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The purpose of this reference guide is to go over the different ancillaries that may be required during an anabolicsteroid cycle or in post cycle therapy and discuss what they do, how they work, how they may best be utilized and give an idea of some general dosing guidelines. I hope you find it helpful!
Aromatase Inhibitor’s (ai’s):
Aromatase Inhibitors do exactly what their name states. They inhibit the aromatase enzyme. The aromatase enzyme is the enzyme responsible for the conversion of testosterone to estrogen. Any testosterone based steroids aromatize to estrogen. In order to avoid excess estrogen an aromatase inhibitor should be run on cycle with these types of compound. The goal when running an ai on cycle is to manage estrogen levels so that you still get the positive benefits of estrogen without the undesirable side effects of excess estrogen. I recommend keeping estrogen levels within the clinically normal range even while on cycle. Blood work is essential to determine proper ai dosage no matter which ai you choose.
There are 2 types of ai’s. Type 1 and type 2. Type 1 ai’s include Exemestane (aka Aromasin /Stane). These are often referring to as suicidal ai’s. They permanently render the aromatase enzyme inactive. Now do not be confuse, this does not mean you take them once and all aromatase is inactive for ever and no more need be take. The body is continually producing the aromatase enzyme so Exemestane needs to be continually taken while on cycle. Type 2 ai’s include Anastrozole (Arimidex /Dex) and Letrozole (Femara/Letro). These ai’s temporarily bind to the aromatase enzyme, essentially blocking it, not allowing testosterone to bind to it and be aromatized to estrogen. These ai’s also need to be continuously taken while on cycle.
Let’s briefly take a look at each ai, its effectiveness and common dosages for a moderate testosterone based steroid cycle.
Exemestane (Aromasin,Stane), although often touted as weaker than letrozole but stronger than anastrozole, is probably in all likelihood, the mildest or most forgiving ai. It is commonly dosed at 25 mgs/ tab or ml of liquid. It has a fairly safe profile having at the very least no negative impact on igf and possibly increasing it slightly. It has no adverse impact on lipid (cholesterol) profiles as well. While Exemestane is very effective at lowering estrogen it is very difficult to “crush” or lower estrogen too much while taking this ai. These factors make this ai a very desirable choice for on cycle use. For a common testosterone cycle, say between 500-600mgs/week the starting dosage for this ai would be from 12.5mg-25mg/day.
Anastrozole (Arimidex,Dex) is a fairly potent ai. It is commonly dosed at 1mg/tab or ml of liquid. It, like exemestane, also has a relatively safe profile and may have either no adverse effect, or a slightly adverse effect on igf levels and lipid profiles if dosed properly. It is easier to lower estrogen levels too much while taking anastrozole than it is when taking exemestane. Anastrozole is a more potent ai than many people give it credit for. It also has a longer active life than exemstane so daily dosing is not required. Every other day use is fine with anastrozole. For a common testosterone cycle say between 500-600mgs/week the staring dosage for this ai would be from .25mg-.5 mg Every Other Day.
Letrozole (Femara, Letro)is by far the most potent ai available. It is most commonly dosed at 2.5mg/tab or ml of liquid. It has the largest negative impact on both igf and lipid profiles of any ai (probably due to its strength). It can be very easy to lower estrogen levels too much when taking letrozole. For this reason I recommend only those with serious estrogen/aromatization issues of those doing very heavy cycles consider using letrozole to manage estrogen levels. Often I see people recommend letrozole for the treatment of Gyno, I do NOT recommend this In order for an ai to effectively treat gyno your estrogen levels must essentially be reduced to zero. While letrozole is very capable of this, some estrogen is essential for basic bodily function, health and wellbeing. For a common testosterone cycle say between 500-600mg/week the staring dosage for this ai would be approximately .25mg every other day or every third day. Be warned even at these low doses it is fairly easy to lower estrogen too much while using letrozole. Use it with caution if it is the ai you choose.
To sum it up an ai should be used on cycle, to manage estrogen levels, keeping them within the clinically normal range. Their use should start upon the start of your cycle and stop when you begin your Post cycle Therapy protocol. Blood work is essential to determine proper ai dosage for you while on your cycle. Ai’s are not meant to treat or reverse gyno, simply manage estrogen levels.
HCG:
HCG, or Human Chorionic Gonadotropin , is a Luteinizing Hormone Mimetic. HCG is dosed in iu’s and comes in various sizes most common being a 5000iu kit. Luteinizing Hormone (LH) is a hormone produced by the Pituitary that Stimulate the leydig cells causing the production of testosterone. HCG mimics this LH, stimulating the leydig cells causing the production of testosterone. This takes place in the testes.
HCG has been used in many different ways over the years by steroid users, many of them incorrect. The proper use of HCG in my opinion is using it while on cycle, to maintain testicular function, allowing for an easier recovery of testicular function post cycle. There are added benefits of HCG as well such as backfilling hormonal pathways. When shutdown, hormones such as dhea and pregnenolone are not produced. More and more it has been discovered these are not simply testosterone precursors but provide function and benefit on their own. HCG allows for the production and thus the benefits these hormones have to offer. As we know steroids shut down the HPTA (hypo pituitary testicular axis) thus testicular function ceases. We then use Post Cycle Therapy (PCT) to try to re-induce the function of the HPTA as quickly as possible. The use of HCG ON CYCLE maintains this testicular function allowing for a smoother, faster easier recovery of natural testicular function. It should not be taken only at the end of the cycle in large doses; it should not be taken on large doses at all as it may cause desensitization of the leydig cells. It also should not be taken during PCT as it is Suppressive of pituitary function of LH production. The proper method for HCG use is to use it on cycle, starting at the beginning of your cycle and running it up to 3 days before you start your PCT. Proper dosage should be 250iu’s inject 2x/week (ie: mon/thurs). HCG is often overlooked as an ancillary but thankfully is becoming more and more widely used and accepted as a standard part of a steroid cycle protocol. Rightfully so.
SERMs:
SERMs, or Selective Estrogen Receptor Modulators, bind selectively to estrogen receptors in various locations in the body. They illicit 2 effects that are primarily of interest to the steroid user; first they block the estrogen receptor in breast tissue preventing or potentially treating the condition known as Gyno. Second they bind to estrogen receptors in the hypothalamus and pituitary blocking the suppressive effect of estrogen on the production of LH (negative feedback) and to some degree FSH, inducing the production of testosterone and in some cases spermatogenesis. Now we will be looking at 4 different serms and how effective they are at the aforementioned effects. You will find certain serms are best suited for inducing or preventing certain effects.
Tamoxifen (Nolva,Tamox) is the first serm we will look at. It comes in a standard dosage of 20mg tabs (10 are also avail) and 20mg liquid. This is also the most diverse serm. Offering effectiveness at both gyno prevention and treatment as well as the induction of natural testosterone production.
Tamoxifen has a strong binding affinity to the estrogen receptor in breast tissue, second only to Raloxifene (to follow) when it comes to this effect. This makes Tamoxifen an excellent choice when it comes to either gyno prevention or treatment. It can be run on cycle alongside an ai should gyno symptoms start to occur to prevent/treat gyno on cycle. It can also be run standalone off cycle to treat gyno.
On cycle dosage of Tamoxifen for gyno treatment would be 20mg/day. Much has been made of running Tamoxifen with an type 2 ai and that it reduces the effectiveness of the ai. The fact is that while it lowers serum blood levels of type 2 ai’s, it does not reduce the ai’s effectiveness and is of no clinical significance. Also much is made of running Tamoxifen on cycle with 19 nor steroids such as tren and deca and the upregulation or the progesterone receptor. The fact is if you are controlling your estrogen this is of little significance. Also after 2 weeks of Tamoxifen use the progesterone receptor actually is down regulated! So the 2 aforementioned ideologies need to be dismissed and Tamoxifen can be run with a type 2 ai with no adjustment in ai dosage and also alongside a 19 nor steroid without adverse effect.
Off cycle for gyno treatment one would dose Tamoxifen as follows: 40mg/day for the first week, 20mg/day every week after that. It should be mentioned when using a serm to treat gyno results do not come overnight. You should plan on at least 8 weeks of treatment and quite often treatment is required longer than that.
Tomoxifen in PCT. Tamoxifen is a very effective serm for the induction of natural testosterone production. It has become a PCT staple for this very reason. The combination of Tamoxifen and Clomiphene (to follow) has become the standard in post cycle recovery of natural testosterone production. Tamoxifen dosage in PCT should be as follows: 40mg/day the first week, 20mg/day each week thereafter. I say thereafter as normal PCT runs 4 weeks, however when I run a 19nor steroid such as Tren or Deca I add an additional 2 weeks of Tamoxifen at 20mg/day for a total of 6 weeks of Tamoxifen use. This is due to the extremely suppressive nature of 19-nor steroids. I’ve found the added 2 weeks of Tamoxifne greatly improves y recovery of testicular function.I am also of the opinion that Tamoxifen should be combined with Clomiphene for the most effective PCT protocol I will get into the Clomiphene dosage for PCT next.
Clomiphene (Clomid) comes in standard dosage of 50mg/tab and 70mg/ml liquid. Clomiphene shines in 3 particular areas. One is in PCT (combined with Tamoxifen) for recovery of natural testosterone production. The second is in the area of male fertility, and the third is in the area of Hormone Replacement Therapy (HRT) in males. While Clomiphene does bind to the estrogen receptor in breast tissue the binding affinity is not near that of Tamoxifen, Raloxifene or even Toremifene (to follow). This makes it the least desirable SERM for gyno prevention of treatment and in my opinion it should not be used for that purpose.
Let’s look at Clomiphene use and dosages in PCT. When using tabs the dosage protocol would be as follows: 100mgs/day the first week, 50mgs/day the next 3 weeks. When using liquid the dosage protocol would be 70mg(2ml)/day the first week, 35mgd(1ml)/day the next 3 weeks. For best effect it should be combined with Tamoxifen at the dosages mentioned above. I will summarize the Tamoxifen/Clomiphene PCT protocol at the end of the SERM section.
Clomid has proven particularly effective in the area of male fertility. This is likely due to its secondary effect on FSH and spermatogenesis in addition to its primary effect on LH. Dosage for this purpose would be 50mg/day.
More and more clomid is being accepted as a replacement for Hormone Replacement Therapy. The dosages for this are anywhere from 25-50mgs/day to 25-50mgs every 3 days.
Toremifene (Fareston, Torem) is a serm very similar in effects to Tamoxifen. It is equally effective at stimulating the production of natural testosterone and slight less effective at binding to the estrogen receptor in breast tissue when it comes to gyno prevention and treatment. It comes in dosages of 60mgs/tab and 60mg/ml in liquid. It does seem to have a slightly better safety profile than Tamoxifen but this difference is very slight. Why isn’t it used more in PCT might be the natural question. Well it is a newer drug and quite frankly there isn’t nearly as much in the way of studies or case studies using it for this purpose. Perhaps down the road there will be but as of now there isn’t. Based on the above information I would not recommend using Toremifene for gyno prevention or treatment. It may however be used as part of a successful PCT protocol.
Dosage of toremifene for PCT would be as follows: 120mgs/day the first week followed by 60mgs/day the next 4 weeks. While many claim great results running Toremifene on its own in PCT I would be more comfortable combining it with Clomiphene at dosages of 100mg/day the first week and 50mgs/day the next 3 weeks. If I were running a 19 nor (tren of deca) I would do the same with Toremifene as I do with Tamoxifen. I would extend the PCT 2 weeks and take just Toremifene those 2 weeks at 60mg/day.
Raloxifene (Evista/Ralox) is a SERm with an extremely high binding affinity for the estrogen receptor in breast tissue. It comes in dosages of 60mg tabs and 60mg/ml liquid. While it is extremely effective in the prevention and treatment of gyno it is the least effective SERM at stimulating the production of natural testosterone. For this reason I recommend it not be used in PCT but be the SERM of choice for Gyno treatment or prevention.
For Gyno prevention or treatment on cycle this should be dosed at 60mg/day for the first week and at 30mg/day every week after that. It can be run alongside an ai and is extremely effective at gyno prevention. For off cycle Gyno treatment I would suggest dosing it at 120mg/day for the first week and 60mg/day every week after. Again Gyno treatment is a slow process. Expect to run this for at least 2 months possibly more. If anything short of surgery will treat your Gyno – Raloxifene is it.
So to sum up serms, their applications, and my recommended combinations.
PCT in order of preference in my opinion would be as follows:
1-Tamoxifen 40/20/20/20 + Clomphene 100/50/50/50. If running post 19 nor Tamoxifen 40/20/20/20/20/20 + Clomiphene 100/50/50/50. (dosage in mgs by day per week)
2-Toremifene 120/60/60/60 + Clomiphene 100/50/50/50. If running post 19 nor Toremifene 120/60/60/60/60/60/60 + Clomiphene 100/50/50/50
On cycle Gyno Treatment in order of Preference:
1- Raloxifene 60mg/day the first week and 30mg/day every week after up to pct.
2- Tamoxifen 20mg/day up to pct
Off cycle Gyno Treatment in order of preference:
1-Raloxifene 120mg/day first week, 60mg/day every week after (expect at least 8 weeks +)
2-Tamoxifen 40mg/day the first week, 20mg/day every week after (expect at least 8 weeks +)
Dopamine Agonists:
Dopamine Agonists are used on cycle to decrease Prolactin. 19 Nor Steroids such as Deca or Tren are reported to increase Prolactin levels. Proactin is a hormone that plays a key role in sexual function as well as the induction of lactation from the breast. If Prolactin becomes elevated Undesirable sexual side effects can occur and in more extreme cases even lactation from the breast (yes in males). So how does a Dopamine Agonist decrease Prolactin? Well it so happens that Dopamine has an inverse relationship with Prolactin, meaning the higher our Dopamine levels, the lower our Prolactin levels. Dopamine agonists have become a very practical way to lower elevated Prolactin. There are many Dopamine Agonists but below I will discuss the 2 most popular and effective.
Cabergoline (Dostinex,Cabeser,Caber) is a long active life Dopamine Agonist. It comes dosed in tabs at .5mg and is not stable in liquid so it should not be used in that form. It has a very long active life and can effectively be taken at a dosage of .5mg 1-2x/week. It acts primarily on the D2 receptor providing a substantial increase in dopamine thus effectively lowering prolactin. Side effects are common with Dopamine Agonists and common side effects in over 50% of Cabergoline Users are GI disturbances including nausea and vomiting and also neurological disturbances such as depression and vertigo. In over 30% of users cardiovascular sides were noted such as hypertension, edema, arrhythmias and palpitations. Dopamine Agonists are not to be taken lightly in the side effect department.
Pramipexole (Mirapex,Mirapexin,Prami) is a shorter active life Dopamine Agonist. It comes dosed from .125mg to 1.5mg tabs. Most common are 1mg tabs which are scored to be split 4 ways. It also comes in 1mg liquid form. Due to its active life Pramipexole should be dosed daily. Daily dosage is from .5-1mg/day for our purposes. Anyone taking Pramipexole, even if they are prescribed it, starts off at a very low dose, usually .25 mg/day for one week. Then they bump it up to .5mg. It acts both on the D2 and D3 receptors substantially increasing dopamine and thus lowering Prolactin. Particularly of interest for our purposes are it’s effect on the D3 receptor as well. Since most of the sides we will experience from elevated prolactin are sexual in nature. The D3 receptor plays a key role in male sexual function as well as desire. The fact that Praamipexole agonizes this receptor is an added benefit of Pramipexole that Cabergoline does not have. Also of interest Pramipexole has quite the reputation for side however upon researching when it is taken properly and the dosage started low and ramped up sides are significantly less than those associated with Cabergoline. The % of GI sides is lower, there are no reported sides of depression and no reports of any cardiovascular sides. Now this is not to say Pramipexole is side free, it is not. It would just appear when taken properly the sides are less and the effects, particularly the sexual effects, are more desirable in our circumstances.
DHT Inhibitors:
DHT Inhibitors are used by those on cycle concerned with hair loss or who are prone to Male Pattern Baldness. DHT Inhibitors fall into 2 categories: Topical and Oral. The oral DHT Inhibitors are a class of compounds that inhibit the conversion of testosterone to DHT. Testosterone is converted to DHT in the body by and enzyme known as 5-aplha reductase. Oral DHT inhibitors act upon this specific enzyme to reduce this conversion. This is primarily an issue with regards to Male Pattern Baldness or hair loss on cycle. The Topical DHT Inhibitors address the buildup of DHT at the area of concern (ie: The hair follicle) and act as an anti-androgen – neutralizing the DHT present there.
Oral:
Finasteride (Proscar, Propecia, Fina) is available in 5mg tabs. It is a DHT inhibitor that prevents the conversion of Testosterone to DHT by rendering one of the two 5-alpha reducatse iso-enzymes inactive. By doing so it reduces the circulating level of DHT in the entire body. DHT substantially weakens the hair at the follicle causing it to fall out. The overall reduction in DHT as a result of Finasteride results in less DHT in the hair follicle and a reduction in hair loss. Dosage for Finasteride is 5mg/day.
Dutasteride (Avodart, Duta) is available in 2.5 mg tabs abd 2.5mg liquid. It also prevents the conversion of Testosterone to DHT but it acts on both of the 5-alpha reducatse isoenzymes. It is actually more effective at lowering overall DHT than Finasteride at half the dose. It works the same way, reduces overall circuslting DHT level, lowering DHT levels in hair follicle, resulting is less hair loss. It just does do more effectively. Dosage of Duatsteride is 2.5mg/day to 2.5mg every other day.
Topical:
Spironolactone (Spiro) is available as a 5% cream or liquid. It is applied directly to the hair follicle and acts as a powerful anti-androgen there, rendering the DHT (or other androgens that may be present) inactive. This reduces the loss of hair and does do directly at the site rather than lowering systemic levels of DHT. Topical Spiro is applied daily post shower and should not be confused with oral Spiro which may have some undesired side effects. This acts locally and is very effective.
Ketoconozole Shampoo (Nizoral 2%) is a shampoo with 2% Ketoconozole. Ketoconozole is a topical anti-androgen. It is used like regular shampoo but left in hair for several minutes before rinsing. It renders the DHt in the hair follicle inactive, thus reducing hair loss. It is recommended to be used 3x/week but can be used daily if necessary.
PDE5 Inhibitors:
PDE5 Inhibitors are commonly used to treat erectile dysfunction. While this may occur on cycle for various reasons that is not the reason I am including it in the Ancillary Reference Guide. There is one particular PDE5 Inhibitor that offers multiple benefits that make it an ancillary worth looking at for regular use on any cycle. That PDE5 Inhibitor is Tadalafil.
PDE5 Inhibitors inhibit the phosphodiesterase type 5 Enzyme. This enzyme is present in smooth muscle tissue. It limits the release of Nitric Oxide (a vasodilator) and regulates blood vessel constriction/dilation. Inhibiting PDE5 Increases blood flow to the extremities while slightly decreasing the return flow to the heart. It relaxes smooth muscle tissue.
Tadalafil (Cialis,Cia) is available in various Tablet dosages from 5mg-20mg and in Liquid Dosed at 30mg/ml. It is a long acting PDE5 Inhibitor. While its benefits in the area of sexual dysfunction are widely known let’s focus on why it should be an ancillary while we are on a steroid cycle. The vasodilation caused by Tadalafil results in a reduction in blood pressure. High Blood Pressure is a regular side effect of steroid use . This reduction in blood pressure is of clinical significance. Also anabolic steroid use causes an enlargement of the prostate, Tadalafil is a recognized treatment for this condition also known as Benign Prostatic Hyperplasia. It offsets the symptoms of BPH by relaxing the smooth muscle tissue in the prostate and the bladder as there is a significant presence of the PDE5 enzyme in both places. The dosage for daily use Tadalafil to lower blood pressure and treat BPH is 5mg/day.
Researched and Written by Jimmyinkedup
