Will I ever Recover?? Blood Work Pt.2

[WORLD]

A few months ago I posted up some blood work for you all to look at. These were results from months after my first cycle. My values were low and I asked for some advice on helping with my recovery.

I took some advice and ran some hcg (3 months after the end of the cycle).

I got new blood work 3 months later from the last ones, making it 6 months from the end of the cycle in total.

I'm honestly pissed off because it doesn't seem like everything will get back to normal again. I don't know what else to do. I want to continue running cycles safely but I'm basically scared to continue.

I've attached both results in simple pdf format.

-LH raised a bit, but still low
-fsh stayed non existant
-Free test actually lowered and is at the very low range

Any thoughts fellas?

[Proteinkiller]

i ran aromasin for pct with nolva this cycle and i feel almost 100% recovered and seemed to have kept all strenght...im gonna get blood work done this month ill let you know how my levels are to compare... first time running aromasin for pct and to tell yah the truth seems to be the best so far for me .

[Namelessone]

Other than that HCG what was your PCT bro?

[nisser]

These may be your ORIGINAL values. Did you do a blood test BEFORE you started the cycle?

You may have recovered as well as you could have but I would give it another 3 months and see if there's any improvement.

[WORLD]

I heard it takes upward of a year to return to normal (Libido, etc) after a few cycles.

Most recover fairly quicky, so it seems. But I can imagine getting fully recovered takes some time.



i ran aromasin for pct with nolva this cycle and i feel almost 100% recovered and seemed to have kept all strenght...im gonna get blood work done this month ill let you know how my levels are to compare... first time running aromasin for pct and to tell yah the truth seems to be the best so far for me .

If I continue I will definitely it.



Other than that HCG what was your PCT bro?



It was Nolva @ 40/40/20

To my understanding it was all I needed for a first test-only cycle. Keep in mind that I ran the Hcg 3 months after the end of my cycle, just to try and kick start things.

[Seth]

Let's throw a theory out there. What if your values were naturally low before the cycle and you've now pretty much recovered to your initial state. Did you have works done before the cycle?

[WORLD]

Let's throw a theory out there. What if your values were naturally low before the cycle and you've now pretty much recovered to your initial state. Did you have works done before the cycle?

Hmm. I never considered that. I did have blood work done but I didn't get these values checked. I wish I did so I could compare. The thing is, I don't feel normal. Things just don't seem right like they did before.

[St]

You should run another course of PCT.
Hcg--LH
Toremifene Citrate-Lh&Fsh or Clomid Lh&Fsh

[Vomit]

What did you take for your 1st cycle?

[phatkid77]

How big was the cycle..long?

Your boys are not working yet,I'm thinking they should be... Your test levels are great for a 80 year old.....

Phats

[gustavo77]

Well for one, your pct was shit...Two, HCG alone will not help you recover, you need to stimulate LH/FSH production along with estrogen control during pct (AI use).

If i were you, i would do another pct and do it correctly this time:

Wk 1- HCG 1000iu x 2 (ie. mon, thurs), Aromasin 25mg/day
Wk 2- HCG 1000iu x 2 (ie. mon, thurs), Aromasin 25mg/day
Wk 3- HCG 500iu x 2 (ie. mon, thurs), Aromasin 25mg/day
Wk 4- Clomid 100mg/day, Aromasin 25mg/day
Wk 5- Clomid 50mg/day, Aromasin 25mg/day
Wk 6- Clomid 50mg/day, Aromasin 25mg/day
Wk 7/8- Aromasin 25mg/day

Wait 4-5 weeks and get blood work done again.

[WORLD]

You should run another course of PCT.
Hcg--LH
Toremifene Citrate-Lh&Fsh or Clomid Lh&Fsh

You would suggest to run a second pct? Or just wait it out.


What did you take for your 1st cycle?

10 weeks of test @ 500/wk.


How big was the cycle..long?

Your boys are not working yet,I'm thinking they should be... Your test levels are great for a 80 year old.....

Phats

10 weeks. Considering I'm 22, your comment made me feel great :ilu

[WORLD]

Well for one, your pct was shit...Two, HCG alone will not help you recover, you need to stimulate LH/FSH production along with estrogen control during pct (AI use).

If i were you, i would do another pct and do it correctly this time:

Wk 1- HCG 1000iu x 2 (ie. mon, thurs), Aromasin 25mg/day
Wk 2- HCG 1000iu x 2 (ie. mon, thurs), Aromasin 25mg/day
Wk 3- HCG 500iu x 2 (ie. mon, thurs), Aromasin 25mg/day
Wk 4- Clomid 100mg/day, Aromasin 25mg/day
Wk 5- Clomid 50mg/day, Aromasin 25mg/day
Wk 6- Clomid 50mg/day, Aromasin 25mg/day
Wk 7/8- Aromasin 25mg/day

Wait 4-5 weeks and get blood work done again.


Thanks Gustav, thats very helpful.

The second pct I did involved Hcg @ 500iu/week for two weeks, followed by Nolva for another two. What you're suggesting is similar, other than the fact that the doses are higher in yours and you included an AI.

Even after realizing that Nolva alone is unsufficient for a pct, I still see people preaching that its alright for a first small cycle. It's too easy to be misinformed.

Have you witnessed anyone or recommened running three pct's before?

[gustavo77]

Thanks Gustav, thats very helpful.

The second pct I did involved Hcg @ 500iu/week for two weeks, followed by Nolva for another two. What you're suggesting is similar, other than the fact that the doses are higher in yours.

Even after realizing that Nolva alone is unsufficient for a pct, I still see people preaching that its alright for a first small cycle. It's too easy to be misinformed.

Have you witnessed anyone or recommened running three pct's before?


No prob bro... i just see too many people doing nolva alone for pct when i do not even think it should be used at all...but i digress...

HCG for two weeks is not enough bro.. you need to stimulate the testes for at least a few weeks, keep estrogen down (high estrogen levels will shut your test production back down) and stimulate LH and FSH with the use of clomid... as Nolva IMO does not sufficiently do this..

Too me, if you are using nolva for pct, then you are basically recover on your own.

Again, if this does not work, then you may have to give your body more time to recover....everyone is different. Some people's endocrine systems are simply more sensitive than others. If six months have past and you are still not seeing any improvement then you may need to see an Endocrinologist. And in that case there would have had to be an issue prior to your cycle...one cycle of test should not shut a healthy male down for good.

[St]

You would suggest to run a second pct? Or just wait it out.



10 weeks of test @ 500/wk.



10 weeks. Considering I'm 22, your comment made me feel great :ilu

Ya you want a second pct like Gus said.You can take Tormeifene or Aromasin your pic.A few guy latety have said its the best thing they ever tired for pct was Toremifene.

[gustavo77]

Ya you want a second pct like Gus said.You can take Tormeifene or Aromasin your pic.A few guy latety have said its the best thing they ever tired for pct was Toremifene.

I am interested in Tor....you know of any studies showing it;s ability to increase LH and FSH??

[gustavo77]

Found one, Tor looks like a good choice for pct:

http://www.ncbi.nlm.nih.gov/pubmed/17412336

Now, i wonder what the sides of Tor are...

[gustavo77]

Some good studies on Clomid:

http://www.ncbi.nlm.nih.gov/pubmed/17070201

And:

Clomiphene Citrate Effects on Testosterone/Estrogen Ratio in Male Hypogonadism
J Sex Med 2005;2:716–721.

ABSTRACT

"Aim. Symptomatic late-onset hypogonadism is associated not only with a decline in serum testosterone, but also with a rise in serum estradiol. These endocrine changes negatively affect libido, sexual function, mood, behavior, lean body mass, and bone density. Currently, the most common treatment is exogenous testostosterone therapy. This treatment can be associated with skin irritation, gynecomastia, nipple tenderness, testicular atrophy, and decline in sperm counts. In this study we investigated the efficacy of clomiphene citrate in the treatment of hypogonadism with the objectives of raising endogenous serum testosterone (T) and improving the testosterone/estrogen (T/E) ratio.

Methods. Our cohort consisted of 36 Caucasian men with hypogonadism defined as serum testosterone level less than 300 ng/dL. Each patient was treated with a daily dose of 25 mg clomiphene citrate and followed prospectively. Analysis of baseline and follow-up serum levels of testosterone and estradiol levels were performed.

Results. The mean age was 39 years, and the mean pretreatment testosterone and estrogen levels were 247.6 ± 39.8 ng/dL and 32.3 ± 10.9, respectively. By the first follow-up visit (4–6 weeks), the mean testosterone level rose to 610.0 ± 178.6 ng/dL (P < 0.00001). Moreover, the T/E ratio improved from 8.7 to 14.2 (P < 0.001). There were no side effects reported by the patients.

Conclusions. Low dose clomiphene citrate is effective in elevating serum testosterone levels and improving the testosterone/estadiol ratio in men with hypogonadism. This therapy represents an alternative to testosterone therapy by stimulating the endogenous androgen production pathway."

[St]

Found one, Tor looks like a good choice for pct:

http://www.ncbi.nlm.nih.gov/pubmed/17412336

Now, i wonder what the sides of Tor are...

Great link,but i only read what was in the anabolex reference.A few vets on Muscle Chemistry said they did everything,and the torm was amazing overal.I have been around forever but i like to try new things out after some vets give there 2 thumbs up.So i will try it out.

[phatkid77]

22!!! How's yoir build? How did you feel b4 cycle??
As gustavo said and I think, this is a prior condition

Phats

[Seth]

Wk 1- HCG 1000iu x 2 (ie. mon, thurs), Aromasin 25mg/day
Wk 2- HCG 1000iu x 2 (ie. mon, thurs), Aromasin 25mg/day
Wk 3- HCG 500iu x 2 (ie. mon, thurs), Aromasin 25mg/day


Correct me if I'm wrong, but won't HCG shut down his LH even more? I understand that this PCT protocol would be great for unresponsive testes, but as far as I understand, the problem here is further down the loop; LH

[pinhead]

I heard it takes upward of a year to return to normal (Libido, etc) after a few cycles.

I second this. Be patient, it will all go back to normal.

[Praetorian]

A few months ago I posted up some blood work for you all to look at. These were results from months after my first cycle. My values were low and I asked for some advice on helping with my recovery.

I took some advice and ran some hcg (3 months after the end of the cycle).

I got new blood work 3 months later from the last ones, making it 6 months from the end of the cycle in total.

I'm honestly pissed off because it doesn't seem like everything will get back to normal again. I don't know what else to do. I want to continue running cycles safely but I'm basically scared to continue.

I've attached both results in simple pdf format.

-LH raised a bit, but still low
-fsh stayed non existant
-Free test actually lowered and is at the very low range

Any thoughts fellas?

What was your PCT protocol with dosing?
P

[Redz]

It was Nolva @ 40/40/20

To my understanding it was all I needed for a first test-only cycle. Keep in mind that I ran the Hcg 3 months after the end of my cycle, just to try and kick start things.
Big mistake, that is not a good pct, I always run Clomid/Nolva and an ai like aromasin and have not had recovery issues, a strong pct is worth every penny.

[JonnyO]

Why dont you let nature take it course and let time do it's thing. I wouldnt bother with any more drugs to help recover as they may be shutting/keeping you down and from recovering. All I would do it get a good Tribulus product and wait it out. If your values have not improved after 3-4 more months then your going to have to explore other options.

I know many guys who do not even bother with PCT because of this reason. They feel for them it just prolongs everything. I cant say for me they are right or wrong but it works for them and they have tried all methods.

[gustavo77]

Correct me if I'm wrong, but won't HCG shut down his LH even more? I understand that this PCT protocol would be great for unresponsive testes, but as far as I understand, the problem here is further down the loop; LH

How do you know for certain LH is the only problem here?? Are you a doc?? What is being done with my protocol is that we are stimulating the testes, making sure that they are responsive to HCG/LH. Then later once the leydig cells of the testes are functioning we use the clomid to get LH production going again.

[Seth]

How do you know for certain LH is the only problem here?? Are you a doc?? What is being done with my protocol is that we are stimulating the testes, making sure that they are responsive to HCG/LH. Then later once the leydig cells of the testes are functioning we use the clomid to get LH production going again.

Not a doctor at all. Don't be so defensive man, I'm just asking to understand; hence the "correct me if I'm wrong" ;). His blood works show LH to be very low, so even if the testes were responsive (which, I agree with you, we have no idea about) there isn't any LH to tell them to produce anything. So as I understand it, the problem right now is further up the HPTA loop. With his current levels of testosterone, the body should be producing LH, but it isn't. I'm just concerned that more HCG would only shut the production/recovery of LH even more. We can't be sure that LH is the only problem, but if the other problems are lower down the loop, they won't be solved before the upper ones are dealt with.

World: Just so you know, I'm approaching this from a very academic point of view, no experience speaking here at all, take my advice/reasonning lightly

[Seth]

^

[WORLD]

Not a doctor at all. Don't be so defensive man, I'm just asking to understand; hence the "correct me if I'm wrong" ;). His blood works show LH to be very low, so even if the testes were responsive (which, I agree with you, we have no idea about) there isn't any LH to tell them to produce anything. So as I understand it, the problem right now is further up the HPTA loop. With his current levels of testosterone, the body should be producing LH, but it isn't. I'm just concerned that more HCG would only shut the production/recovery of LH even more. We can't be sure that LH is the only problem, but if the other problems are lower down the loop, they won't be solved before the upper ones are dealt with.

World: Just so you know, I'm approaching this from a very academic point of view, no experience speaking here at all, take my advice/reasonning lightly


Absolutely, and I thank you for putting thought into this. Keep on discussing!

[gustavo77]

Not a doctor at all. Don't be so defensive man, I'm just asking to understand; hence the "correct me if I'm wrong" ;). His blood works show LH to be very low, so even if the testes were responsive (which, I agree with you, we have no idea about) there isn't any LH to tell them to produce anything. So as I understand it, the problem right now is further up the HPTA loop. With his current levels of testosterone, the body should be producing LH, but it isn't. I'm just concerned that more HCG would only shut the production/recovery of LH even more. We can't be sure that LH is the only problem, but if the other problems are lower down the loop, they won't be solved before the upper ones are dealt with.

World: Just so you know, I'm approaching this from a very academic point of view, no experience speaking here at all, take my advice/reasonning lightly

I wasn't being defensive bro, I was just asking what you are basing your thoughts on. Thanks for elaborating though and i totally understand what you are saying. The thing is, because his testes are not producing much test all, some of the leydig cells could very well be dormant. There is no way for us to know this of course without him getting some tests. I am not a doc either, so like you, i am just trying to give him the best feedback I can. You may be correct though. Maybe a pct of clomid or Tor with Aromasin would be all that is needed.

[big_luse]

Honestly - I think clomid and aromasin is all you need. Aromasin alongside a SERM works great in speeding recovery ... just watch your joints.

Im a in a similar situation myself here bro ... coming off for the first time myself, and will be getting bloodwork monday, then 4-6 weeks from now.

[Praetorian]

Honestly - I think clomid and aromasin is all you need. Aromasin alongside a SERM works great in speeding recovery ... just watch your joints.

Im a in a similar situation myself here bro ... coming off for the first time myself, and will be getting bloodwork monday, then 4-6 weeks from now.

Incorrect and you should do a bit more research on how each of the compounds you mentioned works. What Gustavo said is partly true...if the leydig cells have not been sensitized to LH for a long time then nolva/clomid or an anti e like aromasin or arimidex will do little if anything to stimulate endogenous test production. A significant amount of HCG is required to effectively stimulate the leydig cells....this can be seen in blood tests after HCG cessation. Aromasin only acts a as a anti estrogen (prevents conversion of test to estro) which is necessary but not the entire solution. You need HCG+aromasin+clomid effectively recover form hypogonadism caused by long term aas usage....see below. Nolva is used in place of aromasin but aromasin actually works better.

HPTA reversal using HCG+Clomid+Tamoxifen

Objective:
Although shown to be effective for their intended medical treatment, AAS have been shown to induce hypogonadotropic hypogonadism in adult males. The medical literature is conflicting in the reports of spontaneous return and long-term suppression of gonadal suppression post AAS usage. This observational study documents the treatment protocol of HCG, clomiphene citrate, and tamoxifen in returning hormonal function to normal post AAS usage. Design:
Five HIV-negative males age 27-49, weighing 77-100 kg, with serum total testosterone levels below 240 ng/dL and luteinizing hormone (LH) levels below 1.5 mIU/mL were considered for this observational study. All five patients were administered the treatment protocol.
Methods:
Treatment consisted of combination therapy which included concurrent administration of (a) Human Chorionic Gonadotropin, (b) Clomiphene Citrate and (c) Tamoxifen Citrate for a standard duration of 45 days. This protocol was repeated with every patient until serum LH and total testosterone values reached normal ranges.
Results:
All five patients were considered eugonadal by normal laboratory reference ranges by the conclusion of treatment. Average serum total testosterone rose from 98.2 to 692.8 ng/dL (p<.001) while the average serum LH rose from an average undetectable value of less than 1.0 to 7.92 mIU/mL (p<.0008).

Conclusions: Although the treatment protocol of HCG, clomiphene citrate, and tamoxifen proved beneficial in reversing AAS induced hypogonadotropic hypogonadism, future controlled studies need to be performed to confirm the beneficial effects of this combined pharmacotherapy in returning HPGA functioning to normal.
Key Words- anabolic-androgenic steroids, clomiphene, HCG, tamoxifen, testosterone, HIV

INTRODUCTION
Testosterone and testosterone analogues, anabolic-androgenic steroids
(AAS), have long been used in the athletic community for improving lean muscle tissue and strength. A positive correlation has been shown with testosterone to include:
increased protein synthesis resulting in lean muscle tissue development (Bhasin et al, 1996; 1997; Hervey et al, 1981; Tenover, 1992),
enhanced sexual desire (libido) (Schiavi et al, 1991),
increased muscular strength (Bhasin et al, 1996; 1997; Hervey et al, 1981; Sih et al, 1997),
increased erythropoiesis (Bhasin et al, 1997; Evans & Amerson, 1974; Sih et al, 1997; Tenover, 1992),
a possible positive effect on bone development (Anderson et al, 1996; 1997; Baran et al, 1978; Tenover, 1992),
improved mental cognition and verbal fluency (Alexander et al, 1998), and male masculinizing characteristics (Starr & Taggart, 1992).

Recently, however, clinicians have recognized the potential benefits of their use in the treatment of various disorders and ailments. Numerous studies have discussed the use of AAS in the treatment of HIV-associated conditions (Bhasin et al, 2000; Grinspoon et al, 1998; 1999; 2000; Rabkin et al, 1999; 2000; Sattler et al, 1999; Strawford et al, 1999; Van Loan et al, 1999), hypogonadism (Bhasin et al, 1997; Davidson et al, 1979; Rabkin et al, 1999; Sih et al, 1997; Snyder et al, 2000; Tenover, 1992; Wagner & Rabkin, 1998; Wang et al, 2000), impotence (Carani et al, 1990; Carey et al, 1988; Klepsch et al, 1982; Lawrence et al, 1998; McClure et al, 1991; Morales et al, 1994; 1997; Nankin et al, 1986 Rakic et al, 1997; Schiavi et al, 1997), burn victims (Demling et al, 1997), various anemia’s (Doney et al, 1992; Gascon et al, 1999; Hurtado et al, 1993; Stricker et al, 1984), deteriorated myocardium (Tomoda, 1999), glucose uptake (Hobbs et al, 1996), continuous ambulatory peritoneal dialysis (CAPD) (Dombros et al, 1994), alcoholic hepatitis (Bonkovskyet al 1991; Mendenhall et al, 1993), hemochromatosis (Kley et al, 1992) and prevention of osteoporosis (Anderson et al, 1996; 1997; Baran et al, 1978; Behre et al 1997; Hamdy et al, 1998; Prakasam et al, 1999).
While AAS have proven effective in cases of lean muscle wasting conditions (HIV/AIDS), this class of medicines is not without their inherent problems. AAS have been shown to induce hypogonadotropic hypogonadism (Alen et al, 1987; Bhasin et al, 1996; Bijlsma et al, 1982; Clerico et al, 1981; Jarow & Lipshultz, 1990; Strawford et al, 1999; Stromme et al, 1974). This condition typically results from an abnormality in the normal functioning of the hypothalamic-pituitary-gonadal axis (HPGA), usually from a negative feedback inhibition of one of the hormone secreting glands, causing a cascading unbalance in the rest of the axis. Possibly resulting from a physiological abnormality (i.e. mumps orchitis, Klinefelters syndrome, pituitary tumor) or as an acquired result of exogenous factors (i.e. androgen therapy, AAS administration). Clerico et al (1981) found a dramatic suppression of serum gonadotropin levels in athletes given methandrostenelone, suggesting a direct action of AAS on the hypothalamus. Similar results of suppressed gonadotropins have been found in patients supplementing solely testosterone (Bhasin et al, 1996; Marynick et al, 1979; Strawford et al, 1999; Tenover, 1992). Case report studies discussed a 36-year old male competitive bodybuilder and a 39-year old father, each using various AAS regimens over extended periods of time, who showed a blunted response to GnRH stimulation tests (Jarow & Lipshultz, 1990). One particular study administered 600 mg of nandrolone decanoate to 30 HIV-positive males over twelve weeks (Sattler et al, 1999). The results made no reference to LH or testosterone levels. The lack of gonadotropin measurement is puzzling as the data showed 12 of 30 subjects experienced testicular shrinkage, implying Leydig cell dysfunction and suppressed testosterone levels. Other studies using AAS have also shown no reference to LH or FSH levels but suppressed values are expected in each case (Bagatell et al, 1994; Behre et al, 1997; Sheffield-Moore et al, 1999; Tricker et al, 1996).
Declining, or suppressed, circulating testosterone levels as a result of either pathophysiological or induced hypogonadal conditions can have many negative consequences in males. Declining levels of testosterone have been directly linked to a progressive decrease in muscle mass (Mauras et al, 1998), loss of libido (Schiavi et al, 1991), decrease in muscular strength (Balagopal et al, 1997; Mauras et al, 1998) impotence (Rakic et al, 1997), oligospermia or azoospermia (Vermeulen & Kaufman, 1995), increase in adiposity (Mauras et al, 1998) and an increased risk of osteoporosis (Wishart et al, 1995).
While some research suggests that the hormonal axis will spontaneously return to normal shortly after cessation of testosterone administration (Knuth et al, 1989), documented cases have taken up to 2 ½ years to return to normal (Jarow & Lipshultz, 1990). This case of a 39-year old male who previously used AAS was found to have low serum testosterone levels (6nmol/L, range 14 to 28 nmol/L) 2 ½ years after his last administration of the drugs (Jarow & Lipshultz, 1990). For most men, suffering with diminished libido, impotence, depression, fatigue, muscle atrophy, and infertility for 2 ½ years is not a pleasant option. Other androgen or anabolic steroid induced cases of hypogonadotropic hypogonadism have taken 6 months (Gazvani et al, 1997; Wu et al, 1996), 8 months (Gazvani et al, 1997), 10 months (Boyadjiev et al, 2000), 12 months (Schurmeyer et al, 1984), and 18 months (Gazvani et al, 1997) to finally return to eugonadal status.
The individual use of human chorionic gonadotropin (HCG), clomiphene citrate, and tamoxifen citrate in the treatment of testicular sub-function and gonadotropin suppression, respectively, is well documented. HCG has been shown to significantly improve gonadal function in hypogonadotropic hypogonadal adult males (Barrio et al, 1999; Burgess & Calderon, 1997; Cisternino et al, 1998; D’Agata et al, 1982; 1984; Dunkel et al, 1985; Kelly et al, 1982; Ley & Leonard, 1985; Liu et al, 1988; Martikainen et al, 1986; Okuyama et al, 1986; Ulloa-Aguirre et al, 1985; Vicari et al, 1992). Studies using clomiphene citrate to induce endogenous gonadotropin production in males found significant improvements in LH and FSH values after treatment (Bjork et al, 1977; Burge et al, 1997; Guay et al, 1995; Landefeld et al, 1983; Lim & Fang, 1976; Ross et al, 1980; Spijkstra et al, 1988). Tamoxifen citrate has also been found to produce a profound increase in serum LH levels as well as improved semen and sperm quality (Gazvani et al, 1997; Krause et al, 1985; Lewis-Jones et al, 1987; Wu et al, 1996).
As HCG’s effect is centralized at the Leydig cells of the testicles, clomiphene citrate and tamoxifen citrate act upon the hypothalamic-pituitary region in stimulating gonadotropin production. Tamoxifen, a nonsteroidal antiestrogen, and clomiphene citrate, a nonsteroidal ovulatory stimulant, compete with estrogen for estrogen receptor binding sites, thus eliminating excess estrogen circulation at the level of the hypothalamus and pituitary and allowing gonadotropin production to resume normally. The normal operation of both the testicular and hypothalamic-pituitary regions is crucial in returning HPGA function to normal. Returning one component of the axis to normal without concurrently returning the other would sabotage and inhibit the operation of the entire HPGaxis. It was with this understanding that HCG was eventually combined with clomiphene citrate and tamoxifen as attempted therapy to reverse gonada function in hypogonadotropic hypogonadal males.
In accordance with previous studies, each medication was used individually, and along with HCG, in initial trials. The simultaneous use of clomiphene citrate and tamoxifen was determined through preliminary use of clomiphene citrate and tamoxifen individually. It was discovered that although both clomiphene citrate and tamoxifen met with some success, when combined together they achieved a more significant increase in gonadotropin production. This clinical outcome resulted in the combination therapy of HCG, clomiphene citrate and tamoxifen.

Following is a clinical evaluation of the combined, simultaneous use of HCG, clomiphene citrate, and tamoxifen citrate as a treatment option in suppressed testosterone and gonadotropin levels in hypogonadotropic hypogonadal adult males. This observational analysis of the aforementioned treatment protocol assessed the efficacy of these medicines under non-controlled conditions.

METHODS
An observational study was done on the medical records of 5 adult male patients presenting to a clinic with induced hypogonadotropic hypogonadism. Patients were monitored and treatment recorded for the purposes of this observational study.
SUBJECTS
The medical records of five males age 27-49, mean 35.2, weighing 77-100 kg, mean 89.8 kg, with serum total testosterone levels below 240 ng/dL and serum luteinizing hormone (LH) levels below 1.5 mIU/mL were examined. Average presenting testosterone level was 98.2 ng/dL (normal= 240-827 ng/dL) while average LH level was undetectable at <1.0 mIU/mL (normal= 1.5-9.3 mIU/mL). The 5 patients had a history of AAS usage ranging from 9-60 months prior to presentation. All patients had ceased any testosterone therapy or AAS usage prior to initiation of treatment. Initial laboratory values confirmed that all patients had discontinued AAS long enough for endogenous lab values to fall below normal reference ranges. All patients were muscular in nature with an average BMI less than 27 at presentation. Table 1 presents the patient characteristics, anabolic history, and side effects upon presentation of the 5 patients.

LABORATORY STUDIES
Initial blood screening consisted of:
AST, ALT, GGT, TOTAL CHOLESTEROL, LH, FSH, TESTOSTERONE, GLUCOSE, PROLACTIN, PSA TOTAL, TSH, T3 UPTAKE, T4 TOTAL, T4 FREE, HEMOGLOBIN, HEMATOCRIT
Table 2 shows all baseline serum blood levels at presentation. Baseline blood screening excluded any form of hyperprolactinemia or hypothyroidism as causes of hypogonadism in most patients. After physician examination and history and physical evaluation, it was determined that a history of AAS usage was present and most likely the cause of the patients’ hypogonadotropic hypogonadal lab values; not hyperprolactinemia or hypothyroidism.
Laboratory testing was performed by Quest Diagnostics Inc., (Houston, TX) and SmithKline Beecham Clinical Laboratories, (Houston, TX). Repeat serum LH & testosterone samples were measured by immunoassay using chiron reagant kits on an ACS-180 instrument.

METHODS
A review of patients’ medical records showed a treatment intervention of (a) human chorionic gonadotropin (HCG) (Ferring Pharmaceuticals), (b) clomiphene citrate (Teva Pharmaceuticals), and (c) tamoxifen (AstraZeneca). Typical dosage of HCG consisted of 2500 units every other day for 16 days.
All HCG injections were self-administered intramuscularly. Starting dosages of clomiphene citrate and tamoxifen were 50mg and 20 mg daily, respectively. Patients started all three medications simultaneously and reported for the first follow-up blood work after completion of HCG, 16 days later. The post HCG blood analysis assessed testosterone-total response only. If testicular stimulation, i.e. testosterone production, was inadequate, additional HCG was administered at this stage of therapy rather than waiting an additional 30-45 days before the protocol completion. If the testicular response to the HCG demonstrated sufficient testicular stimulation (typically a blood serum level of >300 ng/dL), clomiphene citrate and tamoxifen were continued for 15 and 30 days, respectively. The arbitrary cut-off level of 300 ng/dL was used as a general assessment where sufficient Leydig cell stimulation was taking place even in light of artificial stimulation from HCG. A repeat blood sample was then taken at day 45 to assess hypothalamic-pituitary-gonadal axis status via luteinizing hormone and total testosterone levels. Because of the varying cessation times of the medications, the concluding blood sample was taken after a 30 and 15-day washout period of HCG and clomiphene citrate, respectively. For HPGA function to be considered normal, both LH and testosterone values had to fall within the normal reference ranges. For the purposes of patient treatment, if LH and testosterone values were still below normal limits at the conclusion of 45 days of treatment, a repeat protocol administration of HCG, clomiphene citrate, and tamoxifen was given. This protocol was repeated with every patient until LH and testosterone values reached normal ranges.

RESULTS
All five patients were considered eugonadal by normal laboratory reference ranges by the conclusion of treatment. Average serum total testosterone rose from 98.2 to 692.8 ng/dL. Average serum LH rose from <1.0 to 7.92 mIU/mL. An average of 48,974 U of HCG (five 10,000 Unit boxes), 3412.5 mg of clomiphene citrate (68.25 50mg tablets), and 968.71 mg of tamoxifen (48.44 20mg tablets) were used to treat all patients to eugonadal. Total treatment time ranged from 43-120 days. Mean elapsed time from initiation of treatment to eugonadal was 68.6 days. Statistical analysis was performed using repeated measures ANOVA. Pre and post treatment testosterone values were significantly (p<.001) different as were the LH values (p<.0008). Table 3 demonstrates the hormone changes during the treatment period and the duration to eugonadal.

ADVERSE EVENTS
None of the study subjects had any serious or treatment-terminating effects as a result of the multi-drug protocol. No problems were noted with regards to parameters of normal urologic function or treatment causing gynecomastia. Any side effects documented at presentation were reversed by the conclusion of treatment.

DISCUSSION
This observational study demonstrates the possible efficacy of HCG, clomiphene citrate, and tamoxifen citrate in returning the HPGA to normal physiological function in adult males suffering from androgen induced hypogonadotropic hypogonadism. In the case of decreased testicular function manifested by low testosterone levels, it is of primary importance to first return the normal function of the testicular cells. The initial lack of response to HCG should not immediately be a cause for the initiation of testosterone replacement therapy, as with the current accepted therapy modality by many physicians. Blood analysis confirmed that no exogenous testosterone was administered during the treatment period, as exogenous androgens would have had a suppressive effect on endogenous gonadotropin production. Therefore, because of the corresponding normal gonadotropin and testosterone values, it is accepted that gonadotropin and testicular function were normal by the conclusion of treatment. The standard treatment of HIV-related muscle wasting, AAS therapy, may involve decades of treatment and the attendant problems with any therapy of a prolonged nature. Polycythemia vera, elevated hepatic enzymes, and prolonged negative alterations in lipid profile are a few of the dangers experienced by HIV patients administered AAS for extended periods. Of greatest concern is the increasing numbers of individuals who are currently being treated with AAS to increase muscle mass either for medicinal or recreational means without attention being given to periodically returning the HPGA to normal. With roughly 4 million men in the U.S. being considered hypogonadal (Lacayo R., 2000; Sheffield-Moore et al, 1999; Shelton DL, 2000), an estimated 200,000 men are currently receiving testosterone treatment for the condition (Shelton DL, 2000). As stated earlier, AAS are being prescribed to HIV & AIDS sufferers to combat progressive muscle loss. The Centers for Disease Control and Prevention (CDC) reported an estimated 635,000+ men diagnosed with AIDS through December 2000 while an estimated 97,700 have been reported with HIV (Centers for Disease Control, vol.12, No. 2, table 5; Centers for Disease Control, vol. 12, No. 2, table 6). In 2000 alone over 31,000 men were diagnosed with the AIDS virus (Centers for Disease Control, vol. 12, No. 2, figure 3). Between hypogonadal, AIDS, & HIV males, potentially over 900,000 men are being administered AAS therapy.
Studies recently published on patients suffering from various tissuedepleting conditions and HIV affliction (Bhasin et al, 2000; Grinspoon et al, 1998; 1999; 2000; Rabkin et al, 1999; 2000; Sattler et al, 1999; Strawford et al, 1999;1999; Van Loan et al, 1999) have not identified what should be done to restore normal endocrine status post-treatment. Considering the dosages and compounds administered in many studies, there is no question that subjects were left hypogonadal after therapy. In the cases where the periodic use of testosterone or AAS are necessary, intervention to return the HPGA to normal should be initiated as soon as possible after the cessation of the AAS. As described herein, a possible treatment modality may be the combined regimen of HCG, clomiphene citrate, and tamoxifen. Medical history has demonstrated examples of physician-induced complications resulting from treatment. Iatrogenic hyperthyroidism (Bartsch & Scheiber, 1981) and iatrogenic Cushing’s syndrome (Cihak & Beary, 1977; Kimmerle & Rolla, 1985; Smidt & Johnston, 1975; Tuel et al, 1990) are cases were administered medications or treatments provoked abnormalities in patients’ normal physiology. The administration of testosterone as a treatment for hypogonadotropic hypogonadism falls into this same category of causing endocrine related abnormalities (Bhasin et al, 1996; Marynick et al, 1979; Strawford et al, 1999; Tenover, 1992). Testosterone replacement therapy has proven to be very effective in reversing the symptoms of suppressed testosterone production, but does not treat the underlying cause of the deficiency. Positive effects of testosterone treatment; i.e. improved sex drive, improved sense of well-being, lean body mass; are all transient in light of plummeting gonadotropin levels. Upon cessation of testosterone treatment patients can expect a complete reversal of positive benefits as exogenously influenced testosterone levels metabolize and decline rapidly. Further controlled studies need to be performed showing the combined effects of HCG, clomiphene citrate, and tamoxifen in returning HPGA functioning to normal. Long-term follow-up on these patients returning to normal will be necessary to ensure permanent reversal of hypogonadotropic hypogonadal conditions. In addition, studies documenting dose-response curves for pituitary inhibition and reversal due to AAS administration are critical in determining the correct dose, duration, and form of treatment that is optimal without causing permanent damage. When the need for long-term androgen use presents, using moderately supraphysiologic doses of androgens as suggested by Strawford and colleagues (1999) coupled with post-treatment HPGA restoration as demonstrated here, may be a more effective means over high-dose protocols used to offset negative alterations in lean body mass. Unfortunately current studies have yet to adequately address a standard of patient care post-androgen therapy. Because of the negative impact of the hypogonadal state on physical and mental well- being, pharmacotherapy that restores HPGA function more rapidly than current modalities would greatly benefit men with hypogonadotropic hypogonadism.
While we believe that the treatment protocol was effective in returning normal hormonal function to these men, the lack of randomization or a control group leaves room for speculation. Although cases of spontaneous return to eugonadism with no medicinal intervention have been published, these reports documented durations anywhere from 6-18 months before normal hormone status was achieved (Gazvani et al, 1997; Wu et al, 1996). If the alternative treatment modality described herein can reverse suppressed gonadotropin production and AAS associated side effects much sooner than non-treatment, further evaluation of this therapy should continue.


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Alexander GM, Swerdloff RS, Wang C, Davidson T, McDonald V, Steiner B, Hines M. April Androgen-behavior Correlations in Hypogonadal Men and Eugonadal Men. II. Cognitive Abilities. Hormones and Behavior. 1998; 33(2): 85-94.
Anderson FH, Francis RM, Faulkner K. Androgen Supplementation in Eugonadal Men with Osteoporosis: Effects of Six Months of Treatment on Bone Mineral Density and Cardiovascular Risk Factors. Bone. 1996 Feb; 18(2): 171-177.
Anderson FH, Francis RM, Peaston RT, Wastell HJ. Androgen Supplementation in Eugonadal Men With Osteoporosis: Effects of Six Months’ Treatment on Markers of Bone Formation and Resorption. Journal of Bone and Mineral Research. 1997 Mar;12(3): 472-478.
Bagatell CJ, Heiman JR, Matsumoto AM, Rivier JE, Bremner WJ. Metabolic and Behavioral Effects of High-Dose, Exogenous Testosterone in Healthy Men. Journal of Clinical Endocrinology and Metabolism. 1994 Aug; 79(2): 561-567.
Bagatell CJ, Matsumoto AM, Christensen RB, Rivier JE, Bremner WJ. Comparison of a gonadotropin releasing –hormone antagonist plus testosterone (T) versus T alone as potential male contraceptive regimens. Journal of Clinical Endocrinology and Metabolism. 1993 Aug; 77(2): 427-32.
Balagopal P, Rooyackers OE, Adey DB, Ades PA, Nair KS. Effects of Aging on In Vivo Synthesis of Skeletal Muscle Myosin Heavy-Chain and Sarcoplasmic Protein in Humans. American Journal of Physiology. 1997; 273 (4 pt 1): E790-800.
Baran DT, Bergfeld MA, Teitelbaum SL, Avioli LV. Effect of Testosterone Therapy on Bone Formation in an Osteoporotic Hypogonadal Male. Calcified Tissue Research. 1978 Dec; 26(2): 103-106.
Barrio R, de Luis D, Alonso M, Lamas A, Moreno JC. Induction of Puberty with Human Chorionic Gonadotropin and Follicle-Stimulating Hormone in Adolescent Males With Hypogonadotrophic Hypogonadism. Fertility and Sterility. 1999 Feb; 71(2): 244-248.
Bartsch G, Scheiber K. Tamoxifen Treatment in Oligozoospermia. European Urology. 1981; 7(5): 283-287.
Behre HM, Kliesch S, Leifke E, Link TM, Nieschlag E. Long-Term Effect of Testosterone Therapy on Bone Mineral Density in Hypogonadal Men. Journal of Clinical Endocrinology and Metabolism. 1997 Aug; 82(8): 2386- 2390.
Bhasin S, Storer TW, Berman N, Callegari C, Clevenger B, Phillips J, Bunnell TJ, Tricker R, Shirazi A, Casaburi R. The Effects of Supraphysiologic Doses of Testosterone on Muscle Size and Strength in Normal Men. New England Journal of Medicine. 1996 July 4; 335: 1-7.
Bhasin S, Storer TW, Berman N, Yarasheski KE, Clevenger B, Phillips J, Lee WP, Bunnell TJ, Casaburi R. Testosterone Replacement Increases Fat-Free Mass and Muscle Size in Hypogonadal Men. Journal of Clinical Endocrinology and Metabolism. 1997; 82(2): 407-413.
Bhasin S, Storer TW, Javanbakht M, Berman N, Yarasheski KE, Phillips J, Dike M, Sinha-Hikim I, Shen R, Hays RD, Beall G. Testosterone Replacement and Resistance Exercise in HIV-Infected Men With Weight Loss and Low Testosterone Levels. JAMA. 2000 Feb 9; 283(6): 763-770.
Bijlsma JWJ, Duursma SA, Thijssen JHH, Huber O. Influence of Nandrolondecanoate on the Pituitary-Gonadal Axis in Males. Acta Endocrinologica. 1982 Sep; 101: 108-112.
Bjork JT, Varma RR, Borkowf HI. Clomiphene Citrate Therapy in a Patient with Laennec’s Cirrhosis. Gastroenterology. 1977 Jun; 72(6): 1308-1311.
Bonkovsky HL, Singh RH, Jafri IH, Fiellin DA, Smith GS, Simon D, Cotsonis GA, Slaker DP. A Randomized, Controlled Trial of Treatment of Alcoholic Hepatitis with Parental Nutrition and Oxandrolone. II. Short-term Effects on Nitrogen Metabolism, Metabolic Balance, and Nutrition. American Journal of Gastroenterology. 1991 Sep; 86(9): 1209-1218.
Boyadjiev NP, Georgieva KN, Massaldjieva RI, Gueorguiev SI. Reversible Hypogonadism and Azoospermia as a Result of Anabolic-Androgenic Steroid Use in a Body Builder With Personality Disorder. A Case Report. Journal of Sports Medicine and Physical Fitness. 2000 Sep; 40(3): 271-274.
Burge MR, Lanzi RA, Skarda ST, Eaton RP. Idiopathic Hypogonadotropic Hypogonadism in a Male Runner is Reversed by Clomiphene Citrate. Fertility and Sterility. 1997 April; 67(4): 783-785.
Burgess S, Calderon MD. Subcutaneous Self-Administration of Highly Purified Follicle Stimulating Hormone and Human Chorionic Gonadotrophin for the Treatment of Male

P

[tex]

great read. thanks for posting it.

[WORLD]

That was a great journal, thanks.

In this study they used clomid, nolva and hcg simultanueously. In their one study, they used males who had just come off of AAS and presented LH levels below normal range, much like my own. After administration levels increased back to normal. What I didnt like is that they ended it off saying that long term studies on control groups haven't been studied and they cant conclude if this is a long term solution rather than a temporary fix.

Nonetheless, the doses administered were:

HCG @ 2500 every other day for 16 days
Nolva at 20mg/day
Clomid at 50mg/day


Gustavs recommendation is very similar, other than the fact that he doesn't include Nolva, and he threw in an AI.

Wk 1- HCG 1000iu x 2 (ie. mon, thurs), Aromasin 25mg/day
Wk 2- HCG 1000iu x 2 (ie. mon, thurs), Aromasin 25mg/day
Wk 3- HCG 500iu x 2 (ie. mon, thurs), Aromasin 25mg/day
Wk 4- Clomid 100mg/day, Aromasin 25mg/day
Wk 5- Clomid 50mg/day, Aromasin 25mg/day
Wk 6- Clomid 50mg/day, Aromasin 25mg/day
Wk 7/8- Aromasin 25mg/day

What I found interesting, and reassuring at the same time is that the journal stated it can take up to years to recover your HTPA if you let it do it on its own. I shouldn't be scared that something is wrong with me, but rather glad to know that I simply went upon my recovery in the wrong way.

[Praetorian]

That was a great journal, thanks.

In this study they used clomid, nolva and hcg simultanueously. In their one study, they used males who had just come off of AAS and presented LH levels below normal range, much like my own. After administration levels increased back to normal. What I didnt like is that they ended it off saying that long term studies on control groups haven't been studied and they cant conclude if this is a long term solution rather than a temporary fix.

Nonetheless, the doses administered were:

HCG @ 2500 every other day for 16 days
Nolva at 20mg/day
Clomid at 50mg/day


Gustavs recommendation is very similar, other than the fact that he doesn't include Nolva, and he threw in an AI.

Wk 1- HCG 1000iu x 2 (ie. mon, thurs), Aromasin 25mg/day
Wk 2- HCG 1000iu x 2 (ie. mon, thurs), Aromasin 25mg/day
Wk 3- HCG 500iu x 2 (ie. mon, thurs), Aromasin 25mg/day
Wk 4- Clomid 100mg/day, Aromasin 25mg/day
Wk 5- Clomid 50mg/day, Aromasin 25mg/day
Wk 6- Clomid 50mg/day, Aromasin 25mg/day
Wk 7/8- Aromasin 25mg/day

What I found interesting, and reassuring at the same time is that the journal stated it can take up to years to recover your HTPA if you let it do it on its own. I shouldn't be scared that something is wrong with me, but rather glad to know that I simply went upon my recovery in the wrong way.


What you need to realize is that you can recover if you approach PCT correctly. As well 1000iu twice per week may not be enough HCG to effectively stimulate the leydig cells. This is all individualistic so you can start low and go from there...as the study indicates 300ng/dL is indicative of leydig stimulation from HCG so until you reach that level youll need to gradually increase the HCG dosage. Aromasin can be used in place of nolvadex as it is acting to control estrogen...a high estrogen environment will not allow recovery which is why many people who use HCG without an anti e or nolvadex concurrently have trouble recovering.
Good luck!
P

[nitrous]

Correct me if I'm wrong, but won't HCG shut down his LH even more? I understand that this PCT protocol would be great for unresponsive testes, but as far as I understand, the problem here is further down the loop; LH

couldnt the HCG even cause the leydig receptors to desensitize so that after you come off the HCG it would be less responsive to your own natural secretion of LH?

[Praetorian]

couldnt the HCG even cause the leydig receptors to desensitize so that after you come off the HCG it would be less responsive to your own natural secretion of LH?

No, HCG mimics LH thus if the leydig cells are responding to HCG then in other words they are responding to LH.
P

[nitrous]

No, HCG mimics LH thus if the leydig cells are responding to HCG then in other words they are responding to LH.
P

but dont they respond more to HCG than they do to LH? as HCG is stronger.. causing the receptors to desensitize?

[Praetorian]

but dont they respond more to HCG than they do to LH? as HCG is stronger.. causing the receptors to desensitize?

If the leydig cells are responding why would they stop. The endocrine system works in feedback loops...desentization comes from lack of use not overstimulation. If they become desensitized then HCG is required...the dosage obviously varies...but once responding they continue to do so...did you read the entire study? Many people misinterpret desensitization with HCG overstimulation and think HCG is the culprit. There are studies to prove this isnt the case including this one.
P

[nitrous]

If the leydig cells are responding why would they stop. The endocrine system works in feedback loops...desentization comes from lack of use not overstimulation. If they become desensitized then HCG is required...the dosage obviously varies...but once responding they continue to do so...did you read the entire study? Many people misinterpret desensitization with HCG overstimulation and think HCG is the culprit. There are studies to prove this isnt the case including this one.
P

well wouldnt HCG be stimulating the receptors.. so just like clen or any other stimulate stimulates receptors they become tollerate and that is why you need to cycle them..

i dont know there are many articles and arguements i have heard from both.. personally i do not know the definitive answer..


one thing that does seem to make sense would be to take it in the middle of a 10 week cycle so that the testes dont become completely shut down throughout and then during pct to just use a normal anti-e and ai.. but that is really just another option that i have read

[Praetorian]

well wouldnt HCG be stimulating the receptors.. so just like clen or any other stimulate stimulates receptors they become tollerate and that is why you need to cycle them..

i dont know there are many articles and arguements i have heard from both.. personally i do not know the definitive answer..


one thing that does seem to make sense would be to take it in the middle of a 10 week cycle so that the testes dont become completely shut down throughout and then during pct to just use a normal anti-e and ai.. but that is really just another option that i have read

HCG is not a stimulant and doesnt act as one so you cannot transfer what stimulant do to HCG. Clen is also not a stimulant it is a specific beta 2 agonist big difference. You dont cycle HCG...it is used for a specific purpose. You can use small amounts throughout the cycle ie 500iu twice per week to avoid total desentization yes but depending on the cycle length, age of user, types of aas used recovery can be still quite difficult and long without HCG during PCT.
Using HCG during PCT is the proper way to do things if you are looking to retain all your hard gains and recover ASAP...if not you can just let nature take its course...up to you.
P

[nitrous]

HCG is not a stimulant and doesnt act as one so you cannot transfer what stimulant do to HCG. Clen is also not a stimulant it is a specific beta 2 agonist big difference. You dont cycle HCG...it is used for a specific purpose. You can use small amounts throughout the cycle ie 500iu twice per week to avoid total desentization yes but depending on the cycle length, age of user, types of aas used recovery can be still quite difficult and long without HCG during PCT.
Using HCG during PCT is the proper way to do things if you are looking to retain all your hard gains and recover ASAP...if not you can just let nature take its course...up to you.
P

ah now that i read that you are correct about clen.. i knew that but forgot it works differently.. always learnin.. .thanks

[Lukin2grow]

"HCG is not a stimulant and doesnt act as one so you cannot transfer what stimulant do to HCG. Clen is also not a stimulant it is a specific beta 2 agonist big difference. You dont cycle HCG...it is used for a specific purpose. You can use small amounts throughout the cycle ie 500iu twice per week to avoid total desentization yes but depending on the cycle length, age of user, types of aas used recovery can be still quite difficult and long without HCG during PCT.
Using HCG during PCT is the proper way to do things if you are looking to retain all your hard gains and recover ASAP...if not you can just let nature take its course...up to you.
"

Jesus Murphy...Now I'm getting even MORE confused. Every other reference source I seem to read out there agree with during cycle use of HCG, but NEVER during PCT because they claim it's counterproductive to your own body recovering. Now you're saying to use it along with PCT? What's your research behind this? I do understand that the very long study you referenced used the HCG for the first couple of weeks, but this was in individuals obviously far past their cycles and suffering from a lack of recovery that had been extended. So using the HCG during the last part of your cycle is supposed to obviate the necessity of an almost 40% longer PCT.

If you DO use it during your cycle, say the last month or so and your boys are up to completely normal size, is it not best to use Clomid/Nolva + Aromasin for the next month or so?

Thanks for the info..your answers are well presented with accompanying research. It'll be nice to finally clarify the ideal procedures.

[big_luse]

"HCG is not a stimulant and doesnt act as one so you cannot transfer what stimulant do to HCG. Clen is also not a stimulant it is a specific beta 2 agonist big difference. You dont cycle HCG...it is used for a specific purpose. You can use small amounts throughout the cycle ie 500iu twice per week to avoid total desentization yes but depending on the cycle length, age of user, types of aas used recovery can be still quite difficult and long without HCG during PCT.
Using HCG during PCT is the proper way to do things if you are looking to retain all your hard gains and recover ASAP...if not you can just let nature take its course...up to you.
"

Jesus Murphy...Now I'm getting even MORE confused. Every other reference source I seem to read out there agree with during cycle use of HCG, but NEVER during PCT because they claim it's counterproductive to your own body recovering. Now you're saying to use it along with PCT? What's your research behind this? I do understand that the very long study you referenced used the HCG for the first couple of weeks, but this was in individuals obviously far past their cycles and suffering from a lack of recovery that had been extended. So using the HCG during the last part of your cycle is supposed to obviate the necessity of an almost 40% longer PCT.

If you DO use it during your cycle, say the last month or so and your boys are up to completely normal size, is it not best to use Clomid/Nolva + Aromasin for the next month or so?

Thanks for the info..your answers are well presented with accompanying research. It'll be nice to finally clarify the ideal procedures.

Theres nothing wrong with HCG post cycle - just ensure that you use a SERM following it because your testes will be primed and ready to respond to gonadtropins. Clomid/nolva will get your pituitary spitting out gonadtropins quicker which will ultimatley make for a smoother transition off.

[gustavo77]

That was a great journal, thanks.

In this study they used clomid, nolva and hcg simultanueously. In their one study, they used males who had just come off of AAS and presented LH levels below normal range, much like my own. After administration levels increased back to normal. What I didnt like is that they ended it off saying that long term studies on control groups haven't been studied and they cant conclude if this is a long term solution rather than a temporary fix.

Nonetheless, the doses administered were:

HCG @ 2500 every other day for 16 days
Nolva at 20mg/day
Clomid at 50mg/day


HCG causes peak output of the testes within 72hrs, taking doses more frequently than that can cause over-stimulation of testes.

Next, i can never understand why people use HCG and a SERM together. SERM use (nolva/clomid) in pct is to stimulate LH production....this will not happen while using HCG. HCG will suppress natural LH..so using nolva or clomid while using HCG is a waste IMO. An AI however, is a much different story. Keeping estrogen levels down around normal range is essential in PCT. With HCG use, surging LH levels from SERM use in PCT, estrogen levels can get pretty high and make recovery that much more difficult. In addition, Aromasin (and other A.I.'s, ie letro, adex) have been shown in clinical studies to increase testosterone levels in males.

[gustavo77]

By the way, there is some great discussion in this thread. Let's keep this going...

[WORLD]

By the way, there is some great discussion in this thread. Let's keep this going...

Absolutely and I appreciate every post.

[Seth]

I read somewhere that too much HCG can actually damage the leydig cells. Anyone has more info?

[Praetorian]

"HCG is not a stimulant and doesnt act as one so you cannot transfer what stimulant do to HCG. Clen is also not a stimulant it is a specific beta 2 agonist big difference. You dont cycle HCG...it is used for a specific purpose. You can use small amounts throughout the cycle ie 500iu twice per week to avoid total desentization yes but depending on the cycle length, age of user, types of aas used recovery can be still quite difficult and long without HCG during PCT.
Using HCG during PCT is the proper way to do things if you are looking to retain all your hard gains and recover ASAP...if not you can just let nature take its course...up to you.
"

Jesus Murphy...Now I'm getting even MORE confused. Every other reference source I seem to read out there agree with during cycle use of HCG, but NEVER during PCT because they claim it's counterproductive to your own body recovering. Now you're saying to use it along with PCT? What's your research behind this? I do understand that the very long study you referenced used the HCG for the first couple of weeks, but this was in individuals obviously far past their cycles and suffering from a lack of recovery that had been extended. So using the HCG during the last part of your cycle is supposed to obviate the necessity of an almost 40% longer PCT.

If you DO use it during your cycle, say the last month or so and your boys are up to completely normal size, is it not best to use Clomid/Nolva + Aromasin for the next month or so?

Thanks for the info..your answers are well presented with accompanying research. It'll be nice to finally clarify the ideal procedures.

Please read the entire study I posted..it will clear things up for you.
P

[Lukin2grow]

Praetorian Wrote:

Please read the entire study I posted..it will clear things up for you.
P

I did re-read it but like I said, they had to use HCG and then discontinue it while still doing many more weeks of the Clomid & Nolva. If their testicles were already working properly by using HCG during the end of a cycle, this would mean it would be unnecessary during PCT, no?

As gustavo77 said above and is exactly what I was referencing at first


Next, i can never understand why people use HCG and a SERM together. SERM use (nolva/clomid) in pct is to stimulate LH production....this will not happen while using HCG. HCG will suppress natural LH..so using nolva or clomid while using HCG is a waste IMO. An AI however, is a much different story. Keeping estrogen levels down around normal range is essential in PCT. With HCG use, surging LH levels from SERM use in PCT, estrogen levels can get pretty high and make recovery that much more difficult. In addition, Aromasin (and other A.I.'s, ie letro, adex) have been shown in clinical studies to increase testosterone levels in males.

So what am I missing here?

[Praetorian]

HCG causes peak output of the testes within 72hrs, taking doses more frequently than that can cause over-stimulation of testes.

Next, i can never understand why people use HCG and a SERM together. SERM use (nolva/clomid) in pct is to stimulate LH production....this will not happen while using HCG. HCG will suppress natural LH..so using nolva or clomid while using HCG is a waste IMO. An AI however, is a much different story. Keeping estrogen levels down around normal range is essential in PCT. With HCG use, surging LH levels from SERM use in PCT, estrogen levels can get pretty high and make recovery that much more difficult. In addition, Aromasin (and other A.I.'s, ie letro, adex) have been shown in clinical studies to increase testosterone levels in males.

You are quite correct in the combination of HCG and (nolva/clomid) taken together. I must point out however that some studies involving these compounds such as the one posted earlier have the same goals but are using different items for different purposes. As an example aromasin is not used here most likely because at the time it was not available. Nolva was used but it wasnt used purposefully to stimulate LH but to control estrogen ie the same basic outcome as aromasin but by a different route and mechanism. I also agree clomid with HCG is somewhat of a waste my normal protocol would be HCG first with aromasin and once the leydig cells are functioning HCG is discontinued and clomid is used as it does act on the hypothalmus and pituitary. Aromasin is continued at this time to control estrogen as you mentioned a high estro environment does prevent recovery.
to have adequate recovery quickly there are several things that need to happen:
1. significant leydig cell stimulation-HCG
2. estrogen control-aromasin/arimidex/nolvadex
3. action upon hypoythalmus and pituitary-clomid not nolvadex
4. a low blood androgen level-discontinued aas usage

P

[Praetorian]

Praetorian Wrote:


I did re-read it but like I said, they had to use HCG and then discontinue it while still doing many more weeks of the Clomid & Nolva. If their testicles were already working properly by using HCG during the end of a cycle, this would mean it would be unnecessary during PCT, no? CAPS ARE USED TO SEPARATE MY COMMENTS -NOT SHOUTING-YOU MAY BE CONFUSED BECAUSE YOU ARE ASSUMING NOLVA AND CLOMID ARE BEING USED FOR THE SAME PURPOSE BUT THEY MAY NOT BE. YES NOLVA DOES ILLICIT LH PRODUCTION BUT IT IS USED HERE PRIMARILY FOR ESTRO CONTROL...AROMASIN HOWEVER IS A BETTER CHOICE AND CAN BE USED INSTEAD. CLOMID IS USED NOT FOR ESTRO CONTROL BUT FOR ACTION ON THE HYPOTHALMUS AND PITUITARY. HCG IS USED TO SENSITIZE THE TESTES TO LH. EACH ITEM HAS A SPECIFIC PURPOSE BUT ARE SOMETIMES USED DIFFERENTLY DEPENDING ON THE PROTOCOL USED AND THE SPECIFC ACTIONS DESIRED.
P

As gustavo77 said above and is exactly what I was referencing at first


So what am I missing here?

...

[Lukin2grow]

I also agree clomid with HCG is somewhat of a waste my normal protocol would be HCG first with aromasin and once the leydig cells are functioning HCG is discontinued and clomid is used as it does act on the hypothalmus and pituitary.

Not sure if you read my other thread yet, but part of the info I posted also supports Nolvadex as acting on the hypothalamus and pituitary and in fact was deemed somewhat superior:

"Pituitary Sensitivity to GnRH

But something more interesting is happening. Researchers were also conducting GnRH stimulation tests before and after various points of treatment with Nolvadex and Clomid, and the two drugs had markedly different results. These tests involved infusing patients with 100mcg of GnRH and measuring the output of pituitary LH in response.

The focus of this test is to see how sensitive the pituitary is to Gonadotropin Releasing Hormone. The more sensitive the pituitary, the more LH will be released. The tests showed that after ten days of treatment with Nolvadex, pituitary sensitivity to GnRH increased slightly compared to pre-treated values. This is contrast to 10 days of treatment with 150mg Clomid, which was shown to consistently DECREASE pituitary sensitivity to GnRH (more LH was released before treatment).

As the study with Nolvadex progresses to 6 weeks, pituitary sensitivity to GnRH was significantly higher than pre-treated or 10-day levels. At this point the same 20mg dosage was also raising testosterone and LH levels to an average of 183% and 172% of base values, respectively, which again is measurably higher than what was noted 10 days into therapy. Within 10 days of treatment Clomid is already exerting an effect that is causing the pituitary to become slightly desensitized to GnRH, while prolonged use of Nolvadex serves only to increase pituitary sensitivity to this hormone. That is not to say Clomid won't increase testosterone if taken for the same 6 week time period. Quite the opposite is true. But we are, however, noticing an advantage in Nolvadex. "

[Praetorian]

Not sure if you read my other thread yet, but part of the info I posted also supports Nolvadex as acting on the hypothalamus and pituitary and in fact was deemed somewhat superior:

"Pituitary Sensitivity to GnRH

But something more interesting is happening. Researchers were also conducting GnRH stimulation tests before and after various points of treatment with Nolvadex and Clomid, and the two drugs had markedly different results. These tests involved infusing patients with 100mcg of GnRH and measuring the output of pituitary LH in response.

The focus of this test is to see how sensitive the pituitary is to Gonadotropin Releasing Hormone. The more sensitive the pituitary, the more LH will be released. The tests showed that after ten days of treatment with Nolvadex, pituitary sensitivity to GnRH increased slightly compared to pre-treated values. This is contrast to 10 days of treatment with 150mg Clomid, which was shown to consistently DECREASE pituitary sensitivity to GnRH (more LH was released before treatment).

As the study with Nolvadex progresses to 6 weeks, pituitary sensitivity to GnRH was significantly higher than pre-treated or 10-day levels. At this point the same 20mg dosage was also raising testosterone and LH levels to an average of 183% and 172% of base values, respectively, which again is measurably higher than what was noted 10 days into therapy. Within 10 days of treatment Clomid is already exerting an effect that is causing the pituitary to become slightly desensitized to GnRH, while prolonged use of Nolvadex serves only to increase pituitary sensitivity to this hormone. That is not to say Clomid won't increase testosterone if taken for the same 6 week time period. Quite the opposite is true. But we are, however, noticing an advantage in Nolvadex. "

This is exactly my point and the very reason why some people feel nolva is superior to clomid. Why...because of the estrogen control nolva illicts at the same time so in essence more LH production. Try this...do the exact same thing as in the study but use aromasin in conjunction with clomid and see what happens.
P

[Lukin2grow]

Ok..I dmit I'm a little confused...but I'm going to have all 4 products anyway...so in your opinion, tell me what you think I should do Ideally. I'll be finishing a 20 week cycle (mainly test and EQ). When to begin HCG and dose and days?

Then I'll use Clomid and Aromasin for: ??

I have Nolvadex..are you suggesting if anything I use it solely as an AI during my cycle if needed?

Truly appreciate your advice. ;)

[WORLD]

What you need to realize is that you can recover if you approach PCT correctly. As well 1000iu twice per week may not be enough HCG to effectively stimulate the leydig cells. This is all individualistic so you can start low and go from there...as the study indicates 300ng/dL is indicative of leydig stimulation from HCG so until you reach that level youll need to gradually increase the HCG dosage. Aromasin can be used in place of nolvadex as it is acting to control estrogen...a high estrogen environment will not allow recovery which is why many people who use HCG without an anti e or nolvadex concurrently have trouble recovering.
Good luck!
P


What you're suggesting is to increase the dosage of hcg in order to achieve sufficient stimulation. What would you recommend as far as dosages go and for how long. I underdstand your point, but I'm not clear as to how much you suggest increasing, and when. We can use gustav's protocal as a template, if you like.

[gustavo77]

Ok..I dmit I'm a little confused...but I'm going to have all 4 products anyway...so in your opinion, tell me what you think I should do Ideally. I'll be finishing a 20 week cycle (mainly test and EQ). When to begin HCG and dose and days?

Then I'll use Clomid and Aromasin for: ??

I have Nolvadex..are you suggesting if anything I use it solely as an AI during my cycle if needed?

Truly appreciate your advice. ;)

Nolva cannot be used as an AI because it is a SERM (selective estrogen receptor modulator)...meaning IT DOES NOT REDUCE ESTROGEN, it binds to specific (not all) estrogen receptors and prevents estrogen from binding.

Start HCG immediately...HCG is best used on cycle from the start, right up till 4-5 days before you start pct. I recommend at least 1000iu of HCG, 2x per for at least 3 weeks with aromasin. Wait 4-5 days after your last shot of HCG and start the following:

Wk 1-3 Clomid 100mg/day
Wk 1-5 Aromasin 25mg/day

[Lukin2grow]

"Nolva cannot be used as an AI because it is a SERM (selective estrogen receptor modulator)...meaning IT DOES NOT REDUCE ESTROGEN, it binds to specific (not all) estrogen receptors and prevents estrogen from binding. "

Sorry..I knew that..I shouldn't have said an AI, I just meant something to prevent estrogen related problems during the cycle like gyno. Supposedly Nolvadex is a good choice for progestone producing steroids like Deca instead of an AI for example..


"Start HCG immediately...HCG is best used on cycle from the start, right up till 4-5 days before you start pct. I recommend at least 1000iu of HCG, 2x per for at least 3 weeks with aromasin. "

Good God! I'm not on a cycle yet, but I was planning on a 20 week one this time...Surely I could reduce it to the last 6 weeks or so? I've got 2 bottles coming so I believe that's 10,000 IU's...


Wait 4-5 days after your last shot of HCG and start the following:

Wk 1-3 Clomid 100mg/day
Wk 1-5 Aromasin 25mg/day

Ah ok..so you do recommend the Aromasin instead of the Nolva for PCT. Cool.

So referring to the other question I asked about incorrectly...Is Nolva ok to use through the cycle if gyno issues come up? I've done 3 cycles although they were years ago now and I was always lucky. Even with test 500 mg a week and Deca I never seemed prone to gyno or any bad androgenic effects either, but who knows if that would change with time? Better for me to have options on hand just in case..

[gustavo77]

Sorry..I knew that..I shouldn't have said an AI, I just meant something to prevent estrogen related problems during the cycle like gyno. Supposedly Nolvadex is a good choice for progestone producing steroids like Deca instead of an AI for example..



Good God! I'm not on a cycle yet, but I was planning on a 20 week one this time...Surely I could reduce it to the last 6 weeks or so? I've got 2 bottles coming so I believe that's 10,000 IU's...



Ah ok..so you do recommend the Aromasin instead of the Nolva for PCT. Cool.

So referring to the other question I asked about incorrectly...Is Nolva ok to use through the cycle if gyno issues come up? I've done 3 cycles although they were years ago now and I was always lucky. Even with test 500 mg a week and Deca I never seemed prone to gyno or any bad androgenic effects either, but who knows if that would change with time? Better for me to have options on hand just in case..


Firstly, Nolva should NEVER be used for progesterone/prolactin issues. It can increase progesterone!!

Surely..i would not wait till the last six weeks of the cycle to use HCG, your testes will be shut down hard by then. Prevention is the key here, use HCG from the start then your boyz never shut down on cycle...in fact your testes will continue to produce small amounts of test on cycle if you use HCG.

Nolva is effective for the treatment of gyno...as for the other estrogen related sides: increased SHBG, water retention, fat accumulation, nolva is very ineffective at treating these issues. Remember nolva is a SERM, SELECTIVE estrogen receptor modulator....it will not target all estrogen receptors only "selective" ones...If a person is sensitive to estrogen, then they should use an AI, not a SERM, period.

[Lukin2grow]

Firstly, Nolva should NEVER be used for progesterone/prolactin issues. It can increase progesterone!!

I have heard this and then I heard almost the opposite saying it was the ideal one to use if you were having bad sides from those types. I don't plan on using Deca or any along that line anyways so I won't worry about it this time. I'll have to do some serious searching on this one and see what I can find...obviously one side is pushing the wrong information.


Surely..i would not wait till the last six weeks of the cycle to use HCG, your testes will be shut down hard by then. Prevention is the key here, use HCG from the start then your boyz never shut down on cycle...in fact your testes will continue to produce small amounts of test on cycle if you use HCG.

Ok, maybe I'll modify this to a 16 week cycle..I should have enough HCG to do it properly.


Nolva is effective for the treatment of gyno...as for the other estrogen related sides: increased SHBG, water retention, fat accumulation, nolva is very ineffective at treating these issues. Remember nolva is a SERM, SELECTIVE estrogen receptor modulator....it will not target all estrogen receptors only "selective" ones...If a person is sensitive to estrogen, then they should use an AI, not a SERM, period.


So during a cycle of 500 mgs/wk test cyp and 500 mgs EQ, (plus the HCG injects), and Aromasin (if needed) during the cycle for estrogen related issues. Thanks very much for the info!

[Praetorian]

500 test and 500 EQ will result in very little estrogen conversion...I dont see the need for aromasin with this unless you already have an existing gyno condition. Having it on hand is good just in case...but avoid using it unless absolutely necessary.
IMO a good PCT protocol would be:

500iu HCG twice weekly during the cycle
Aromasin on hand, used only if required
2 weeks after last test inject 2000iu HCG ETD for a total of 5 shots (10,000iu)
clomid 100mg ED for two weeks following the cessation of HCG
aromasin 12.5mg ED concurrently with HCG and clomid and continued 4-6 weeks post clomid.
P

[WORLD]

I have heard this and then I heard almost the opposite saying it was the ideal one to use if you were having bad sides from those types. I don't plan on using Deca or any along that line anyways so I won't worry about it this time. I'll have to do some serious searching on this one and see what I can find...obviously one side is pushing the wrong information.



Ok, maybe I'll modify this to a 16 week cycle..I should have enough HCG to do it properly.




So during a cycle of 500 mgs/wk test cyp and 500 mgs EQ, (plus the HCG injects), and Aromasin (if needed) during the cycle for estrogen related issues. Thanks very much for the info!

Bro, contribute to my thread, please don't hi-jack it. Thanks for your prior input, though.

[Lukin2grow]

Bro, contribute to my thread, please don't hi-jack it. Thanks for your prior input, though.

Oops. Sorry WORLD. I got carried away.

[whofarzed]

Since you are planning to do a few more cycles you could do some hcg and another proper pct. However, you will not be 100% recovered, it can take years to get things back in order. If you are worried about the risks to your endocrine system then I think you should just stay off everything and with time hopefully things will get back to normal.

This is just my personal experience-- you can read all the studies you want.
I have been off for 2 years and still don't feel normal, and sex drive is still not what it once was. Every month I feel a little bit better but it is taking a very long time... who knows if things will ever be the same. (I only did 4 cycles, pretty much 1 a year, with all the proper precautions (pct, hcg even tried to control prolactin in the last one). I was once like many on the boards, feeling like I was informed and could do everything right with the least amount of risk. However, you can't fool your body, it is always smarter than you.

And yes I have done bloodwork. Last one was in Sept. and my test was only in the normal range, however, my LH was abnormally high--(meaning my testes are not responding to LH as they should). Also, my testes are not back to their original size, and I am not sure they ever will be (according to my doc, it has been her experience that they don't fully recover-- from what she has seen). Also, 6 months is not that long to be off. I had bloodwork done 7 months after a different cycle and my test levels were abnormally high (but didn't feel right). I asked the doc about this, she thought that there might have been some exogenous hormones still in my body (as they stay in your lipids for a long time). Guys who think they are recovered after 6 months, just because they "feel" good or bloodwork looks normal might change their minds if they actually stayed off longer to find out. Also, I did try all these things, such as running a couple extra pct 6 months to a year after and even some hcg. All that did was make me feel good for a while then right back to where I started.

Just some thought. But I know personally if I could go back in time I would have only done short cycles with short esters that clear fast with lots of time in between cycles. Although the gains probably wouldn't have been as great, I think it would have been less risk to my endocrine system.