What is the point of going cold turkey on HRT?

[Astrozombie]

When I first started HRT my doc had me go for about 6 months and then quit cold turkey for about a month. This was to see if the added testosterone would "kick start" my natural production in some way.

I've now been on HRT for about 18 months and he mentioned we should try this again. The cold turkey approach sucked and I really crashed last time. If we try this again is there any real point? Should I talk to him about hcg or an anti-e to help?

FWIW: No AAS background, had symptoms for about 18 months before starting HRT, 33 years old, did 4 weeks of pro-hormones about 4 years ago (didn't really know what I was doing and got suckered for an ad) but I don't think that made any difference, currently on 100mg cyprionate injection 1x per week.

[mranak]

Originally Posted by Astrozombie

When I first started HRT my doc had me go for about 6 months and then quit cold turkey for about a month. This was to see if the added testosterone would "kick start" my natural production in some way.

I've now been on HRT for about 18 months and he mentioned we should try this again. The cold turkey approach sucked and I really crashed last time. If we try this again is there any real point?

Unless there is a good reason to believe that your testosterone might recover to resonable levels, what your physician is doing is a bad idea. You should reject this approach.

Originally Posted by Astrozombie

Should I talk to him about hcg or an anti-e to help?

That would kind of nullify the whole point of going cold turkey (well, there isn't any point, but it would nullify the point in your physicians mind). For example, the hCG would likely elevate your testosterone. So what does that tell you? Nothing. A SERM would also artificiailly elevate your serum testosterone.

Originally Posted by Astrozombie

FWIW: No AAS background, had symptoms for about 18 months before starting HRT, 33 years old, did 4 weeks of pro-hormones about 4 years ago (didn't really know what I was doing and got suckered for an ad) but I don't think that made any difference, currently on 100mg cyprionate injection 1x per week.

At least your physician has you on weekly dosing. Many physician don't know that much. Of course, I strongly believe that adding a little bit of hCG to the regimen is a huge help, but that is another battle with your physician I suspect.

[Weatherlite]

Some feel that giving exo T will allow the pituitary or testicles to "take a break". The thought is that they are overstressed and that is the cause of the low T. This is possible but from what I have read it is also very rare.

The idea is to give EXO T for a while and then, when the doc thinks they are rested, to drop the T so they can resume working. The problem is that this only works for thos who could produce in the first place AND that it can take up to a year for normal production to be seen, esp for those who have been on AAS before (I know you weren't...just stating).

So, not a good idea. If you are truly hypo then convince/tell the doc you don't want to go through that again and to keep you on the weekly dose.

[HeadDoc]

it sounds like there was not attempt to determine the nature of the hypogonadism originally and then there was this break to "see what happens". I guess I don't beleive that response to treatment is a good form of diagnosis. It gets done though. I have had any number of children, adolescents, and adults sent to me for evaluation who were put on stimulants for attention deficit disorder.

[pmgamer18]

Originally Posted by HeadDoc

it sounds like there was not attempt to determine the nature of the hypogonadism originally and then there was this break to "see what happens". I guess I don't beleive that response to treatment is a good form of diagnosis. It gets done though. I have had any number of children, adolescents, and adults sent to me for evaluation who were put on stimulants for attention deficit disorder.

HeadDoc in the 21 yrs. that I have been on TRT I never got past the fatigue. Then they came out with concerta my Dr. has tried stimulants but they made my heart race. When he gave me Concerta I told him I am not ADD. He told me that they use it for HIV and CFS to help with the fatigue. I can't believe how it got me past the fatigue. Can you tell me why.
Phil

[HeadDoc]

I assume its the enhanced levels of dopamine. I wonder if you would benefit just as much from 2-3 gms of acetyl-l-carnitine taken over the course of the day. Tyrosine and arginine are dopamine precursers. You could also try these in small doses.One of my old patients who was coming off methadone benefited from tyrosine anda small dose of tricyclic antidepressant to cope with fatique, sleep d.o., and poor focus.

[pmgamer18]

I take this also and I sleep good no problems there. I stopped the concerta for 6 months and little by little the fatigue came back. So I went back on it. I will never put an antidepressant in my mouth again. The first five yrs. I was sick with low T they told me I had Major Depression and it was Low T. I feel like I lost 5 yrs. of my life on AD meds I can't even remember what went on in those 5 yrs. I walked around in a fog. I never got better on them and they just kept pushing the dose up or trying something else. I was on Remeron for a long time gaining over 75 lbs. And all they could tell me was to keep taking it the side effects will go away. When the Dr. I had to see for a bad bladder infection from taking Prozac found me to not be surrering from Depression but is was Low T. I had to go into Re-hab to get off all the drugs they had me on for Depression. No never again.
Phil

[HeadDoc]

sorry to hear about the long suffering you experienced. Since I got into the antiaging/hrt stuff, my rule out lists got longer than before. Now, my new patients get screened for thyroid, cortisol, androgens, and of course family histories cardiac and metabolic disorders. I try not to waste good psychotherapy or psychotropics. This is why my first conversation after meeting my new patient is with his/her primary care physican. I've found that most are more than open to my non-medical intrusion or questions.

[pmgamer18]

You are by far way ahead of your time. Where were you when I needed you.
Phil

[stat1951]

Originally Posted by HeadDoc

sorry to hear about the long suffering you experienced. Since I got into the antiaging/hrt stuff, my rule out lists got longer than before. Now, my new patients get screened for thyroid, cortisol, androgens, and of course family histories cardiac and metabolic disorders. I try not to waste good psychotherapy or psychotropics. This is why my first conversation after meeting my new patient is with his/her primary care physican. I've found that most are more than open to my non-medical intrusion or questions.

HeadDoc, what would be your recommendations for hypercortisolism? Not simply mild-to-moderate elevated cortisol (since you test for that), but full blown hypercortisolism? Numbers like 250 - 360 (reference range of 20 - 100) in 24-hour Urinary Free Cortisol Tests. Numbers like that month after month and not just isolated?

Strange, but my PCP put me on Remeron specifically for its cortisol lowering capabilites as shown very strongly in multiple clinical trials. He said that he didn't think that it was a good medication for someone who didn't have ultra high cortisol levels (possibly why Phil had the reaction that he did). Personally, I've put on maybe 10 pounds from being on it... and that was all in the first month. Also, he has no intent of keeping me on it for any length of time. The goal is to see if it will (A) significantly lower cortisol levels, (B) continue to keep them lowered, and (C) if the lowered cortisol levels will allow the HPA Axis to re-set.

Larry

P.S. In my case (according to a hypercortisolism specialist team and more tests than I care to recall), it was the sudden hypercortisolism that caused my hypogonadal state. My follow-up question down the road somewhere is going to be whether or not - at age 54 - correcting the hypercortisolism situation will establish an environment where the HPT Axis can also be re-set (via HcG therapy or whatever) or whether TRT is simply going to be a life long process from now on.

[HeadDoc]

has the doc considered Cushing syndrome? What is causing the hypercortisolism? Is it a growth on the pituitary? Check out hypercortisolism on Web MD.