Testosterone Withdrawal (FTM): Stopping Hormone Therapy
One of the most important things to remember about taking testosterone is that you can become dependent on the hormone over time. If you then stop taking the hormone, for whatever reason, you experience testosterone withdrawal symptoms.
Taking testosterone supplements for a transitioning body causes the body to stop producing testosterone naturally, which is standard in cisgender women, so when you then stop, instead of returning to a lower level, you might have a testosterone deficiency instead.
Generally speaking, it seems that the longer you have been taking testosterone treatment, the longer it will take your body to adjust once you stop taking testosterone. In addition to the time that you spend on testosterone, there are also lifestyle factors that will impact withdrawal symptoms.
Things like diet, exercise, and stress levels will likely impact how your body adjusts to lower testosterone levels. The last factor that might affect your withdrawal experience is the dosage that you have been taking. Higher doses are more difficult to come down from.
Let us take a closer look at what to expect from withdrawal, how long it will last, and why people might want to stop taking hormones for transitioning purposes. We will also briefly discuss what kind of changes a person might expect once testosterone is stopped.
Reasons for Stopping Testosterone Replacement Therapy
Unfortunately, as with any hormone therapy, some side effects should be expected. Side effects are vast and varied because of how many variables can impact an individual person's reaction to testosterone therapy.
The most concerning side effects are often high blood pressure and increased risk of blood clots. There is also always a risk of depression, weight gain, and mood swings when one takes hormones. Luckily some of these possible side effects are often temporary and might only be due to your body adjusting to the hormone. It is only in rare cases where these less serious side effects are long-term.
One of the only other reasons that people taking testosterone therapy would stop is personal reasons related to their transition. Some trans men never expect to stay on testosterone therapy life-long, mainly because they do not want to be dependent on medications for their entire lives. There might also be other personal reasons for wanting to stop.
Whatever the reason, stopping gender-affirming hormone therapy will likely result in quite some regression of changes that have occurred thus far. Although not everything will go straight back to how it was before starting hormone therapy, there will be some regression. We discuss some of this regression later in the article.
It is important to remember that a single individual is unlikely to experience all of the withdrawal symptoms on this list. Still, some trans men might even experience withdrawal symptoms that are not listed here.
Many withdrawal symptoms can be lessened or avoided through cycle-off programs that a healthcare provider manages. A cycle-off schedule involves decreasing doses over a period of time and can include spreading those doses out further and further to effectively wean the body off of the hormone more gradually. This is the healthiest way to stop taking certain medications, including hormone therapies.
Most commonly, withdrawal symptoms will last around a week or two and are more likely to occur if you are not cycling off. However, if there are more severe symptoms reported, then there is a possibility that it can take months to recover fully.
Headaches are a prevalent withdrawal symptom for any drugs and are not exclusive to withdrawal from a sex hormone. However, tension headaches are the most common type of headache associated with withdrawal.
It is common to experience cravings when adjusting to lower hormone levels. Especially when you plan to quit 'cold turkey', which this website does not advise. In the case of testosterone therapy, the cravings are mostly related to unwanted withdrawal symptoms.
Anxiety is a common withdrawal symptom of suddenly lowered testosterone levels.
Because masculinizing hormone therapy enables a person to build muscle mass quicker, it is understandable that cessation of such hormone therapy will lead to a decrease in this ability, which leads to a loss of muscle mass.
Another symptom that is common with the cessation of masculinizing hormone therapy is an increased level of depression. This is also due to adjustments to lower levels of testosterone. It is noted that although the depression reported is not usually severe and normally subsides within two weeks, there is evidence that the depression factor can be worse with age, and in this case, it can also last longer.
It is common to experience brain fog when coming down from masculinizing hormone therapy because excess testosterone increases cognition.
Because testosterone is a sex hormone, it does affect one's sex drive, and stopping hormone therapy often results in changes in libido. With testosterone therapy, a decrease in libido is most common.
It is common during a gender transition to experience changes in ht due to the presence of more testosterone. The opposite is likely to happen when testosterone hormone therapy is stopped. There is also expected to be a redistribution of fat within the body.
Possible ways to avoid or lessen withdrawal:
There are two ways that seem to have some effect on withdrawal symptoms.
Natural testosterone supplements
There are some reports of minimal success or relief with natural testosterone supplements, although they usually do not provide long-term relief. That being said, if withdrawal symptoms only last a week or two, then the use of such supplements can provide the needed relief for a limited period of time.
Also, note that some natural testosterone supplements can have other side effects that can make them difficult to tolerate. They also only provide low-dose relief.
The consequences of stopping testosterone hormone therapy should be discussed before initially starting treatment, and alternative treatment options should be discussed with the medical provider managing the masculinizing hormone therapy.
Doctors can help with planning out a schedule of progressively lower and more spaced-out testosterone administrations. This often significantly lessens withdrawal symptoms. They work out an appropriate dose and an appropriate schedule to follow in order to minimize adverse effects associated with the cessation of testosterone treatment.
It is never advised to just abruptly stop medications without consulting with a doctor. Even with something like hormones, there is always a risk of serious complications associated.
What Can Transgender Men Expect when Stopping Masculinizing Hormone Therapy?
Changes not associated with withdrawal symptoms.
Obviously, when you started masculinizing hormone therapy, you expected some changes to happen to your body. Now some of those changes can slowly begin to abate.
Body hair growth can change again to be less masculine in appearance. This might include the sudden stopping of male pattern baldness or thinning hair, which can result from testosterone treatment. Facial hair growth can also stop when testosterone is stopped.
There can also be some muscle pain associated with losing muscle mass, although this should not be extreme. Often it can be alleviated with light exercise and a healthy diet. You will need to adjust your diet anyway when you stop taking hormone therapy. It is essential to eat a balanced diet so that you can be sure that you are getting all of the vitamins, minerals, and nutrition that your body needs in order to function optimally.
Blood pressure also lowers when testosterone levels lower. However, there is also some evidence that increased estrogen levels can also increase blood pressure. But this will largely depend on your unique body.
There might be some changes in breast tissue associated with changes in hormone levels. Furthermore, menstrual periods might return within a few months, and there is likely to be a need to start using birth control should there be a risk of pregnancy.
Clitoral enlargement will stop, and there might be some regression, but it is not likely to abate entirely. This will differ depending on the individual experiences of different transgender men. There will also be some voice changes. When you started testosterone, your voice became lower, but once you stop, you will likely lose the lower notes, but not all of them.
You might experience feeling tired, or there might be random body aches when you stop treatment with testosterone. This is normal and will likely not last more than a few weeks.
Furthermore, in very isolated cases, you could experience increases in depression symptoms and even suicidal thoughts. If something like this occurs, it is very important to contact a healthcare provider in order to try and find treatment to manage these factors in the meantime.
Testosterone remains a hormone and treatment with hormones like testosterone. Although it is safe, you might need to have some other drugs administered in conjunction with the testosterone to manage unwanted side effects from the testosterone. So it stands to reason that when you stop treatment with testosterone, you might also need to adjust treatment with those other drugs as well.
This is yet another reason why it is not advised to stop any kind of treatment without the assistance of a doctor. It is best to understand the risks involved both with the treatment itself and possibly having to stop treatment in the future before the treatment even commences.
There are many factors involved in a medical transition process for gender-affirming hormone therapy. First, a doctor would need to understand any preexisting medical conditions and would need to manage any other medical conditions that may crop up during the course of your treatment.
What is ultimately most important is that you remain healthy and that you have the opportunity to be the best possible version of yourself that you can be.
Frequently Asked Questions
Can I still get breast cancer while on testosterone?
Yes, you can still get breast cancer while on testosterone. Therefore, it is always wise to still attend a breast cancer screening at least once a year. Even if you have had masculinizing chest surgery, some tissue might have remained where cancer can develop, especially under the arms. Top surgery will have decreased the risk, but it does not completely negate it.
I have heart disease, can I still take testosterone?
This is something that you will need to discuss with your doctor. In some cases, you should be able to continue with testosterone, but it might not be possible, depending on the extent and type of heart disease that you have.
People who already have a heart condition are at greater risk of a heart attack. People who have sleep apnea should also be cautious when taking hormones. We also need to remember that heart attack is not the only risk that increases; there is also stroke, clotting disorders, etc.
It is best to consult with your doctor about the possibility of taking hormones if you have any of these risk factors.
My hair is falling out; is that from the testosterone?
Yes, some people are more sensitive to DHT, which often leads to hair loss. This is because of the effect that DHT has on hair follicles. It makes them shrink, which eventually makes them incapable of maintaining a strand of hair.
Do cisgender men take testosterone for prostate cancer treatment?
No, quite the opposite, actually. Hormone therapy for cancer treatment involves the suppression of testosterone or prostate-specific antigen.
How this is done, including the dose for medications, will depend on many different factors that will be discussed with an oncologist. It can range from surgical treatment to hormone therapy (high dose or low dose), and would depend on the disease as well as the individual man and his personal circumstances.