PCT Explained

Discussion in 'Steroid Forum' started by MR10X, Jan 15, 2013.

  1. MR10X

    MR10X Member

    Found this on another forum and seems to be good information,maby DR Scally and DR Jim can comment.....
    Hypogonadotropic Hypogonadism:

    Pulsatile secretion of gonadotropin releasing hormone (GnRH) from the hypothalamus is required for both the initiation and maintenance of the reproductive axis in the human. Pulsatile GnRH stimulates the biosynthesis of luteinizing hormone (LH) and follicle stimulating hormone (FSH) that in turn initiates endogenous testosterone production and spermatogenesis as well as systemic testosterone secretion and virilization. Failure of this episodic GnRH secretion or disruption of gonadotropin secretion results in the clinical syndrome of hypogonadotropic hypogonadism (HH).

    The usage of anabolic androgenic steroids (AAS) may result in a functional form of HH known as Secondary Acquired Hypogonadotropic Hypogonadism and is diagnosed in the setting of a low testosterone level and sperm count in association with low or inappropriately normal serum LH and FSH concentrations.

    In order to avoid any unnecessary confusion, it is important to understand what the actions of Gonadatropin therapy and Selective Estrogen Receptor Modulators are as well as how they differ from each other and more specifically, during post cycle recovery (pct).

    Gonadotropin Therapy:

    There is nothing more effective than Human Chorionic Gonadotropin (hcg ). The action of HCG is identical to that of pituitary LH. This takes place independently and is not affected by exogenous hormones and/or preexisting HPTA suppression. Therefore, it directly stimulates a dramatic increase in endogenous testosterone production, spermatogenesis and testicular volume. The primary goal during the first few weeks of PCT is to quickly restore testicular volume and function. Also, the dramatic increase in testosterone production is necessary to avoid and/or minimize the unfavorable "crash" effect. In the majority of individuals with larger testes at baseline, HCG alone is sufficient in restoring endogenous testosterone production as well at the induction of spermatogenesis which is most likely a result of residual FSH secretion. Once there is a plateau in the response to HCG, treatment with an FSH preparation such as human menopausal gonadotropin (HMG) or recombinant follicle stimulating hormone (rFSH) should be added in combination to HCG.

    *The addition of an FSH preparation is rarely required and is best suited for severe cases of HH. FSH preparations are not readily available to most individuals. Therefore, there is no need to go into details with respect to its application at this time.

    HCG is administered by subcutaneous (SC) or intramuscular (IM) injection. The average (3ml 22-25G x ?-1½") syringe is adequate for IM injections but insulin syringes (½-1ml 28-30G x ½-1") are recommended for SC injections. In regards to effectiveness, there should be no discernable difference between either of the techniques. The individual should opt for the most comfortable and/or convenient form of administration.

    The following is a description of the available preparations by Serono:

    HCG ampoules are supplied in 500, 1,000, 2,000, 5,000 and 10,000 IU preparations accompanied by 1 ml of sterile dilluent. It should be stored at a controlled room temperature (15-30 degrees C or 59-86 degrees F) and should be used immediately after reconstitution.

    HCG multidose vials are supplied in 2,000, 5,000 and 10,000 IU preparations accompanied by 10 ml of bacteriostatic water. It should be stored at a controlled room temperature (15-30 degrees C or 59-86 degrees F), refrigerated (2-8 degrees C or 36-46 degrees F) after reconstitution and used within 30 days.

    Other manufacturers are available and preparations may vary.

    The terms international units (IUs) can occasionally cause confusion when reconstituting and measuring HCG. The actual process is quite elementary and the concentration per ml (cc) is dependant on the concentration of the lyophilized powder and the volume of dilluent used for reconstitution. For example, if you dilute 5,000 IUs HCG with 5ml (cc) solvent, the end result is 1,000 IUs per ml (cc). Divide the same 5,000 IUs with 10 ml (cc) and the end result is 500 IUs per ml (cc).

    *Bacteriostatic water should always be utilized during reconstitution when long term (30 day) storage and multi dose administration are required.

    Selective Estrogen Receptor Modulators:

    Selective estrogen receptor modulators (SERMs) such as Clomiphine (clomid) and tamoxifen (nolvadex ) increase pituitary LH secretion in secondary manner by blocking estrogen negative feedback on the HPTA. On average, this is not strong enough by itself to counteract the severe imbalance of the androgen:estrogen ratio that is encountered post cycle, especially in the presence of testicular atrophy. Therefore, SERMs are used during PCT primarily as an anti estrogen and to continue the stimulation of pituitary LH after HCG has been discontinued.

    Nolvadex is widely available in 10 mg or 20 mg tablet preparations and Clomid is available in 50 mg tablet preparations.

    Before Beginning PCT:

    It is highly recommended to establish baseline blood values before beginning a cycle. The same principle applies to establishing post cycle blood values, which are necessary for evaluating recovery. Post cycle blood work should be obtained approximately 4 weeks after the cessation of PCT in order to determine accurate readings. Additional blood work should be performed when applicable and/or required.

    The following are Fasting blood values:

    Hormone

    1. Cortisol, Total
    2. Estradiol, Extraction
    3. prolactin
    4. LH
    5. FSH
    6. t3, Free
    7. T4, Free
    8. TSH
    9. Testosterone, Total, Free and Weakly Bound
    10. Hemoglobin A1C
    11. Fasting Insulin
    12. Somatomedian C (optional)

    Cardiovascular

    13. CBC
    14. Comprehensive Metabolic Panel
    15. Lipid Panel

    Other

    16. GGT Important Liver Value not included in Comp Metabolic Panel

    When to begin PCT:

    On average, begin PCT approximately 5-10 days after your last injection regardless of longer acting esters. Begin PCT 1-3 days after your last injection and/or intake when using short acting esters.

    Keep in mind, pituitary LH secretion automatically increases as the hormones diminish from your system. The elevated androgen levels are from an exogenous source and your endogenous production is suppressed. Therefore, waiting for the exogenous androgens to completely clear from your system, ultimately results in lower total concentrations of androgens in your system when beginning PCT. This leads to an unfavorable andgrogen:estrogen ratio and the well known "crash" effect.

    *As previously mentioned, the actions of HCG take place independently and is not affected by exogenous hormones and/or preexisting HPTA suppression. There are no contradictions with respect to the effectiveness of HCG usage while exogenous hormones are present in your system.

    PCT Protocol(s):

    1.) 1,000 IUs HCG 3x/wk (mon/wed/fri) in combination with 20 mgs Nolvadex ED for the first 3 weeks. After, discontinue HCG and continue with 20 mgs Nolvadex ED for an additional 3 weeks.

    2.) 1,000 IUs HCG 3x/wk (mon/wed/fri) in combination with 20 mgs Nolvadex ED and 50 mgs Clomid ED for the first 3 weeks. After, discontinue HCG and continue with 20 mgs Nolvadex ED and 50 mgs Clomid ED for an additional 3 weeks.

    3.) 1,500 IUs HCG 3x/wk (mon/wed/fri) in combination with 20 mgs Nolvadex ED for the first 3 weeks. After, discontinue HCG and continue 20 mgs Nolvadex ED for an additional 3 weeks.

    4.) 1,500 IUs HCG 3x/wk (mon/wed/fri) in combination with 100 mgs Clomid ED and 20 mgs Nolvadex ED for the first 3 weeks. After, discontinue HCG and continue with 50 mgs Clomid ED and 20 mgs Nolvadex ED for an additional 3 weeks.

    Option one can be considered as a standard PCT protocol. This should apply to all basic cycles. Option 2 is generally the same as option one except for the addition of Clomid which is added as a supporting recovery aid. Option three and four incorporate a higher HCG dosage and have a relationship similar to options one and two in the sense that Clomid is incorporated in the latter as a supporting recovery aid.

    *The majority of my experience is with intermediate to advanced athletes whom have completed multiple cycles with higher dosages. Therefore, based upon previous blood work results and considering the common or convenient preparations available, we have established that 1,500 IUs 3x/wk (mon/wed/fri) to be the optimal HCG dosage to begin with. The Nolvadex dosage remains unchanged however Clomid is utilized throughout the entire PCT at 100 mgs ED during the first 3 weeks and 50 mgs ED for the last 3 weeks.

    HCG During Cycle:

    HCG in combination with Nolvadex can and should be used during prolonged (12+/wks) and high dosage (1,000+mgs/wk) cycles. In this case, 500-1,000 IUs HCG ED in combination with 20 mgs Nolvadex ED for 7-10 days consecutively is administered mid cycle or intermittently (every 6-8 weeks) during the cycle.

    Maintaining testicular volume during cycle does in fact improve recovery when compared to atrophied testes when beginning PCT. This solution addresses both testicular atrophy and prevention of Leydig cell desensitization (discussed next) associated with HCG usage.

    Leydig Cell Desensitization:

    Leydig cell desensitization does in fact occur to some degree with prolonged or high dose HCG usage. Using it continuously during a cycle could possibly cause the LH receptor to desensitize which in turn would ultimately render the PCT to be either less effective or possibly useless. This seems counterproductive. HCG will not be needed on cycles where the proper ancillaries are used and where the dosages/durations are realistic.

    The previous summary was a general statement. The reality and good news is that Leydig cell desensitization due to HCG usage is blocked and/or minimized by Nolvadex. This occurs by suppressing HCG's ability to inhibit the conversion of 17 alpha hydroxyprogesterone to testosterone.

    Additional Factors That Influence Recovery:

    Factors that may complicate and/or delay recovery are elevated levels of estrogen and prolactin. Both of these hormones, when elevated, exert negative feedback on the HPTA. Estrogen and its side effects can be controlled by using an aromatase inhibitor such as aromasin , Femara and arimidex during cycles including aromatizing AAS. Prolactin and its side effects can be controlled by using an anti Prolactin such as cabergoline (Dostinex) or Bromocriptine (Parodel) during cycles containing nandrolones. If these measures have not been addressed during the cycle, they will more than likely need to be addressed during PCT. In this scenario, the objective is to lower these hormones to acceptable levels in order to avoid the complications and/or delay in recovery. Blood work is imperative in evaluating the effectiveness of therapy. This will provide a clear and concise answer in regards to the adjustment of dosages and continuation of medication if necessary.

    *There are numerous studies which support and refute the association of nandrolones and prolactin. However, based on first hand experience and blood work results, there are far more individuals today whom can testify that the usage of nandrolones can attribute to an increase in prolactin concentrations. In addition, many individuals have reported elevated prolactin levels during cycles which do not contain nandrolones. The common factor within these cases is supraphysiological levels of estrogen. Estrogens act directly at the pituitary level by causing the stimulation of lactotrophs which in turn enhances prolactin secretion. This is another reason why estrogen management in the form of an aromatase inhibitor should be included with cycles containing aromatizing AAS. Although not absolutely necessary and considering the necessary restoration of physiological estrogen values, there is sufficient evidence which suggests that aromatase inhibitors can improve and increase recovery rates.

    Unsuccessful PCT:

    In some cases the aforementioned post cycle therapy protocols as well as those which are not mentioned may be unsuccessful in the restoration of homeostasis. This should not warrant immediate concern. Many endocrinologists have concluded that the only form of treatment in this particular scenario is hormone replacement therapy (HRT).

    This is far from the truth. The reason many endocrinologists have come to this conclusion is due to the fact that very few of them have the experience treating severe forms of secondary acquired hypogonadotropic hypogonadism. They are unfamiliar with proper protocols which include high dosage HCG administration and additional gonadotropin preparations such as HMG or rFSH. This complication puts the patient at risk for potential and unknown side effects in the eyes of the doctor. Therefore, HRT is a reasonable solution since it will quickly alleviate the majority of the uncomfortable symptoms that the patient is experiencing.

    Aside from disappointing blood work results which illustrate the typical signs of an unsuccessful recovery, the key physical indicator that the treatment is unsuccessful is testicular atrophy. In this case, HCG is continued with the necessary adjustments in dosage and frequency until an increase in testicular volume has been achieved. There is no one size fits all protocol since every case varies and deserves an individualized approach. Subsequent changes will be based upon the individual's response to each particular stage. All the variable factors involved during the recovery process need to be considered. It's far from accurate to reach the conclusion that HRT is needed if one specific recovery protocol is not successful.

    Ongoing Argument(s):

    Hypothetically speaking, if testicular function and volume have been maintained during cycle with HCG, SERMs are then utilized to counteract the imbalance in the androgen:estrogen ratio encountered post cycle as the exogenous androgens diminish. This results in the prevention of estrogenic side effects while increasing pituitary LH secretion which in turn increases testosterone production.

    There is nothing wrong with using a commonly referred to protocol which recommends 250-500 IUs HCG 1-2x/wk to be incorporated throughout the cycle. However, a significant cause for concern in regards to this protocol relates to the cessation of HCG once the cycle has completed and from that point on, the only substances used during PCT are SERMs which consist of Nolvadex and/or Clomid. Realistically, there is absolutely no guarantee that this formula prevents testicular atrophy to the extent where the overall volume and function of the testes are in an optimal state. Unfortunately, a large majority of individuals do not realize or are not aware that Leydig cell desensitization does in fact occur with prolonged or high dosage HCG usage. Therefore, users which follow this protocol whom do not incorporate Nolvadex or an aromatase inhibitor are now susceptible to Leydig cell desensitization which may render HCG usage post cycle ineffective when and if needed.

    During conservative cycles, there is substantial evidence which exists that supports the effectiveness of the HCG during cycle and SERMs only post cycle protocol, especially when proper estrogen and prolactin management has been incorporated. However, this conclusion is much more difficult to achieve on heavy or prolonged cycles. Testicular volume should be maintained to an acceptable extent but that does not necessarily result in an improved recovery as severe HTPA suppression still exists which is not immediately repairable through the usage of SERMs.

    The most common argument here when incorporating HCG during PCT is that HCG itself is suppressive. This is true and one particular way this occurs is though the constant binding of HCG which disrupts the endogenous pulsatile secretion of LH. A recent study which included the usage of 250 mcgs Ovidrel (rHCG) 2x/wk for 12 weeks demonstrated that the patients resumed normal HPTA function within four weeks upon cessation, without the usage of SERMs. What's even more interesting is that 250 mcgs rHCG is the equivalent of approximately 5,000 IUs uHCG. Therefore, putting things into perspective, a few additional weeks of suppression is nothing to be overly concerned about compared to and considering the 12 weeks of suppression incurred during the average cycle. The usage of HCG during PCT is a minimally intrusive variable where the benefits clearly exceed the associated costs.

    Conclusion:

    PCT should begin after the last injection and/or AAS intake. More specifically, a relative guideline to begin PCT is within 5-10 days when using long acting esters or 1-3 days when using short acting esters. This PCT protocol should consist of 1,000-1,500 IUs HCG 3x/wk (mod/wed/fri) in combination with 20 mgs Nolvadex ED and, if necessary, 50-100 mgs Clomid ED. The mid/intermittent cycle protocol of 500-1,000 IUs HCG and 20 mgs Nolvadex ED for 7 days consecutively can and should be utilized when necessary during prolonged (12+/wks) or heavy dosage (1,000+mgs/wk) cycles. In addition, blood work should be performed before beginning a cycle and after completing a cycle in order to establish baseline values and evaluate recovery, respectively.

    If recovery is unsuccessful, HCG is continued with an adjustment in dosage and frequency as necessary until the increase in testicular volume and function have been achieved which is unlike the more typical, yet incorrect belief that HCG is only to be used for a short period of time. Once there is a plateau in the response to HCG, treatment with an FSH preparation such as human menopausal gonadotropin (HMG) or recombinant follicle stimulating hormone (rFSH) should be added at a starting dose of 75-150 IUs on alternate days. This continual usage is not necessary and avoidable in most cases by utilizing the mid/intermittent protocol previously mentioned, but it is much more common and less avoidable with long term (1+/yr) users, whom have not taken the suggested preventive measures, and/or improper recovery from previous cycles regardless of which protocol is chosen.

    With the usage of HCG post cycle, your androgens are elevated but well below that of supraphysiological concentrations from exogenous hormones. In addition, a noteworthy difference is that the effect is through a direct stimulation of testicular production compared to the secondary nature of SERMs in conjunction in the presence of testis that are not guaranteed to be in an optimal functioning state. Upon completion, blood work will display significantly higher levels of LH, FSH and testosterone in this environment which includes HCG and SERMs during PCT versus HCG during cycle and SERMs only during PCT. This ultimately results in a more comfortable as well as tolerable recovery both physically and psychologically. In conclusion, HCG should always be included during PCT in combination with SERMs regardless of what protocol has been utilized during cycle to prevent testicular atrophy, in order to achieve an optimal recovery.
     
  2. Michael Scally MD

    Michael Scally MD Doctor of Medicine


    I did not read your whole post. Immediately when I came upon this statement, the whole PCT post is suspect. It is for this very reason that almost all AAS users fail to restore the HPTA. It is crucial and critical to take into account the AAS half-life and dose. This is what determines the timing of hcg, SERM, AI, ... In many cases, hCG must be continued for 30+ days after the last AAS administration. SERM/AI will begin afterwards. For this alone, the PCT as written will result in failure often. [FWIW: This so-called "androgen:estrogen ratio" and baseline labs are bunk.]
     
    Last edited: Jan 15, 2013
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  3. Michael Scally MD

    Michael Scally MD Doctor of Medicine


    More crap!!! I challenge anyone to produce any support for "Leydig Cell Desensitization" in the doses used clinically. And, using hCG during a cycle as causing this myth is total BS.

    Herein, lies the problem. The author is spouting off any and all crap he can find peppered with some good info. The final result is to toss this shit into the circular file. It will end up only getting one into trouble - AIH!
     
    Last edited: Jan 17, 2013
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  4. Pericles

    Pericles Member

    This.^ I also stopped reading when the piece said HCG would result in complete restoration of the HPTA. Absolutely false, and very dangerous for inexperienced users.

    HCG stimulates the Leydig cells in the balls, but the pituitary and hypo. are still shut down. In fact HCG shuts them down as much as AAS use. For complete restoration of the HPTA, clomid and also (I know that some say that only 1 SERM is fine....my experience is that it is better to use both) are needed.
     
  5. Pericles

    Pericles Member

    Are you referring to the 250 IU eod while on, or the (what I have used for years, and what you call "power pct")?

    The power pct is 2k IU's eod....I usually recommend 20 days, and you posit that 30 is often needed. Is there no Leydig desensitization for the 2k IU 15 eod shots?
     
  6. SHARK1

    SHARK1 Member

    All my esthers are cleared in 3-4 days, I started my pct 3 days after my last injection with an hcg "blast" of 1,000IU and 60mg nolva/150mg clomid, the next 5 days have been 40N/100C and in 2 days I'll do one last HCG "blast" of 1,000IU.

    Clomid 100/100/100/100
    Nolva 40/40/20/20

    HCG was used during the cycle in low amounts.

    2,5mg Letro once a week to keep estrogen in check.


    :eek: OPINIONS? :eek:
     
  7. Michael Scally MD

    Michael Scally MD Doctor of Medicine


    What esters? What dose and duration? These all matter for a proper PCT.
     
  8. Michael Scally MD

    Michael Scally MD Doctor of Medicine


    For any clinical hcg use "Leydig Cell Desensitization" does not occur! Also, hCG is better used Q3-4D.
     
  9. SHARK1

    SHARK1 Member

    testosterone Propionate
    Trenbolone Hex
    Primobolam Methelonone Enanthate (which I think *could* be in my system for even more than 2 weeks, but I had my last shot of Primo 5 days before hcg "blast")

    It was something like...

    Weeks 1-4:
    Test Prop 300-400mg/wk
    Primo 700-800mg/wk
    tren Hex 300-380mg/wk

    Weeks 4-8:
    Test Prop 600-800mg/wk
    Primo 700-800mg/wk
    Tren Hex 400-680mg/wk

    The ranges are due to the shots being EOD and some weeks placing in 4 shots vs. 3 shots and so on and so forth...
     
  10. Donzi

    Donzi Member

    g2g
     
  11. Michael Scally MD

    Michael Scally MD Doctor of Medicine


    If I am reading this correctly, the PCT will fail. You will be almost certainly hypogonadal.
     
  12. SHARK1

    SHARK1 Member

    Primobolan and tren Hex are active for 2 weeks prior to the last shot.

    My last shot of Primo was on the 5th, and my last shot of Tren was on the 7th, I started my PCT on the 11th and by now, 18th, I'm 1 week into PCT while tomorrow will be 2 weeks from my last Primo shot. Tren is most definitely in my system, still, but I doubt anything to entirely prevent my HPTA from starting to wake up.

    I could always extend my PCT, tapering the nolva down to 20 but adding 2 more weeks of it at clomid 50/50 and Nolva 20/20 until my blood work presents adequate measures.

    I thank you for your reply Dr. Scally, but I did not like the way in which you deemed me as "certainly hypogonadal".

    Is it there something wrong with my PCT choice of ancilliaries/dosages, or is it more related to not having waited enough for the androgens to leave my system and even allow my HPTA to restart?
     
  13. Jagger34

    Jagger34 Member

    Aside from the fact that the word you are looking for here is "subsequent" (as opposed to prior, since this means before) you are not looking at this correctly mathematically. Active amount is dependent not just on half lives but also on dosage administered (100 mg will clear faster than 200 mg of the same substance).

    Carry on
     
    Michael Scally MD likes this.
  14. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Where do you get the belief/notion that having AAS within your "system" will not cause HPTA suppression? It is a FACT that the AAS type,dose, & duration will effect HPTA function. By not taking these into consideration for PCT results in AIH. This is the overwhelming error by AAS users.
     
  15. alxinya

    alxinya Member

    was he supposed to wait two or three weeks before starting pct considering his cycle??
     
  16. alxinya

    alxinya Member

    On this forum, I read that hcg should be used during the cycle to keep the testes working. Back in the day, people would use it at the end of a cycle before using Nolv or clomid to boost the testes back into shape. So which is best?? How about on a 12 week cycle, start at week 10 say 500IU EOD till week 14, then start Nolv and or clomid?? Or is it better to start mid cycle and do 500 EOD every other week for like 8 weeks? I am at the halfway mark, I know my nuts have shrunk a bit cause I measured them with a digital caliper. I can't figure out if I should start now or wait till week 10. Am I way off base here?
     
  17. alxinya

    alxinya Member

    I found this and it is interesting. I wish one of our resident experts would read it and tell me what he thinks. Is it nonsense or does the part about aromasin, nolvadex and hcg make sense??


    Post Cycle Therapy (pct)
    After a cycle, we have one goal: to hold onto the gains we made during the cycle. Unfortunately, this is easier said than done, because the levels of various hormones and other substances that were circulating around your body during the cycle (huge amounts of testosterone, insulin-like growth factor, growth hormone, and lower amounts of muscle-wasting glucocorticoids) are now changing. Sadly, they are making way for lower amounts of the hormones we want for building muscle, and higher amounts of the catabolic ones. What needs to be done, as quickly as possible, is to get your body to begin production of your own natural anabolic hormones, and produce less of the catabolic ones. Unfortunately, your body has other plans.
    But then, so do I…
    …and I’m very confident that this protocol will allow you to recover your own natural hormonal levels quickly and lose far less of the gains you worked so hard for on the cycle. This protocol, which is typically implemented after a cycle is called “Post Cycle Therapy” or “PCT” for short.

    First, I’m going to tell you what anabolic hormones are typically low when a cycle ends, and which catabolic ones are high, then I’ll tell you what drugs can change that condition as fast as possible. Is all of this necessary? No, not at all. You can skip to the end of the article and look for a little chart I made - the extent of my computer skill - which has all of the dosage recommendations and compounds involved to properly recover from your cycle. I think, however, that you’ll see some very odd recommendations if you simply skip to the end, and will find yourself reading through the whole article to find out where they came from - or maybe you’ll just try to find out what’s gotten into me?

    I’m not re-inventing the wheel here, and you may have seen a piece of this information elsewhere (possibly in something I’ve written, possibly somewhere else on the internet or in a magazine), but I’m sure of two things:
    You’ve never seen this PCT protocol anywhere
    This is the most effective PCT you’ll ever see
    First, I’ll give you a brief explanation on the body and how it works, and why there’s a lag-time after the cessation of Anabolic Steroids before the body returns to normal. Remember, during this lag-time you lose gains, so we really need to make it as short as possible. First, we need to understand a bit of what is going on in your body, what causes it to happen naturally, and what hormones are performing what function. Don’t worry, I’ll try to make it painless.

    At the age of puberty, Gonadatropin Releasing Hormone (GnRH) is increasingly released from the Hypothalamus, in turn causing the secretion of Follicle Stimulating Hormone (FSH) and Luetenizing Hormone (LH) from the pituitary, and finally the male gonads (testes) are then stimulated by those pituitary hormones (LH and FSH). (1). FSH, although generally thought to only have a role in production of sperm, actually aids the in regulation of Leydig Cell function (2), while LH directly causes the Leydig Cells in the testes to secrete androgenic hormones such as testosterone (which is causes a surge in other anabolic hormones: Insulin Like Growth Factor, Growth Hormone, etc…). Androgens do this by then targeting other tissues inside the body, either by attaching to the Androgen Receptors (AR), which are found primarily in the cytoplasm of specific cells, or by what’s known as non-receptor mediated effects. When an androgen (your own natural testosterone or an anabolic steroid you’ve injected or ingested) binds to a receptor inside the cell, it activates the transcription of specific genes. What does this mean? Don’t worry, it just means that the steroid molecule gives the cell a message to do something. In the case of testosterone, for example, one of the messages it sends to the cell is to increase nitrogen retention in your body, thus allowing you to use more of the protein you take in, and build more muscle. In the case of testosterone (or anabolic steroids in general), this transcription causes a lot of different anabolic effects to take place: an increase in IGF, a decrease in cortisol, an increase in Red Blood Cell count, and the increased protein synthesis I already told you about. This is not to say that AR binding is the only thing that causes anabolic or androgenic effects, however. Oxymetholone and Methandrostenolone (Anadrol and Dianabol) both bind very weakly to the AR yet are both highly anabolic and androgenic. The diagram below is an example of an androgen’s entry into a target cell, where it (in this case) stimulates protein synthesis, which is a major anabolic effect:




    Under the control of this heightened state of androgens, you also go through androgenic development as well as anabolic development. This can be seen in puberty when males grow body hair experience voice changes, as experience genital development and growth.

    Another characteristic of androgens in the body is that they are subject to what’s known as a “negative feedback loop”. Lets review one of the first things I mentioned, ok? Your Hypothalamus secretes GnRH, thus making the pituitary secrete LH & FSH, finally in turn causing the testes to stimulate the Leydig cells to produce testosterone (by conversion of cholesterol), remember? Ok, now, once testosterone is created however, it has the ability to in turn to undergo various metabolic processes that will inhibit GnRH, which in turn inhibits the secretion of LH and FSH, and that brings a halt to natural testosterone production. Once testosterone has stopped being produced, it no longer sends this negative signal, and GnRH eventually begins to do its job again. In this way, your body prevents excess hormones from being secreted and thus maintaining homeostasis (the status quo… in this case a state where you are neither gaining nor losing muscle) (1). This negative feedback loop is partially why we use anabolic steroids…we want more testosterone for anabolic purposes (or more Anavar or whatever) than our body will let us produce (not that our bodies produce Anavar, but you get the idea). When we use that injectable testosterone, it sends the message to our body to begin the negative feedback loop and discontinue producing/secreting the hormones that cause our natural testosterone production. The chart below clearly shows this process, displaying both the negative and positive feedback system(s):



    So what I’m saying is that anabolic steroids increase androgen levels in the blood, bringing a halt to GnRH, making the pituitary gland (eventually) responds by reducing the release of LH; this loss of LH has the effect of shutting down testosterone, of course, which you know is produced by the Leydig cells in the testes after they are stimulated by LH. Am I being repetitive? Yes. Do you need to understand all of this in order to understand the PCT protocol I’m about to outline? Yes. Remember, the negative feedback loop is, of course, no problem while we are on a cycle. Want more testosterone (or androgens) in your body? Fill up a few more syringes!

    But all good things come to an end, and most of us choose to end our cycles at some point. At this point, while there is still some androgens floating around in us, our natural production won’t begin, and even once they are out, there may be some lag time before your body figures out that it needs to start producing its own androgens again. As I said before, this lag time is severely catabolic and it’s where you lose a lot of your gains. SO what we need to do is coax the body into quickly producing its own androgens.

    One of the first drugs we’ll consider for this purpose is what is typically called a SERM. Nolvadex (tamoxifen) is a SERM (Selective Estrogen Receptor Modulator, which means that it has the ability to act as an anti-estrogen with regard to certain genes, yet also acting as an estrogen with respect to others. That’s the “selective” part I guess. It does this by blocking gene transcription in some cases, and initiating gene transcription in others (3). Luckily for us, it has estrogenic effects on bones (meaning it increases their density), and blood lipids -meaning it lowers cholesterol-, (4)(5)as well as preventing gynocomastia by preventing estrogen gene transcription in breast tissue. However, it acts as an anti-estrogen in the pituitary, thus increasing LH and FSH, which results in an increase in testosterone. 20mgs of Nolvadex will raise your testosterone levels about 150% (6)...Nolvadex actually has quite a few applications for the steroid using athlete. First and foremost, it’s most common use is for the prevention of gynocomastia. Nolvadex does this by actually competing for the receptor site in breast tissue, and binding to it. Thus, we can safely say that the effect of tamoxifen is through estrogen receptor blockade of breast tissue (7).
    Estrogen is also important for a properly functioning immune system, and not only that, but your lipid profile (both HDL and LDL) should also show marked improvement with administration of tamoxifen (34).

    Nolvadex also has some important features for the steroid using athlete. In hypogonadic and infertile men given nolvadex, increases in the serum levels of LH, FSH, and most importantly, testosterone were all observed (35)It can also block a bit of estrogen in the pituitary, which is a great benefit when used with HCG (more on that later) (36)(37). The increase in testosterone Nolvadex can give someone with a dysfunctional is basically that 20mgs of Nolvadex will raise your testosterone levels about 150% (6)...Why don’t we use clomid, another SERM? Well, basically because it takes much more to do the same thing. In comparison, it would require 150mgs of Clomid to accomplish that type of elevation in testosterone, but Nolvadex also has the added benefit of significantly increasing the LH (Leutenizing Hormone) response to LHRH (LH-releasing hormone) (6). This most likely indicates some kind of upregulation of the LH-receptors due to the anti-estrogenic effect Nolvadex has at the pituitary. Although both Nolvadex and Clomid are both SERMs, they are actually quite different. As you already know, Nolvadex is highly anti-estrogenic at the hypothalamus and pituitary, while Clomid exhibits weak estrogenic activity at the pituitary (7), which as you can guess, is less than ideal. It should be avoided for the PCT I’m suggesting…and in fact, avoided in general…it’s simply not as good as Nolvadex.

    Need I even add that the 150mgs of Clomid you need to get the hormonal increase experienced with 20mgs of Nolvadex is much more expensive? So lets dump the Clomid…and no, using it along with Nolvadex will provide no “synergy” that I’ve ever seen in any relevant study.

    SO how much Nolvadex should you use during PCT? I favor using 20mgs.day, although to be totally honest, you can probably even get away with far less than that. Doses as low as 5mgs/day have proven to be as effective as 20mgs/day for certain areas of gonadal stimulation. (8) 20mgs/day, however, is a dose that myself and others have used with great success, and the research I’ve done in this area typically uses this milligram amount. SO lets stick with 20mgs/day for now.

    So that effectively suggests Nolvadex can not be used at Mega-doses to get a mega-increase in your natural hormones. We can’t use huge doses of any Anti-Estrogen, actually, and expect huge increases in our natural hormones, actually. arimidex (an aromatase inhibitor –which means it stops the conversion of testosterone into estrogen-another drug used to fight breast cancer like Nolvadex) exhibits basically the same effects when .5mgs or a full 1mg is used (9) and I have even read studies where up to 10mgs/day of Arimidex is studied with no clear benefit over 1mg/day. letrozole (another Aromatase Inhibitor) is capable of inhibiting Aromatase maximally at a mere 100mcg/day (10.). So clearly we need to add in other compounds to our PCT, because Mega-Doses of one compound will not I think it’s absurdly funny to see people recommending upwards 40-80mgs/day of Nolvadex, or a full milligram (or two!) of Arimidex, in their post-cycle or on-cycle suggestions. I’d steer very clear of listening to anyone who makes those types of recommendations…

    All of this tells me that you can’t simply use mega-doses of Anti-Estrogens or SERMS to do anything more than reasonable doses. It must be, therefore, that your body can only respond with so much vigor to any one drug in those families. So lets add in another drug or two, ok? This way we can use reasonable doses of a few drugs and produce some synergy…hopefully decreasing our recovery time.

    We’ll need something to go with Nolvadex, which acts in a different manner, and Human Chorionic Gonadatropin (HCG) is the clear choice here. Here’s where things get a bit controversial (no, really…I know you , because I’m pretty much the only person around (currently) who recommends HCG for Post-Cycle Therapy. Although I’m seen as Old School in this respect, really, this is a totally new paradigm for HCG use, made possible only by the inclusion of the other compounds I am introducing to you for PCT. HCG is the natural choice, as it has been used successfully to cure AAS induced (11), and this alone warrants its inclusion to our cycle.

    HCG is a peptide hormone manufactured by the embryo in the early stages of pregnancy and later by the placenta to help control a pregnant woman’s hormones (can anything really be said to control a pregnant woman’s hormones except ice-cream and chocolate?). Obviously, as you can guess from the name, it is a substance that stimulates the gonads (hence: gonadotropin). It does this by initiating gene transcription that is identical to that of Luetenizing Hormone, thereby causing the Leydig Cells to produce testosterone. Sounds great right? We can stimulate LH and FSH production with our Nolvadex, and then directly stimulate the Leydig Cells as well, to produce tons of testosterone by different routes! Well...it’s not all that simple.

    Unfortunately, while HCG increases Testosterone, it increases estrogen as well(12). As you probably know, estrogen acts directly on the Leydig cells to effect changes in the activities of enzymes important for testosterone synthesis (13) and may actually be considered an important part of that negative feedback loop I mentioned earlier. In addition, an increase in circulating levels of LH have been shown to induce down-regulation of LH-receptors in both rodent studies (14), as well as in human studies (15); since HCG mimics LH, you can expect it to do the same. This LH downregulation can cause an increase in steroidogenic cholesterol (the cholesterol earmarked by your body for conversion into testosterone). (16). Thus, after the initial HCG induced surge in testosterone is over, if you have used enough to downregulate your LH-receptors and increase estrogen too much, then more steroidogenic cholesterol is available. This is telling me that less is being converted to testosterone. In fact, rodent models suggest that if you take a dose large enough to cause a sharp increase of plasma testosterone, you will actually desensitize your Leydig cells to your next shot, and will possibly not experience any rise in testosterone from the second dose at all, or may only experience a very slight one at best (17.). Since this is due to LH-Receptor downregulation, and that occurs in human models too, it is pretty fair to assume that if your first dose of HCG is too large, your second won’t be very effective. Unfortunately, this lack of an increase in testosterone doesn’t necessarily mean that the HCG may be unable to increase circulating levels of Estrogen (18) And remember that increase in Estrogen will (most likely) cause your body ultimately to produce less testosterone. Low LH post-cycle is not the primary cause of slow recovery, because LH generally rises to levels above baseline after a cycle much sooner than testosterone production does. This is probably because the pituitary is working very hard to get your atrophied Leydig cells to start producing testosterone again. HCG should also bring back testicular volume; I feel the need to mention this because it’s important to me and I suspect most men as well. It would also appear that HCG works very well when it’s used on men who have low levels of LH to begin with (as you would be after a cycle), as many studies on pre-pubertal boys and Hypogonadotropic Hypogonadal men would suggest (19)

    This suggests that a pre-exposure to normal LH levels or gonadatropins in general is necessary for HCG-induced Leydig Cell desensitization. This, of course is not a problem for us, as we’ll be using it when LH/Gonadatropin levels are very low anyway …we just need to stop using it before we regain normal function, or it will work against us eventually. (19) (20). Luckily, the temporary Anabolic steroid induced hypogonadism that is experienced after a cycle basically allows us to respond to HCG like anyone with low LH levels (21), and thus, as I told you, a lot of the possible inhibitory effect of HCG is not going to be relevant because there was no prior “priming” by circulating gonadotrophins. This is great news for us, because we are going to be using HCG during PCT, when we need to get back some HPTA function, and not when we have levels of gonadatropins high enough to cause HCG-induced desensitization.

    But are we still risking some inhibition and possibly delaying our recovery by using HCG? Probably not…you see, some studies in humans have shown that HCG does not actually have a direct effect on inhibiting LH release in men (22)(23), but rather (probably) works to inhibit LH secretion indirectly, simply by stimulating the production of testosterone (thus activating the negative feedback loop). Another factor involved is the induction of testicular aromatase, which raises estrogen levels, again causing inhibition. Unfortunately, yet another process, the downregulation of the Leydig Cell LH receptor itself, seems to also play a role in high dose HCG testicular desensitization. This is also done by HCG actually blocking the conversion of 17 alpha-hydroxyprogesterone (17 OHP) to testosterone (24). Nolvadex actually stops this blocking-action of HCG from taking place (25). Most likely, because of Nolvadex’s direct antiestrogenic effect and LH-upregulating effect on the Pituitary, suppression of gonadotropins via HCG is (25) almost totally stopped with concurrent administration of Nolvadex! So if we Use Nolvadex and we are only using HCG when we are low in gonadatropins, we won’t be inhibited by it at all! Right?

    Well…maybe…but there’s still the issue of estrogen caused by that HCG-stimulated surge in testosterone. Well…we can use low doses (300iu or so) to avoid some of that major spike in estrogen, and thus cause far less inhibition from the HCG (26). Of course, I’d want to use a bit more HCG per injection (500iu), if I could, to get my body functioning fully more quickly, and lose less of my gains. Maybe we can get away with taking some Vitamin E with our HCG, since it increases the responsiveness of plasma testosterone levels to HCG, making them significantly higher during vitamin E administration than without it (27). So we can get a better response with our HCG by taking Vitamin E (I recommend 1,000iu/day), but that doesn’t get rid of the problem that we have, which is the estrogen increase the HCG will cause.

    Lets solve that pesky estrogen problem now…. Lets add in an Aromatase Inhibitor! Which one, though? Well, since we are already using Nolvadex, we can’t use Letrozole or Arimidex, as the Nolvadex will actually greatly decrease the blood plasma levels of them (28)!

    So we have to use Aromasin (exemestane) as our AI, because it’s an aromatase inactivator, meaning it makes estrogen receptors useless, and instead of just inhibiting production (as an anti-aromatase would do) it cuts off production totally. Aromasin can also cause androgenic sides (29)(30)(31), which may help to elevate your mood while you are on PCT. This final drug in my recommended PCT can effectively remove up to about 85%+ of estrogen from your body (32). Most importantly, using Aromasin together with Nolvadex doesn’t reduce exemestane’s effectiveness (33). So now, I think the problem of ANY inhibition possible with HCG is solved, and we can use that 500iu/day dose that I wanted to use previously.

    With this PCT, there will be a rapid increase in LH, FSH, and testosterone, as well as almost a complete block on all the factors that could be causing your natural hormones to be delayed in returning to baseline. For this reason, I feel that the second your cycle is over is when you should start this PCT (a week after your last shot, or the day after your last pill is fine). Remember, waiting for some of the extra androgens you’ve been taking to leave your body is nonsensical, as we want to start recovery as soon as possible to retain maximum gains. There is no evidence to suggest waiting any length of time after your cycle is over will increase PCT effectiveness…it simply prolongs the time you aren’t doing anything positive to regain your natural hormones. And how long do we run this for? Well…we need to stop the HCG relatively soon for reasons discussed earlier. But the Nolvadex, and Aromasin can be used for awhile longer. Ideally, we’d be getting weekly blood work, but we could also get it done monthly, and just running this PCT until we see our natural hormones restored…but weekly bloodwork isn’t really an option for most of us. Failing the option of monitoring recovery with blood-work, I’m going to give you my best thoughts on the time you should be running your PCT. It’s important to note I haven’t discussed nutrition or other compounds that may be beneficial…this is because in this article, I am primarily concerned with the restoration of hormonal function, nothing else. And with no further delays, here are my recommendations for PCT:

    Week Nolvadex HCG Aromasin Vitamin E
    1 20mgs/day 500iu/day 20mgs/day 1,000iu/day
    2 20mgs/day 500iu/day 20mgs/day 1,000iu/day
    3 20mgs/day 500iu/day 20mgs/day 1,000iu/day
    4 20mgs/day 20mgs/day
    5 20mgs/day
    6 20mgs/day

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    Effect of lower versus higher doses of tamoxifen on pituitary-gonadal function and sperm indices in oligozoospermic men.m Dony JM, Smals AG, Rolland R, Fauser BC, Thomas CM
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    Inhibitory effect of co
     
  18. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    mands likes this.
  19. mands

    mands Member AnabolicLab.com Supporter

    LMAO. My thoughts exactly.

    mands
     
    Michael Scally MD likes this.
  20. Stretch

    Stretch Member


    Would you rather change the oil in your car as routine maintenance?

    Or just replace the motor when it blows up?