Overview

Estrogen cessation means stopping feminising hormones — estradiol plus, usually, an anti-androgen (spironolactone, cyproterone acetate, bicalutamide or a GnRH agonist such as Lupron) — after a period of use. For males who detransition it is normally the first and most important medical step. While these drugs are taken, the body's own testosterone production is switched off or blocked. Stopping them is an attempt to let the male hormonal system restart.

What follows depends on three things: whether the testes are still present, how long and how heavily the hormones were used, and what they changed in the meantime. Some effects fade within weeks. Others, especially breast tissue, usually stay. For men who had an orchiectomy, there is no natural testosterone to return to.

This page covers the evidence, which is thin, and what male detransitioners on /r/detrans report about the process. It is not medical advice. Anyone stopping hormones should do it with a doctor who can check hormone levels. For what these drugs do while they are being taken, see estrogen and testosterone blockers in males. For the female equivalent, see testosterone cessation.

Known risks

Stopping feminising hormones is usually described as simple: stop the pills and the body "goes back." For many men the body does mostly recover. But stopping carries its own risks, and some harms from the treatment period only become clear once the drugs are gone. No study has followed male detransitioners after cessation, so most of the evidence below is indirect. It comes from men treated with androgen deprivation for prostate cancer, from trans women who paused hormones, from tissue studies, and from detransitioners' own accounts.

What detransitioners report

The accounts below come from men on /r/detrans who did not recover as they were told they would. They are a self-selected group, and many other men report good recovery (see the timeline below). But clinics rarely follow up people who stop, so these accounts are often the only record of what went wrong.

Testosterone that never came back.

my natural testosterone production has never returned to its pre-estrogen state despite reassurances that it would, and two years later I’m still suffering with the affects of hypogonadism amongst other things such as frequent erectile dysfunction. —MythicalDawn, detrans male

A single shot of exogenous hormones can mess up your HPTA for a really long time -- at least a few years, and for some men the rest of their life. —split_skunk, detrans male

Sexuality that did not return.

For me, I took hormones for ten days… TEN DAYS my first time EVER, and things were never the same for me after that. It killed me Libido when I was 21 and I’m almost 28 now and it has never came back even though I stopped my final round of hormones 3 years ago. —Beautifulsexybabe, detrans male

I hated my body, I hated the breast tissue, I hated that I'd destroyed my sexual function, something that devastates me to this day as I haven't got it back. —MythicalDawn, detrans male

A body that stays changed.

Tell that to my lack of bone density, extreme muscle atrophy that i’m still trying to build back almost a year and a half later, and the man tatas i’m now stuck with. They recede a little bit but then they just stop and stay there —d1no__, detrans male

In one month I had considerable breast growth, which was fast enough to cause me some kind of either nerve damage or internal flaw in the right breast gland, which hurts me to this day almost two years later. —UniquelyDefined, detrans male

Stopping after orchiectomy. Men without testes describe the gap without hormones as dangerous.

One thing - don't stop taking hormones entirely. I did this for two years and got osteopenia in my 20s. —CandidEg2, detrans male

However...I became so weak, so tired...I was not well physically or mentally. —Mindless_Low_1047, detrans male

The withdrawal period.

I was very depressed and suicidal when I stopped estrogen and puberty blockers. Id say the cause was realizing my mistake and withdrawing from HRT. —Aware-Resist-8655, detrans male

These accounts share a theme: the men were told, by clinicians or by online communities, that the effects would reverse, and for them they did not. Anyone in a crisis during cessation can find detransition-aware help through the support directory.

How the male hormonal system restarts

In males, testosterone is controlled by a feedback loop called the HPG axis (hypothalamus–pituitary–gonads). The hypothalamus signals the pituitary gland. The pituitary releases LH (luteinising hormone), which tells the testes to make testosterone, and FSH (follicle-stimulating hormone), which supports sperm production. Taking estrogen shuts this loop down from the top, because the brain reads high estrogen as a sign that it should stop the signal. Anti-androgens either block testosterone from acting (spironolactone, bicalutamide) or suppress its production further (cyproterone, GnRH agonists).

Once the drugs stop, estradiol levels fall over days to weeks. How fast depends on the form: injected estradiol esters linger longer than pills or patches. The pituitary then has to start sending LH and FSH again, and the testes have to respond. If the testes have shrunk badly during suppression (testicular atrophy), they may respond only partly. Unlike stopping testosterone in females, there is no monthly cycle to show that the system is working again. The usual signs are morning erections, libido, ejaculate volume, facial hair growth and, most reliably, blood tests.

Timeline: what men report

The timelines below come from individual accounts, not a study. They vary a lot, and the people posting are a self-selected group.

Some men describe a fast rebound. One commenter who stopped spironolactone and estradiol said that when he quit before, "my testosterone took back over pretty quick, I got my sexual function back within three days" (deleted). Another, who had used estrogen for three years, wrote that after "about a month and a week" he was "already seeing sexual function return to normal" (ajakakaks, detrans male).

Others recorded their recovery in detail. One man who had six months of injectable estrogen with anti-androgens shared his own blood results:

Testosterone levels have gone from 200ng/dl at 2 months off, to 670ng/dl at 4, and back to 1200+ at 7 months. —Hakureign, detrans male

When testosterone does not come back

Many accounts describe recovery, but some men describe low testosterone that lasts for years. One man who had used estrogen for 16 months reported that his levels "havent returned to pre hrt" and that "low testosterone is really aweful" (Aggravating-Display2, detrans male). Another described years of only partial recovery without any surgery:

My T has never returned to its pre-HRT levels, and I've been having consistent issues with erectile dysfunction that only started while I was on estradiol- it seems that my testes have just never recovered their old capacity… for me its been about 3 years now and stuff hasn't gone back to normal on its own —MythicalDawn, detrans male

No study has followed testosterone recovery in male detransitioners. The closest comparison is androgen deprivation therapy (ADT) for prostate cancer, where GnRH agonists suppress testosterone in a similar way. In a Spanish cohort of 208 men, how long ADT lasted and how old the man was when it stopped both predicted whether testosterone came back. Many did not return to normal levels within years (Borque-Fernando et al. 2023). These men were in their seventies and had cancer, so the results cannot be applied directly to young detransitioners. They do support a principle that detransitioners also describe: longer and stronger suppression, and older age, make full recovery less certain.

Some men in this situation describe their doctors temporarily prescribing drugs meant to restart the HPG axis, or long-term testosterone replacement. Commenters disagree about when that makes sense, partly because outside testosterone suppresses sperm production too. Those decisions belong with an endocrinologist or urologist, who can test LH, FSH and testosterone and find out why levels are low.

Libido and erectile function

Loss of libido and erections is one of the best-known effects of estrogen and anti-androgens, and their return is often the first sign of recovery. One detrans male logged it month by month:

0 months, no erection, no morning wood, no sex drive… 1 month, morning wood stronger, only hard if physically stimulated… 3rd month, male libido… erections harder… Still improving —mautedefamboesi, detrans male

Other men's recovery has been slower or incomplete. One wrote that nearly nine months after stopping, his libido "still hasn't fully come back. Maybe 40% or 50%" and that he still had erectile dysfunction (split_skunk, detrans male). Another, almost three years off hormones, said his "functionality has not fully returned" but was "a lot better being off HRT than when I was on it" (Beautifulsexybabe, detrans male). Commenters also mention penile atrophy: tissue that has gone months or years without regular erections, or with painful ones, may not come back fully. One young man put on estrogen at 13 said in a video interview that erections had been "extremely painful" on hormones and were no longer painful after he stopped (Beyond Gender with Jonni Skinner).

Psychology also plays a part. Depression, anxiety, porn habits and a changed sense of one's own body all affect sexual function, and several commenters point out that mood is a large factor in recovery. Some men describe a "ghost" sense of their anatomy while on hormones that faded as testosterone returned. See sexual function for the broader picture.

When libido returns, so can old fantasies

For men whose wish to transition was tied to autogynephilia (sexual arousal at the idea of oneself as a woman), getting libido back can be destabilising. Estrogen and anti-androgens suppress sex drive, and with it, some men say, the urge to transition. When testosterone comes back, so can those fantasies. Several commenters warn about this cycle:

HRT kills their libido and thus the underlying motivation to transition along with it. But off blockers and the testosterone libido comes back and thus the impetus to transition again comes back. Rinse, Repeat. —Rare_Treat_5098, detrans male

One man who described himself as AGP (autogynephilic) wrote that "with testosterone running through my system" he could now admit he had been "in denial", and that AGP scenarios were "once again erotically appealing" (krjrhrhrhewiheh, detrans male). He called transition and detransition "the ultimate binge and purge", echoing the cycles of buying and throwing away clothes that cross-dressers describe. Another commenter put the diagnostic point bluntly: a feeling that "comes back with libido and can't exist without it" looks more like transvestic fetishism (sexual arousal from cross-dressing) than gender dysphoria (recursive-regret, detrans male). Men in this position often say that understanding the sexual side of their history, sometimes alongside work on porn use, matters as much as the hormones themselves. On the urge to start again, see retransition.

The reverse also happens. One commenter with a fluid identity found that estrogen gave him a sexuality he had never felt before, and that after stopping, "my sexuality is all fucked up again" (theatrix_, MTX questioning). Recovery means different things to different men.

Testicles, sperm and fertility

Testicles usually shrink on estrogen and anti-androgens, and often regrow partly once testosterone returns. Men describe their size increasing within weeks. One man said he "could feel my balls grew larger about 1.4x" three weeks after stopping, following five years on injections (Entire-Construction1, questioning). Others say some smallness remains years later. One man nearly five years off hormones described ongoing "ED and testicular atrophy" (MythicalDawn, detrans male).

Fertility is the most uncertain outcome. The evidence points in two directions:

• Tissue removed during orchiectomy shows mixed results. In one series of 72 trans women, most of whom had used hormones for about three years, germ cells were still present in about 80% of testicles and spermatogenesis was preserved in about 40%. Larger testicles predicted preserved sperm production (Jiang et al. 2019). Another centre found active spermatogenesis in only 8% of specimens (Sinha et al. 2021). A Belgian study of 97 patients who used cyproterone with estrogen found no complete spermatogenesis in any of them at surgery (Vereecke et al. 2021).
• Stopping hormones led to recovery in the one longitudinal study available. Nine trans women in the Netherlands and Australia who stopped hormones in order to have children (median 36 months of use, range 6–216) were followed. Viable sperm was eventually found in all nine, and one partner conceived naturally within four months. But several produced no sperm at first, and some needed more than a year and repeated tests (de Nie et al. 2023).

These studies are small, self-selected and mostly short-term. The Amsterdam group were young adults who chose to stop hormones because they wanted children. They tell us little about men who started estrogen in adolescence, or after puberty blockers. Testicular tissue from puberty-blocked boys in a Mayo Clinic biorepository showed mild to severe atrophy and cells that still looked prepubertal. The authors said this raised "a potential concern regarding the complete 'reversibility'" of fertility. Their study is a small tissue analysis, not a follow-up of boys after stopping (Murugesh et al. 2024).

Detransitioners' reports cover the same range. One man who used hormones for four years wrote: "I had a sperm test after detransing, 4 years HRT and I had full sperm count" (AlviToronto, detrans male). Another said simply that his testosterone and erections had returned and "I'm praying, fertility" (Irinescence, detrans male). The honest answer is that nobody can predict an individual outcome, and a semen analysis is the only way to know. See fertility for more.

Breast tissue

Breast growth is the change least likely to reverse. Estrogen causes true glandular tissue to grow (gynecomastia) as well as fat. When testosterone returns, the fat part often shrinks and nipples become less swollen, but glandular tissue generally stays.

I wouldn't count on the actual tissue going down. Fat redistribution and changes like building muscle or losing weight may make a visible difference, but any breast tissue is probably there to stay. I still have visible effects five years later —IsntthatNeet, detrans male

Men respond to this in different ways. Some find that shrinkage, chest training and compression shirts are enough, and point out that gynecomastia is common in males who never took hormones. Others choose gynecomastia surgery, the same procedure offered to non-trans men, and several describe being very happy with the result. Others urge caution. One man, told by several doctors to wait six months to a year after new gynecomastia because tissue can keep reducing, wrote that he could not bring himself to rush into "yet another medical treatment" (UniquelyDefined, detrans male). He listed complications such as contour irregularities, nipple problems and nerve damage. One who did have surgery mentioned "a decent amount of internal scarring and sensitivity on the left side" but felt it was still better than visible breasts (TheDrillKeeper, detrans male).

There is also a psychological trap. One man said he regretted putting his whole recovery on hold until surgery: "I waited until gyno surgery to actually start taking the steps I needed to move on. It was just more wasted time" (TheLocustPrince, detrans male). See mastectomy for the surgical side.

Fat, muscle, skin and hair

As testosterone returns, fat tends to move from the hips, thighs and buttocks back toward a male pattern. Skin gets oilier and coarser, body and facial hair grows back, and muscle becomes easier to build. One man ten months off estrogen wrote that the first thing to come back was "increased body and facial hair", and that fat in his thighs and stomach had "significantly reduced" (HotPassenger6868, detrans male).

Recovery is not always tidy. One man found facial hair almost absent for the first month and still slower than before at four months (split_skunk, detrans male). Muscle lost while on hormones mostly has to be rebuilt through training. One man described his testosterone as "absolute shit" a month after stopping and said he was "struggling to regain some muscle mass" (5nine8, detrans male). Height and bone structure are fixed after puberty. For men who took estrogen during adolescence, the bigger question is whether puberty completes at all, which is less studied still.

Mood and the mind

Stopping estrogen means a period with low levels of both hormones, and many men describe a rough few weeks. One commenter warned that it "did make me pretty depressed for several days but that is temporary" (transitionalprogram, questioning). Another said that "going off estrogen was hell though" until his testosterone built back up (5nine8, detrans male).

After that trough, many describe their thinking becoming clearer and their emotions settling. Men talk about brain fog lifting, less anxiety, and having energy and drive again. A man who started estrogen at 16 and later had an orchiectomy described feeling "alive" once he was on testosterone, after years of being "depressed, always down, always sad, always defeated" (Kobe, Stunted by Transition). Others notice that the strong emotions estrogen opened up fade again. Some are glad of this. Others miss it. One commenter realised that the "numbness" he had transitioned to escape had really been depression and dissociation:

I thought I felt nothing so that had to mean I was numb...in reality I was so depressed and disassociated to cope with it. Now I see that I don’t want to disassociate anymore, I'm much more aware of it. —deleted, /r/detrans commenter

Trans women who pause estrogen, for example to bank sperm, often describe the same withdrawal as severe. Some say they gave up partway: "my life was more important than banking sperm" (Whisky-n-Estrogen, trans woman (MTF)). Both groups describe the same few weeks of low hormones. They differ in how they read them: as proof that estrogen was needed, or as a passing withdrawal before the body's own hormones take over. For the underlying conditions that often sit beneath these feelings, see mental health.

After orchiectomy

Men whose testicles were removed cannot recover their own testosterone. Without estrogen, they would have essentially no sex hormones, which leads to fatigue, low mood, sexual dysfunction and bone loss over time. In practice, men in this position describe being prescribed testosterone by an endocrinologist, permanently, as men who lose their testes to cancer are. One wrote that he was "unfortunate in that I had been castrated as part of transition but somewhat fortunate in that they now give me testosterone" and that within a month or two "my dick works totally fine" (nndndbsbsuzb, detrans male).

The road is not always smooth. One man who had used estrogen for nine years described the gap between treatments starkly: "I quit E for a couple years, nearly died, been on T now for a couple years" (joliphotia, detrans male). Several men describe searching for a doctor who understood that they wanted male hormone levels, not an adjusted transgender regimen. Others say losing the gonads affects more than testosterone:

Having gonads helps regulate your hormones properly, let alone fertility or sexual function. I just don't feel normal anymore, and I wish I could take it back... —10231570600, detrans male

Fertility is gone after bilateral orchiectomy unless sperm was banked beforehand. Some men consider testicular implants for appearance. A minority of post-orchiectomy men stay on estrogen while living as men, since they need one hormone or the other and some breast growth is likely either way. One commenter called this "picking what I dislike the least" (CastratedFemboy, detrans male). See orchiectomy and vaginoplasty.

No protocol, little support

There are detailed guidelines for starting feminising hormones but none for stopping them as part of detransition. Butler and Hutchinson pointed out this gap in 2020, noting that "there are still no clear guidelines" for working with detransitioners (Butler & Hutchinson 2020). In a survey of 237 detransitioners, most of them female, medical help to stop or change hormones was among the most commonly reported needs, and only 18% said they had enough support (Vandenbussche 2022). In Littman's survey of 100 detransitioners, only 24% had told the clinicians who managed their transition that they had stopped (Littman 2021). That suggests clinics rarely see how cessation turns out.

Male detransitioners describe clinics losing interest once they stop. One man said his nurse practitioner "made no recommendations" and told him there was "no need to see any doctors or have any follow up or tests" (UniquelyDefined, detrans male). In another thread he described gender clinics as "literally only for transitioning people" (UniquelyDefined, detrans male). Many men instead go to general endocrinologists, urologists or GPs and ask for ordinary male hormone tests. Commenters suggest reasonable checkpoints, such as testing testosterone, LH and FSH some weeks after stopping, then semen analysis later. These are their own experiences, not a clinical schedule. Jorgensen's review of iatrogenic harm argues that detransitioners should be recognised as patients with ongoing medical needs, not as people who simply dropped out of treatment (Jorgensen 2023).

The emotional side

Stopping estrogen is a medical event, but men describe it mainly as an emotional one. Many describe relief, and a sense that the body is "setting itself right". One former estrogen user found that soon after stopping "I realised how toxic it was for me" (PachaDub, detrans male). Another enjoyed being able to "just be a normal person again, rock climb, and get buff" (Vedeneres, detrans male).

Alongside the relief there is often grief over breasts that stay, fertility that may not return, years spent, and the vulnerability of waiting to see which changes last. Some men describe anger at how little they were told. Others take a gentler view, in which transition taught them something even though it was a mistake. One man advised: "don't think by stopping that you're going backwards" (PerfectBeginning2, detrans male). The men who seem to cope best treat the body as one part of recovery, alongside understanding why they transitioned, rebuilding relationships, and accepting themselves as men, including gentle or gender non-conforming men. See healing and recovery and gender non-conformity without labels.

Peer support helps many men through the uncertain middle stretch. The support directory lists detransition support groups and gender-exploratory therapists, and the video archive includes male detransitioners describing their own recovery.

Related pages

• Estrogen and testosterone blockers in males
• Testosterone cessation
• Orchiectomy
• Sexual function
• Fertility
• Autogynephilia
• Healing and recovery
• Detransition

References

• Butler, C. & Hutchinson, A. (2020). The pressing need for research and services for gender desisters/detransitioners. study page, source.
• Littman, L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. study page, source.
• Vandenbussche, E. (2022). Detransition-Related Needs and Support: A Cross-Sectional Online Survey. study page, source.
• Jorgensen, S. C. J. (2023). Iatrogenic Harm in Gender Medicine. study page, source.
• Murugesh et al. (2024). Puberty Blocker and Aging Impact on Testicular Cell States and Function. study page, source.
• de Nie, I. et al. (2023). Successful restoration of spermatogenesis following gender-affirming hormone therapy in transgender women. Cell Reports Medicine 4, 100858. source.
• Jiang, D. D. et al. (2019). Effects of Estrogen on Spermatogenesis in Transgender Women. Urology. source.
• Sinha, A., Mei, L. & Ferrando, C. (2021). The effect of estrogen therapy on spermatogenesis in transgender women. F&S Reports. source.
• Vereecke, G. et al. (2021). Characterisation of testicular function and spermatogenesis in transgender women. Human Reproduction 36(1). source.
• Borque-Fernando, Á. et al. (2023). Testosterone Recovery after Androgen Deprivation Therapy in Prostate Cancer: Building a Predictive Model. World Journal of Men's Health. source.
• APCCC 2024 (UroToday report). Testosterone Recovery After Stopping ADT – Who Is at Risk for Long-Term Non-Recovery? source.
• Hembree, W. C. et al. (2009). Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline. JCEM 94(9):3132–3154. source.
• Giacomelli, G. & Meriggiola, M. C. (2022). Bone health in transgender people: a narrative review. Therapeutic Advances in Endocrinology and Metabolism. source.
• Dobrolińska, M. et al. (2019). Bone Mineral Density in Transgender Individuals After Gonadectomy and Long-Term Gender-Affirming Hormonal Treatment. Journal of Sexual Medicine. source.
• Guise, T. A. et al. (2007). Estrogenic Side Effects of Androgen Deprivation Therapy. Reviews in Urology 9(4):163–180. source.
• Mikkelsen, S. H. et al. (2021). Use of cyproterone acetate and risk of meningioma: a Danish nationwide population-based cohort study. source.