased my dose from 100 mg to 150 mg without a blood test. I must also mention that I take 0.25 mg of Arimidex every 4 days.

Lastly, I’d like to elaborate more on why I want to quit TRT. For starters, I don’t want to be dependent on medication unless it’s absolutely necessary. Second, my wife and I aren’t trying to get pregnant but we’re not preventing. We’re basically letting nature take its course but the problem is that my sperm count is probably minimal or zero. Last, if I can get to the root cause, then maybe there’s a more suitable treatment options available. If not, then I’m fine with being on TRT for life but I’d rather find out what’s going on first…even if it means an attempt at HPTA restart in order to really find out. I also wanted to mention that I still have no noticeable testicular atrophy. My testes are about the same size and they always were. I measured them at 2.25" long by 1.25" wide but I'm not sure that the size matters except to say there's no noticeable size change.

[kelkel]

Good luck with what you decide PSF and keep us posted on this thread with updates please. I definitely understand not wanting to be on TRT until it's absolutely necessary. You've gotten some good advice above from a few different perspectives. Now it's up to you to evaluate and chart your course. I may differ from others here but it just may be worth a shot IMHO! I agree with Vette on the MRI as well. Rule it out.

Lastly. You measured them!!!

I measured them at 2.25" long by 1.25" wide but I'm not sure that the size matters except to say there's no noticeable size change.

Now half the guys here are gonna be breaking out their rulers or begging the wives/girlfriends to lend a hand. Any excuse I'm sure....

[PSFinAL]

I had an appointment with my doctor this past Thursday and my thyroid test came back close to where it needs to be (see below):

Aug 2012 blood work:

* TSH: 0.620 iUI/mL (0.45 – 4.50) -> In range percentage: 4.19% (between 0.45 and 1.00...perfect)
* T4: 7.4 ug/dL (4.5 – 12.0) -> In range percentage: 38.7%
* T3: 126.0 ng/dL (71.0 – 180.0) -> In range percentage: 50.5%
* Free T4: 1.09 ng/dL (0.82 – 1.77) -> In range percentage: 28.4% (needs to be closer to mid-range)
* Free T3: 3.6 pg/mL (2.0 – 4.4) -> In range percentage: 66.7% (could be a little higher but still good)

Now for the part about quitting TRT. I know the following is probably going to drive a lot of you nuts but here goes. I asked the doctor about the best way to quit TRT in light of the information that I presented to him about HCG, Clomid, and Nolvadex. He stated that particular regimen is normally used by high dosage steroid users and since my dosage is low, it's not necessary. In my case, he stated that the best way to proceed (and save money) is to quit my 150 mg/week of bio-identical testosterone cold turkey while remaining on .25 mg every 4 days of Arimidex for about a month. He stated that barring anything unforseen, I should "recover" in 2 to 3 months. I thought about this for a little bit and I think in my case, I'm ok with this. I have no gains to keep and I only really care about feeling good and having a libido like I did before starting. I also showed him my blood work from 2008 when I felt the best and asked why he thought my total testosterone and free testosterone was low. He stated that the ranges are based on "normal" male values from a wide range of men. I did a little research on this and came to the following conclusion: Even though I'm 5'9", I have a small build and never had any muscle to speak of...basically a wimp LOL. Some males have higher testosterone levels but that doesn't always correspond to high libidos. Anyway, the point I'm getting to is I'm willing to ride this out and have my blood work done again in 3 months. That's when I will ask for the full panel so see where I'm at. If it's still off, I will should know where the problem lies and possibly ask for a pituitary MRI. My only fear is the loss of libido during the recovery period. I've searched through many forums and the general consensus regarding herbal PCT is they don't work. In my case, I only want something to help my libido during this time. I've seen where some folks have tried Post-Cycle by Protein Factory or Forged Post Cycle Therapy and seem to have pretty good results. I would also like to point out that even though I haven't had my vitamin D tested since last December, I know it should be improved dramatically following 8 weeks of bolus dose of 50,000 UIs followed by a daily dose of 5,000 UIs. I feel for the most part that I have recovered from the EBV infection and my energy levels are close to what I used to be. My questions are:

1) Will products like this help keep my libido (or possibly improve it)?
2) If it does help with libido, will it screw up my lab work coming up in 3 months (i.e. give me a false sense of what my norm is without TRT)?
3) Will products like these accelerate normalizing the HPTA/HPGA process?

I appreciate all of the comments thus far! Thanks!