Can you stop TRT once you start it?

Testosterone replacement therapy (TRT) is a hormonal treatment for low testosterone (hypogonadism). It’s an effective way to address accompanying, often-problematic, symptoms such as low mood, low energy, and low sex drive. 

If you’re on or considering TRT, you may wonder whether you could one day stop or pause your treatment. This could be down to fertility plans, finances, health, or something else. In this blog, we look at whether you can stop TRT once you’re on it and the best way to come off treatment if you do. 

 

What happens when you start TRT

When you start TRT, you’re introducing testosterone directly into your body. This testosterone bypasses the usual route via the hypothalamic-pituitary-gonadal (HPG) axis and tells your brain to slow down or stop producing luteinising hormone (LH) and follicle-stimulating hormone (FSH). Over time, this can naturally suppress your own testosterone production, shrink the testicles slightly, and reduce sperm production. 

TRT is used to treat symptoms of low testosterone by bringing the hormone levels back into a healthy range for your body. If you stop taking TRT, your body will attempt to restart its own production. But it’s impossible to say how quickly or fully it will recover. Factors such as how long you’ve been on TRT, your age, your baseline hormone function, and other health issues all play a part. 

 

Can you stop TRT once you start?

Yes, but it needs to be planned, supervised, and realistic. 

Clinical guidelines generally treat TRT as long-term therapy, and discontinuing TRT is considered if the risks start to outweigh the benefits or plans (like wanting to have a child) change. 

You may need to stop for a reason, such as: 

• Fertility plans 
• Financial or practical reasons 
• Persistent or bothersome side effects 
• No meaningful improvement in symptoms 
• A new medical condition that makes TRT unsafe 

 

What happens if you stop TRT?

Once TRT is withdrawn, some men notice symptoms return quickly, while others adjust more gradually. 

Common experiences include: 

• Brain fog, fatigue, and low energy 
• Drop in sex drive or performance (erectile dysfunction) 
• Mood changes or irritability 
• Loss of muscle mass or strength 
• Poor sleep or concentration 
• Incomplete sperm recovery if fertility was suppressed 

There’s no official withdrawal syndrome recognised in the literature, but physiologically, your body needs time to switch its own testosterone production back on, which explains why many men feel a slump during the transition [6][12]. 

 

Monitoring after stopping TRT

If you’re planning to stop, it’s important to do it under medical supervision. 

At Leger, here are a few clinically sound ways you might expect your clinician to help you through the process: 

1. Gradually tapering off 

   Some men benefit from a gradual reduction in dose or frequency rather than stopping cold turkey [8]. This approach helps your hormonal (endocrine) system adapt and may reduce the intensity of your symptoms returning. 

2. Using medications to restart testosterone 

   Drugs such as clomiphene citrate (a SERM) or hCG can stimulate your natural testosterone and sperm production. They’re often used when fertility is a goal or when we want to stimulate the body to make its own testosterone [7][13]. 

3. Lifestyle support 

   Resistance training, quality sleep, stress reduction, and maintaining a healthy weight all support your body’s own testosterone production [12][4]. They’re not replacements for medical therapy, but they make a real difference. 

4. Monitoring and follow-up 

   During and after stopping TRT, regular blood tests are essential [8][14]. 

Your clinician will likely check: 

• Total and free testosterone 
• LH and FSH (to see if your pituitary is responding) 
• Oestradiol, haematocrit, and PSA levels (to monitor your prostate cancer risk) [4][15] 

You’ll also discuss symptoms, like changes to libido, mood, energy, and general wellbeing, at each stage. 

 

Monitoring after stopping TRT 

If you and your doctor agree to stop treatment, a sensible monitoring plan might include: 

• Baseline tests before stopping 
• Repeat tests every 3–6 months for at least a year 
• Semen analysis if fertility is the goal 
• Review of symptoms using structured questionnaires or notes 

If testosterone levels haven’t recovered adequately after 12–18 months, your clinician may discuss options like restarting TRT or using medications to stimulate natural production. 

 

The evidence on testosterone recovery

• Recovery can happen, but it’s not guaranteed: If you’ve only been on TRT a short time, and your testosterone system (the HPG axis) was healthy to begin with, your chances of recovery are higher once treatment stops. 
• It takes time: Studies show it can take several months, often up to a year or more, for natural testosterone to return after long-term TRT or anabolic steroid use. 
• Not everyone gets back to baseline: Some men may not fully recover their original testosterone levels, especially after years on treatment or if there’s an underlying testicular or pituitary issue. Also remember, testosterone levels decline naturally with age, so it's likely your baseline might have decreased slightly, even without TRT. 
• Fertility recovery can be slow too: Sperm production often returns over time, but in some men, it may take more than a year, and full recovery isn’t guaranteed. 

 

Could I stop TRT once I start it?

Yes, you could stop TRT, but it’s not as simple as cancelling a membership and ending medication. 

For most men, TRT is a long-term treatment that works best when carefully managed and regularly reviewed [8][14]. If you ever need or want to stop, do it with a plan, with blood work, and with medical support. 

At Leger, before you even start TRT, we’ll ask whether you have future fertility plans, screen for underlying health conditions, and take your financial goals into account when looking at treatment options. This thorough consultation will get you on the right track to being on treatment plan that works for you in the long run. 

If you do need to stop in the future, testosterone recovery is possible. It just takes time, patience, and the right guidance. 

 

Ready for the next step? Start your Leger TRT journey today with a few simple questions.

 

References 

[1] Baillargeon, J., Urban, R.J., Ottenbacher, K.J., Pierson, K.S., Goodwin, J.S. and Sharma, G. (2015) ‘Trends in androgen prescribing in the United States, 2001 to 2011’, JAMA Internal Medicine, 173(15), pp. 1465–1466. doi:10.1001/jamainternmed.2013.6895 

[2] Corona, G., Vignozzi, L., Sforza, A. and Maggi, M. (2022) ‘Testosterone replacement therapy: what we have learned from recent trials and what remains to be done’, The Journal of Sexual Medicine, 19(1), pp. 74–89. doi:10.1016/j.jsxm.2021.10.003 

[3] Corona, G., Torres, L.O., Sforza, A. and Maggi, M. (2021) ‘Clinical practice update on testosterone therapy for male hypogonadism: systematic review and meta-analysis’, Journal of Endocrine Society, 5(Suppl_1), A726–A727. doi:10.1210/jendso/bvab048.1474 

[4] Coviello, A.D., Lakshman, K.M., Mazer, N.A. and Bhasin, S. (2020) ‘Effects of graded doses of testosterone on erythropoiesis in healthy young and older men’, The Journal of Clinical Endocrinology & Metabolism, 103(4), pp. 1671–1681. doi:10.1210/jc.2017-02130 

[5] Guo, D.P., Lee, S.Y., Kang, S.H. et al. (2019) ‘Predictive factors for recovery of endogenous testosterone production after discontinuation of testosterone replacement therapy in men with hypogonadism’, The World Journal of Men’s Health, 37(1), pp. 64–72. doi:10.5534/wjmh.180028 

[6] Kohn, T.P., Louis, M.R., Pickett, S.M., Lindgren, M.C. and Pastuszak, A.W. (2017) ‘Anabolic steroid-induced hypogonadism: diagnosis and treatment’, Fertility and Sterility, 107(5), pp. 1271–1279. doi:10.1016/j.fertnstert.2017.03.018 

[7] Kovac, J.R., Rajanahally, S., Smith, R.P., Coward, R.M. and Lipshultz, L.I. (2015) ‘Men’s recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use: a systematic review and pooled analysis’, Fertility and Sterility, 103(6), pp. 1278–1283. doi:10.1016/j.fertnstert.2015.02.019 

[8] Mulhall, J.P., Trost, L.W., Brannigan, R.E., Kurtz, E.G., Redmon, J.B., Chiles, K.A., Lightner, D.J. and Miner, M.M. (2018) ‘Evaluation and management of testosterone deficiency: AUA guideline’, The Journal of Urology, 200(2), pp. 423–432. doi:10.1016/j.juro.2018.03.115 

[9] Patel, A.S., Leong, J.Y., Ramos, L. and Ramasamy, R. (2019) ‘Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use’, Translational Andrology and Urology, 8(2), pp. 155–162. doi:10.21037/tau.2018.12.05 

[10] Petering, R.C. and Brooks, N.A. (2017) ‘Testosterone therapy: review of clinical applications’, American Family Physician, 96(7), pp. 441–449. 

[11] Snyder, P.J., Bhasin, S., Cunningham, G.R. et al. (2018) ‘Effects of testosterone treatment in older men’, The New England Journal of Medicine, 374(7), pp. 611–624. doi:10.1056/NEJMoa1506119 

[12] Tan, R.S. and Salazar, J.A. (2021) ‘An evidence-based approach to testosterone replacement therapy in men with testosterone deficiency syndrome’, Translational Andrology and Urology, 10(5), pp. 1909–1922. doi:10.21037/tau-20-1315 

[13] Tirabassi, G., Corona, G., Maggi, M. and Balercia, G. (2016) ‘Endocrine approach to male infertility: the role of the andrologist’, Journal of Endocrinological Investigation, 39(9), pp. 911–924. doi:10.1007/s40618-016-0484-z 

[14] Trost, L.W. and Mulhall, J.P. (2016) ‘Challenges in testosterone deficiency diagnosis and management’, The Journal of Sexual Medicine, 13(5), pp. 772–779. doi:10.1016/j.jsxm.2016.03.370 

[15] Vigen, R., O’Donnell, C.I., Baron, A.E. et al. (2013) ‘Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels’, JAMA, 310(17), pp. 1829–1836. doi:10.1001/jama.2013.280386