PROTOCOL FOR TERMINATION OF HRT/TRT

The use of both female and male use of hormone replacement therapy is and always has been voluntary. If you are currently taking advantage of Hormone Replacement Therapy (HRT) or Testosterone Replacement Therapy (TRT) it is because you have at some in the past chosen to start to use and continue to use HRT/TRT. You have also always had the right to, at any point in time, including today, next week, next month or next year stop using HRT/TRT. The decision is entirely yours.

The above also assumes that you are doing well and you have no problems associated with the use of either HRT or TRT. It is Advanced Wellness West Valley Medical Group’s policy to advise each and every new patient, as well as all ongoing HRT/TRT patients who is either already using HRT/TRT that they have the right and possibly the obligation:

1. To stop using HRT/TRT at any time they believe that stopping HRT/TRT is in their best interest.
2. To stop using HRT/TRT at any time they experience any risky or dangerous negative side effect that puts them, their life or well-being to risk.
3. We also expect that if, during the course of their medical care, they experience any untoward or negative side effects, complications or adverse medical conditions with potential danger to them that they will discontinue use of HRT/TRT upon the advice and/or instructions of their physician after having been advised that they are at risk and should for their health and well- being sake stop HRT/TRT.

If you are using HRT/TRT and decide upon your own, for whatever reason you decide to stop using HRT/TRT we offer the following protocols for stopping.

Protocol for Stopping HRT – Women:

If you have been advised by your physician to stop HRT immediately:
If you are advised by your physician to “Stop HRT Immediately” either because of an impending risk or a current medical condition, then please stop HRT immediately. Simply stop taking any and all oral, topical and/or injectable hormones immediately as soon as you have been advised to stop, unless your physician have been given you other instructions, then follow your physician’s instructions.

If you are a peri-menopausal women choosing to stop HRT on your own:
If you choose are peri-menopausal and you are still having regular, or even irregular menstrual periods, you have not been advised to stop HRT by your physician, you have no medical problem associated with HRT, and you are choosing to stop on your own, and then it is generally recommended that you continue HRT until your next menstrual period and stop once it starts.

If your periods are irregular, or you have not had one in 2 to 3 months then you can stop HRT whenever you like. Please note you may or may not have withdrawal bleeding. This bleeding may only be spotting or it may be lighter, the same, or heavier then your usual menstrual periods. If bleeding continues more than 30 days check with your physician an exam and testing may be necessary.

You can stop by simply stopping the use of any and all oral, topical and/or injectable hormones, unless your physician have been given you other instructions, then follow your physician’s instructions.

If you are a post menopausal women choosing to stop HRT on your own:
You can stop at any time you desire. Simply stop your taking any and all oral, topical and/or injectable hormones, unless your physician have been given you other instructions, then follow your physician’s instructions.

When stopping HRT for any reason, a small number of women may have withdrawal bleeding. This bleeding may only be spotting or may be lighter, the same, or heavier then a usual menstrual period. If bleeding continues more than 30 days check with your physician an exam and testing may be necessary.

Protocol for Stopping TRT – Men:

If you have been advised by your physician to stop TRT immediately:
If you are advised by your physician to “Stop TRT Immediately” either because of an impending risk or a current medical condition, then please stop TRT immediately. Simply stop taking any and all oral, topical and/or injectable hormones immediately as soon as you have been advised to stop, unless your physician have been given you other instructions, then follow your physician’s instructions.

If you are for whatever reason choosing to stop TRT on your own:
If you choose to stop TRT and you have not been advised to stop TRT by your physician, you have no medical problem associated with TRT, and you are choosing to stop on your own, and then it is generally recommended that you can simply stop the use of any and all oral, topical and/or injectable hormones, unless your physician have been given you other instructions, then follow your physician’s instructions.

Some men may have withdrawal symptom upon just stopping any or all oral, topical and/or injectable hormones. If you are choosing to stop TRT and you have not been advised to stop immediately, you can if you choose, instead of stopping suddenly, withdraw or wean yourself off of your TRT slowly, over a period of time. One reason for withdrawing lowly ,for example, may be for men who are reducing or stopping TRT in order to get their wife pregnant. In such cases, we recommend reducing your daily dosage of injected testosterone, from your prescribed amount, to a lower amount or entirely off testosterone over 2 to 6 months.

Reducing testosterone injectable dosage over a period of time:
There is no agreed upon protocol for withdrawing ones self off of TRT, nor for specifically withdrawing one’s self off of subcutaneous testosterone. Generally, instructions to those who are voluntarily stopping use of TRT are specific to the individual either determined by the individual himself or by his physician. At Advanced Wellness West Valley Medical Group we usually ask the man why and how fast he wants to get off of testosterone. Both are his choice if there are no medical issues indicating he should or must stop TRT.

Advanced Wellness West Valley Medical Group’s usual instructions for withdrawal are as follows:
Reduce your daily dose of subcutaneous testosterone cypionate by 0.01 cc weekly. For example, if you are injecting 0.01 cc testosterone cypionate subcutaneously on a daily basis, and you wish to reduce or get off testosterone entirely, then reduce your daily dosage from 0.10 to 0.09 cc

subcutaneously on a daily basis for one week. After this first week reduce your daily dosage from
0.09 cc subcutaneously daily to 0.08 cc subcutaneously daily. At the end of the second week, then reduce your daily testosterone dosage from 0.08 to 0.07 cc subcutaneously daily for another week. On a weekly basis reduce your daily dosage to 0.06 cc subcutaneously daily, then 0.05 cc subcutaneously daily, then 0.04 cc subcutaneously daily. Then 0.03 cc subcutaneously daily, then
0.02 cc subcutaneously daily, then 0.01 cc subcutaneously daily and finally you are entirely off testosterone in 9 weeks. You can take longer of you like reducing your dosage of 0.01 cc subcutaneously daily after a two or three week interval. If you have questions, ask your doctor.

I fully understand this protocol and I realize I have no obligation to follow it but it has been introduced and discussed with me and I am aware of it and I am free to make up my mind and use it or not as I see fit.

___________________________________________________
Patient

___________________________________________________
Witness or Representative of Patient

____________________________________________________
Date