How to discontinue Testosterone Replacement Therapy (TRT)?

From the Guidelines

To discontinue Testosterone Replacement Therapy (TRT), clinicians should reevaluate symptoms within 12 months and periodically thereafter, and discontinue treatment in men with age-related low testosterone with sexual dysfunction in whom there is no improvement in sexual function. This approach is based on the recommendations of the American College of Physicians (ACP) [ 1 ].

When discontinuing TRT, a gradual tapering schedule is recommended to minimize withdrawal effects. The tapering schedule typically involves reducing the dose by 25-50% every 1-2 weeks until discontinuation [ 1 ]. During this process, blood tests may be recommended to monitor hormone levels. For those on injectable testosterone, this might mean decreasing injection frequency or amount; for topical gels or patches, reducing application frequency or amount.

Some key points to consider when discontinuing TRT include:

• Gradual tapering to allow the hypothalamic-pituitary-gonadal axis to recover and resume natural testosterone production
• Monitoring hormone levels through blood tests
• Potential temporary symptoms such as fatigue, reduced libido, mood changes, or decreased muscle mass during the transition period
• The possibility of prescribing medications like clomiphene citrate or human chorionic gonadotropin (hCG) to help stimulate natural testosterone production during this transition period [ 1 ].

It is essential to work with a healthcare provider to develop a personalized tapering schedule and to discuss the potential benefits, harms, costs, and patient's preferences when discontinuing TRT [ 1 ].

From the FDA Drug Label

WARNINGS Hypercalcemia may occur in immobilized patients. If this occurs, the drug should be discontinued. The FDA drug label does not answer the question.

From the Research

Discontinuing Testosterone Replacement Therapy (TRT)

To discontinue TRT, several factors should be considered, including the patient's individual needs and goals, as well as the potential risks and benefits of discontinuation.

• The decision to discontinue TRT should be made in consultation with a healthcare provider, taking into account the patient's medical history, current health status, and treatment goals 2.
• According to a study published in 2014, treatment interruption was defined as a medication gap of >30 days, and patients who remained off treatment were classified as having discontinued treatment 3.
• A 2013 study found that the primary factor in discontinuing subcutaneous testosterone pellets (STP) was cost of therapy (50%) 4.
• Another study published in 2009 discussed the importance of patient compliance and involvement in the selection of the type of testosterone preparation, which may impact the decision to discontinue TRT 5.
• A 2020 review of TRT emphasized the need for close monitoring of patients receiving this therapy, which may include regular check-ups and adjustments to treatment as needed 6.

Factors Influencing Discontinuation

Several factors can influence a patient's decision to discontinue TRT, including:

• Cost of therapy 4
• Convenience 4
• Efficacy 4
• Side effects 4
• Symptom relief 4
• Physician recommendation 4

Considerations for Discontinuation

When considering discontinuation of TRT, healthcare providers should take into account the individual patient's circumstances, including their medical history, current health status, and treatment goals.

• Patients should be closely monitored after discontinuation to assess for any potential adverse effects or changes in their condition 6.
• Alternative treatment options may be considered for patients who wish to discontinue TRT, such as nonhormonal pharmacotherapies 2.