- A controversial new study, “de Haarlem studie,” from the Dutch anti-doping authority, has concluded that PCT is essentially a waste of time—or even actively detrimental.
- The PCT study was a subgroup analysis. The full study with all its different components is currently undergoing the peer review process with a high-impact medical journal. Complete data will be available upon request after publication.
- A brief summary of the study is available in Dutch on the Haarlem Studie Facebook Page. Here's a quick translation, followed by a summary and link to the nationwide survey of Dutch AAS users which constituted the study baseline.
- The national survey of AAS users found doses ranging from 250–3382 mg/wk and cycle lengths from 2–52 weeks. Cycle length averaged 13 weeks and dosage averaged 900 mg. On average, four different AAS compounds were used in each cycle.
- The study conducted AAS compound sample testing via ultra-high performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry (UPLC‐QTOF‐MS/MS).
- AAS quality was strikingly low. Only 47% of samples tested contained the specific AAS subtype as declared on the label. Only 13% of samples contained solely the declared AAS. No AAS brand showed consistent results.
de Haarlem Studie
After a cycle with AAS, many users are used to taking several weeks of medication to promote hormonal recovery. Specifically, post-cycle therapy (PCT) aims to hasten the recovery of testosterone and fertility. Resources that are widely used are anti-estrogens (e.g. tamoxifen), aromatase inhibitors (e.g. anastrozole) and LH analogues (e.g. hCG). Surprisingly, PCT has never been scientifically investigated.
Post-Cycle Therapy
From the HAARLEM study, data are available from 98 subjects for this question. 79 of them did a PCT. 19 didn't.
In the group that did a PCT, 60% had a 17-beta oestradiol of < 167 pmol/L at the time of the cycle, which was equal to or below the level of a man who does not use AAS.
Medications to prevent or treat side effects during the cycle were used by 55 subjects, mainly hCG (26), tamoxifen (23) and anastrozol (22).
PCT lasted an average of 4 weeks, usually using two different means. 70% Tamoxifen (20-40 mg/day), 70% Clomifene (50-100 mg/day), and 55% hCG (500-1000 IU 3x per week) were used in 70% of the PCT courses.
Measurements
You can see the results of the study in the attached table.
Measurement 1 is the baseline measurement.
Measurement 2 took place during the cycle—recognizable by the high testosterone concentration (this study concerns only testosterone, so no trenbolone, nandrolone, etc.).
For Measurement 3, an average of three months have passed since the end of the cycle. By this point, the PCT has been completed. The no-PCT group appears to have a better testosterone and sperm count during this measurement (16.3 vs. 14.4 nmol/L, and a reduction of 6.6 million moving sperm with no-PCT vs. reduction of 39.2 million moving sperm with PCT).
Measurement 4 took place on average eight months after the end of the cycle. The difference in testosterone levels between the groups has almost disappeared. The sperm count is relatively better in the group that did not do PCT (a reduction of 5.3 million moving sperm with no-PCT vs. reduction of 17.6 million moving sperm with PCT).
What can we learn from this data?
1) It is clear that in both groups the testosterone level remains below the baseline. The difference of –1 nmol/L is not statistically significant. Therefore, it could be a coincidence, although it may also mean that the study group was too small to prove the difference.
2) AAS harm fertility. At eight months, the sperm count is still reduced. This difference is also not quite statistically significant, but nearly so (p = 0.06). Hence we can assume with relative certainty that this is occurring.
3) PCT seems to have no effect on hormonal recovery or preservation of fertility. And if there is an effect, it is more harmful than not.
The last point is perhaps the most striking. However, it often happens that a mechanism of action on paper works very differently in practice. This first scientific evidence against PCT will be shocking to many users, since PCT is very deeply ingrained in the current culture of fitness and bodybuilders.
Given the current clinical data, it is unlikely that PCT is effective. This does not alter the fact that there are exceptions at the individual level. The placebo effect also likely plays a significant role. There are of course always remaining questions about the data, the resources, and the research. We will have to wait for further clinical studies to replicate these preliminary results, as this is the first scientific exploration of the topic to date.
Study Baseline
Scandanavian Journal of Medicine and Science in Sports
Just as interesting as the PCT study, the baseline which surveyed all AAS users in The Netherlands, “Baseline characteristics of the HAARLEM study: 100 male amateur athletes using anabolic androgenic steroids,” was published in the Scandanavian Journal of Medicine and Science in Sports (October 2019).
The survey found a range of cycle length between 2–52 weeks and dosage range from 250–3382 mg/wk. Of particular note is the strikingly low quality of AAS compounds when subject to testing (UPLC-QTOF-MS/MS).
Here's a link to the fulltext Acrobat PDF (30 pages) of the study baseline and compound testing results.
Background
The use of anabolic androgenic steroids (AAS) is common among visitors of fitness centers. Knowledge about health risks of AAS use is limited due to lack of clinical studies.
Methods
One hundred men, at least 18 years old, intending to start a cycle of AAS were recruited. Baseline demographical data and reasons for AAS use were recorded. Subjects provided samples of AAS for analysis with ultra-high performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry (UPLC‐QTOF‐MS/MS).
Results
One hundred and eleven men were seen for a baseline visit. 19% had competed in bodybuilding competitions. Recent illicit drug use was reported by 56%. Seventy‐seven percent of participants had used AAS in the past, and 97% of them had experienced side effects.
After exclusion, 100 men comprised the cohort for follow‐up. The AAS cycle performed had a median duration of 13 weeks (range 2‐52), and the average dose of AAS equivalents was 901 mg per week (range 250‐3.382).
Subjects used other performance and image–enhancing drugs (PIEDs) such as growth hormone (21%).
The quality of the AAS used was strikingly low. Of 272 AAS samples tested, only 47% of samples tested contained the specific AAS subtype as declared on the label. Only 13% of samples contained solely the declared AAS. No AAS brand showed consistent results.
The principal reason for AAS use was gain of muscle mass (44%). Forty‐eight percent self‐reported to being addicted to AAS.
Conclusions
The HAARLEM study cohort shows that strength athletes use AAS in a wide variety of cycles and often also use illicit drugs and other potentially harmful PIEDs. Follow‐up of the cohort will provide novel data regarding health risks of AAS use.
