Triptorelin

What triptorelin is

Triptorelin is a synthetic analogue of gonadotropin-releasing hormone (GnRH) and prescription-only. In Germany it is approved, among others, as Pamorelin LA for locally advanced or metastatic hormone-dependent prostate cancer and for the adjuvant treatment of hormone receptor-positive early breast cancer before menopause, together with tamoxifen or an aromatase inhibitor, and as Salvacyl to reduce sex drive in adult men with severe sexual deviation.

Distinction from gonadorelin. Gonadorelin is structurally identical to the body’s own GnRH, acts for only minutes and stimulates the axis only when given in pulses, for example by pump. Triptorelin is a deliberately modified agonist that acts as a depot over weeks and precisely for that reason shuts the axis down. Both bind to the same receptor in the pituitary gland but pursue opposite goals in use.

How it works

According to the summary of product characteristics, LH, FSH and testosterone initially rise temporarily after administration. With longer, continuous administration, LH and FSH fall, and steroid production in the testes and ovaries is suppressed. In men, testosterone falls about 2 to 4 weeks after the start of therapy to the range measured after surgical castration. After stopping, the effect is generally reversible.

How long a single dose acts is shown by a measurement in healthy men: after a depot injection, testosterone rose until day 4, fell to a low level by week 4 and was no longer reduced only from week 8. After intravenous administration, triptorelin is distributed and eliminated in healthy men with half-lives of about 6 minutes, 45 minutes and 3 hours.

What the studies show

Heyns 2003: triptorelin versus leuprorelin

284 men with advanced prostate cancer received either triptorelin 3.75 mg (140) or leuprorelin 7.5 mg (144) every 28 days over 9 months. After 29 days, 91.2 versus 99.3 percent were in the castration range, after 57 days 97.7 versus 97.1 percent. Maintenance between day 29 and day 253 was equivalent. The 9-month survival rate was higher under triptorelin (97.0 versus 90.5 percent), but it was not the primary endpoint. Triptorelin lowered testosterone somewhat more slowly, without any apparent disadvantage.

Del Mastro 2011: PROMISE-GIM6

281 premenopausal women with stage I to III breast cancer received chemotherapy alone or together with triptorelin, starting at least one week before chemotherapy. Twelve months after the last cycle, the rate of early menopause was 25.9 percent without and 8.9 percent with triptorelin, a difference of minus 17 percentage points (95 percent confidence interval minus 26 to minus 7.9). The study was open-label, not blinded.

Pagani 2014: SOFT and TEXT

4,690 premenopausal women with hormone receptor-positive breast cancer received exemestane or tamoxifen for five years, each with suppression of ovarian function by triptorelin, removal of the ovaries or irradiation of the ovaries. After a median of 68 months, five-year disease-free survival was 91.1 versus 87.3 percent in favor of exemestane, hazard ratio 0.72. Overall survival did not differ. The study tests exemestane against tamoxifen, not triptorelin against placebo.

Easton 2025: triptorelin in steroid forums

The analysis of 5,059 posts from four Australian steroid forums describes how users talk about recovery after anabolic steroids. Triptorelin appears there as a controversial agent for recovering the hormonal axis; one user warns that too much of it could chemically castrate. The authors stress the lack of prospective studies and clear clinical guidelines. This is a description of forum discussions, not proof of efficacy.

Where the data stop

• No evidence for a “restart”. For a single dose to restimulate the hormonal axis after anabolic steroids, we found no prospective study. The idea rests on the brief initial rise in LH and FSH, which is considered a side effect in the clinic.
• The opposite effect is documented. In healthy men, the drop in testosterone after a single depot injection lasted until about week 8. What the scene intends and what the medicine demonstrably does are far apart.
• Healthy men are hardly studied. The large trials are in cancer; data on men with a suppressed axis after anabolic steroids are lacking.
• Origin of the product. What is sold as triptorelin outside the pharmacy is not the tested medicine; the study data apply to the latter, not to products from the gray market.

Status, approval and legal

Triptorelin is approved and prescription-only in Germany. Pamorelin LA 3.75 mg has been approved since March 8, 2005; the approved dose is 3.75 mg every 4 weeks. Salvacyl 11.25 mg is given every 12 weeks; treatment must be initiated and monitored by a psychiatrist. Use to stimulate the hormonal axis after anabolic steroids is not an approved use.

Triptorelin is named explicitly in the annex of the German Anti-Doping Act and on the WADA list 2026 under S2.2.1, banned in men in and out of competition. The summary of product characteristics points out that its use can lead to positive results in doping tests.

Safety

The side effects are well documented and result mainly from the intended hormone withdrawal: hot flashes, reduced libido, erectile dysfunction. GnRH agonists can lower bone density. The summary of product characteristics mentions an increased risk of depression, which can be severe, and reported seizures.

Triptorelin can prolong the QT interval. Under androgen deprivation, glucose intolerance, fatty liver and an increased cardiovascular risk were observed in epidemiological data; prospective data did not confirm higher cardiovascular mortality. Rarely, treatment uncovers an undetected pituitary adenoma, with the risk of pituitary apoplexy. Triptorelin is contraindicated in pregnancy and breastfeeding. It belongs in the hands of a physician.

Sources

• Summary of product characteristics Pamorelin LA 3.75 mg (triptorelin, as of 04/2026)
• Summary of product characteristics Salvacyl 11.25 mg (triptorelin, as of 04/2025)
• Heyns CF et al., BJU Int 2003 – triptorelin versus leuprorelin in advanced prostate cancer, 284 men
• Del Mastro L et al., JAMA 2011 – PROMISE-GIM6, triptorelin against chemotherapy-induced early menopause, 281 women
• Pagani O et al., NEJM 2014 – SOFT/TEXT, exemestane with ovarian suppression, 4,690 women
• Easton J et al., Drug Alcohol Rev 2025 – post-cycle therapy in Australian steroid forums
• WADA – Prohibited List 2026, S2.2.1 Testosterone-stimulating peptides in males
• German Anti-Doping Act, annex – releasing factors of CG and LH (triptorelin)