How to Stop Hormone Replacement Therapy (HRT)

Visiting Your Doctor

Talk to your doctor about why you want to stop HRT. Whether you are concerned about side effects or simply believe that you no longer need hormones, tell your doctor before you stop. Do not stop taking your medication without your doctor’s permission. How long you need to stay on HRT may depend on your condition and your doctor. While you can technically use hormones indefinitely, many doctors will stop treatment after 2-5 years. While each case can vary, it is generally recommended that transgender individuals remain on HRT until they are 50 to reduce the risk of osteoporosis.

Ask your doctor what the risks of stopping HRT may be. Based on your age and medical history, you may be at higher risk of certain side effects. Make sure you are aware of these risks before stopping HRT. If you used HRT to ease menopause, symptoms may return, including hot flashes, vaginal dryness, anxiety, mood swings, muscle aches, or a reduced sex drive. If you had a history of vasomotor issues (such as hot flashes or heart palpitations) before taking HRT, ask your doctor how you can manage your symptoms once you have stopped taking hormones. While HRT can prevent osteoporosis from developing, your risk may return if you stop taking HRT.

Work together to determine the best way of stopping hormones. In most cases, the doctor will recommend gradually weaning you off of your hormones. That said, if you have very severe side effects, your doctor may decide to end your treatment immediately. Gradually stopping HRT may reduce the risk and severity of side effects. EXPERT TIP Inge Hansen, PsyD Inge Hansen, PsyD Clinical Psychologist Dr. Inge Hansen, PsyD, is the Director of Well-Being at Stanford University and the Weiland Health Initiative. Dr. Hansen has professional interests in social justice and gender and sexual diversity. She earned her PsyD from the California School of Professional Psychology with specialized training in the area of gender and sexual identity. She is the co-author of The Ethical Sellout: Maintaining Your Integrity in the Age of Compromise. Inge Hansen, PsyD Inge Hansen, PsyD Clinical Psychologist Our Expert Agrees: If you're on hormone replacement therapy, you can stop it for any time, and for any reason. For instance, you may only desire a partial effect from your hormones, or you may need to pause them because you're hoping to bring back fertility or because they're having an unintended side affect. However, it's always a good idea to seek guidance from your doctor before you stop. Also, be aware that some effects of hormones will reverse or partially reverse if you stop taking them, while other effects are more permanent.

Stopping Hormones

Continue taking hormones for as long as your doctor instructs you to. In most cases, you will wean off the hormones over the course of 4-6 months. If you decide to quit cold turkey, however, stop using the hormones immediately.

Take lower doses of hormones. Your doctor may prescribe a lower dosage of hormones. If you take pills, your doctor may recommend that you cut the pill in half before taking it.

Use hormones less often if directed to do so by your doctor. In some cases, especially if you are using a patch or gel, your doctor will recommend that you use the hormones less often. Follow your doctor’s instructions for taking a less frequent dose.

Continue to be monitored by your doctor. Because HRT can affect hormone levels, you may be at higher risk of some diseases, like osteoporosis, if you stop it. Continue to see your doctor regularly both during and after you stop using HRT.

Dealing with Side Effects

Exercise regularly. Exercise can help improve sleep and give you more energy. Do moderate to vigorous cardio 2-3 times a week. You can also do weight lifting and other strength training once or twice a week to protect your bones. If you are going through menopause, exercise can reduce hot flashes. If you have recently stopped taking testosterone or estrogen, you may be at increased risk of weight gain. You can use exercise to maintain or lose weight.

Undergo a bone mineral density screening. While HRT can prevent osteoporosis in menopausal women and transgender men, transgender women may be at higher risk of bone loss while on it. Furthermore, once you are off HRT, your risk of osteoporosis may return. Once or twice a year, visit your doctor for a screening to make sure that your bones are healthy. In most cases, your doctor will scan your bones using a DEXA machine to determine your risk of getting a bone fracture. Staying active and taking supplements with calcium and vitamin D may be able to help protect your bones.

Practice relaxation techniques. Stress can worsen or trigger symptoms. Reducing stress and practicing relaxation techniques can help alleviate symptoms. You can try yoga, meditation, mindfulness, or deep breathing.

Ask your doctor if non-hormonal medicines will help ease menopausal symptoms. Tibolone, clonidine, antidepressants, and gabapentin are sometimes prescribed to women instead of HRT to handle menopause symptoms. That said, these medications still carry some risk. Your doctor will let you know if these medications are right for you. Tibolone can help ease hot flashes and improve your sex drive. It has similar side effects as HRT, including abdominal and pelvic pain, breast tenderness, and a higher risk of breast cancer. Clonidine has a milder effect on menopause symptoms, but it won’t affect your hormones. Side effects include dry mouth, drowsiness, depression, and constipation. Antidepressants may help with hot flashes, but they have side effects such as dizziness, anxiety, agitation, and a reduced sex drive. Gabapentin can help treat hot flashes and insomnia during menopause. Side effects include headaches, dizziness, and sleepiness.

Talk to your doctor about restarting HRT if your symptoms are severe. If your symptoms persist for longer than 6 months or if they are interfering with your quality of life, consider restarting HRT. Talk to your doctor to learn what your options are.