This is an example of just one protocol, since there really is no “one way” to do it. This has proven a very effective foundational protocol for Defy, but of course every patient is different and therefore treatments are individualized as needed.
TRT: EndogenousRestoration protocol for Men Discontinuing TRT
Male patients who have been taking any form of exogenous Testosterone long term, longer than 12 weeks, will have secondary hypogonadism induced by the negative feedback response to the exogenous T use. The purpose of this protocol is to stimulate the testes using HCG so that they are able to produce testosterone once again, while also preparing them to respond to endogenous LH/FSH(gonadotropins). Tamoxifen is taken beyond the HCG as it is shown, as a SERM, to stimulate the pituitaries release of LH/FSH whole suppressing the negative effects of excess estradiol. Estradiol can elevate in men who discontinueTRT so it is important to run the SERM for some time after discontinuingTRT to mitigate E2 rebound.
Meds needed: HCG 11,000iu+mixing kit
Clomiphene 50mg #30-#60 tablets
Tamoxifen 20mg #30-#90 tablets
Syringes and supplies for HCG
Begin protocol 5 days after the last T injection (Cyp/Enanth). If the patient is taking a T cream than begin the protocol one day following the last application of T cream.
First 30 days: HCG 350iu daily sq
Tamoxifen 20mg- 1 tablet POQD
DHEA 50mg- 1 capsule QHS
(Optional) Offer Sildenafil or Tadalafil for any ED. Many Pts experience ED during initial recovery.
30 day F/U: Draw the following labs: Testosterone F&T; Sensitive Estradiol; CBC; CMP
** Physician can order additional labs at his/her discretion.
After 30 days of HCG+Tamox
After the initial 30 days of HCG+Tamox; If the total testosterone is elevated at f/u, then it can be assumed that pt is responding well to HCG. Discontinue HCG and titrate tamoxifen dosage to10mg after the last dose of HCG. Continue the Tamoxifen 10mg for 30 more days. Add Clomid 50mg QHS for 30 days. Set lab reminder for follow up labs 2 weeks after last dosage of Tamoxifen/Clomid. Levels should remain elevated from there. If not, at the physician’s discretion the above protocol can be repeated until labs reflect the desired response. Symptomology must also play a role in determining desired response.
Labs Needed: Testosterone Free and Total; Sensitive Estradiol; LH; CBC; CMP-14; DHEA
Patient Does not Respond after 30-90 days of HCG+Tamox
If the patient does not respond to the HCG+Tamoxifen after90 days (3 cycles), then it can be assumed there is possible primary hypogonadism. This would not have been caused by the TRT, more than likely it has developed naturally with age or has been present for a long time. In this case itis best to suggest continuing TRT so that T levels remain optimal and the patient’s life quality and health also remain optimal. Educate the patient on the importance of maintaining good levels of T, even if that means being treated with TRT.