Editing Openai/6957e12e-1688-8008-b9b0-ff87c1b2d7bb (section)

=== Assistant: Stopping HRT abruptly “cold turkey” does not usually cause liver damage by itself, but anxiety, appetite changes, suppl… ===
Stopping HRT abruptly (“cold turkey”) does not usually cause liver damage by itself, but anxiety, appetite changes, supplements, alcohol, and restarting meds incorrectly can stress the liver during this period. Here’s how to protect your liver in an evidence-based way after stopping HRT:

==== Authoritative liver guidelines (AASLD, NIH LiverTox) agree these are the biggest risks: ====

Avoid completely for now
* Alcohol (even “small” amounts)
* Acetaminophen (Tylenol) unless prescribed
* Herbal supplements (chlorophyll, boldo, “detox” teas, milk thistle blends)
* High-dose vitamins (A, niacin, megadoses of B6/B12)

: 

==== Based on hepatology and endocrine guidelines: ====

Best foods
* Lean protein: chicken, fish, eggs (1 yolk/day max if tolerated)
* Complex carbs: rice, oats, potatoes
* Vegetables (cooked if gut is sensitive)
* Fruit in moderation

Fats
* Do not go zero-fat
* Use small, regular amounts (olive oil, avocado)
* Avoid large fatty meals (harder on bile flow post-HRT)

Estrogen affects bile composition, so after stopping HRT the liver needs steady, gentle digestion, not extremes.

==== Constipation increases bile reabsorption → more liver load. ====
* Drink water consistently
* Magnesium glycinate low dose is generally liver-safe if needed
* Avoid stimulant laxatives

==== There is no medical detox for the liver. ====

Per AASLD:

: 

Anything marketed as a detox increases risk.

==== Endocrine Society guidance: ====
* Restart low and steady, not fluctuating
* Avoid switching routes repeatedly (oral ↔ sublingual ↔ injection)
* Stable dosing is safer for the liver than cycling or panic stopping

If liver anxiety is high, non-oral routes (transdermal/injectable) generally produce less hepatic first-pass exposure.

==== Get labs if symptoms persist or you notice: ====
* Persistent dark stools (not just from food)
* Yellowing eyes/skin
* Right upper abdominal pain
* Severe fatigue or itching

Labs to ask for
* AST, ALT
* ALP
* Total & direct bilirubin
* INR (if symptoms are concerning)

These are standard hepatology markers.

==== Common and not liver damage: ====
* Appetite changes
* GI motility changes
* Anxiety-driven gut symptoms
* Stool color variation (unless black/tarry)

===== You protect your liver after HRT cold turkey by: =====
# Avoiding toxins & supplements
# Eating regularly with moderate fat
# Staying hydrated and regular
# Avoiding panic dosing changes
# Monitoring labs only if symptoms justify it

If you want, I can:
* Help you decide when it’s safe to restart HRT
* Help interpret liver labs calmly
* Build a 2-week liver-gentle meal plan that won’t worsen anxiety or GI symptoms