Restoring HPTA after years of steroid use

[Matsuo Munefusa]

DO NOT run HCG more than 3x week, its counterproductive.

5,000ius is also way too much. 1,500ius is the most I'd use and control E.

how do you control E with HCG when the testosterone is aromatizing in the testicles (i thought AIs didn't touch this).

 

[AnAboliKPiKe]

Your not going to restore the HPTA to endogenous function on Test Enan and Dbol.

You need to come off of them.

That dose of HCG is a joke as well. 1000-1,500ius 2x is plenty with Tamoxifen and Toremifene.

I cant help but think you've got this all back to front. If your on HRT, stay on the TE, drop the Dbol, control estrogen and run HCG at 1,500ius for 6-7 shots at 2-3x week, no more due to the refractory peroid of the leydig cells.

Then come OFF and run a SERM treatment, with an AI if your estrogen dominant.

Thanks for the advice Swifto. There is so much disagreement on how to properly run HCG to reverse hypogonadism. If you search through the literature you will find almost every dose and frequency of administration has been tried. To date, I have not found a study that has identified the most appropriate dose and frequency of administration. I was running 1,666iu 2x/week before I was told that was too much. I also read a study stating that any more than 500iu/day could lead to excess aromitization within the testes and reduced Leydig cell sensitivity. I'd really like a general consensus of what works for my particular situation. This is no post cycle after an 8-weeker of Test-E 500. This is working against years of almost continuous AAS use.

I'm off the Test-E and Dbol. Could you expound upon the refractory period of the Leydig cells?

You must have read my statement that I will be administering HCG @ 500iu/day as 5000iu/day. Never would I think it wise to use 5000iu of HCG daily.

 

[AnAboliKPiKe]

After my first 100mg dose of clomiphene yesterday after a week without it I had return of morning wood this morning. Crazy how quick that worked. I am also sticking by my new HCG protocol of 500iu/day. This article details why:

A.G.H. SMALS, G.F.F.M. PIETERS, G.H.J. BOERS, J.M.M. RAEMAKERS, A.R.M.M HERMUS, Th. J. BENRAAD, and P.W.C KLOPPENBORG
Differential Effect of Single High Dose and Divided small Dose Administration of Human Chorionic Gonadotropin on Leydig Cell Steroidogenic Desensitization
JCEM 1984 58: 327-331; doi:10.1210/jcem-58-2-327

 

[Dopamin]

In the article they used HCG on healthy males

i used also small doses of HCG,250 Units ed without success

now i will run it old school

2500IU 4 times with tamox and clomid like Dr Scully posted in his article

 

[Swifto]

how do you control E with HCG when the testosterone is aromatizing in the testicles (i thought AIs didn't touch this).

You can limit its effects with the use of Tamoxifen.

The increase in endogenous testosterone can be controlled with an AI.

Testicular estrogen with a SERM.

Thanks for the advice Swifto. There is so much disagreement on how to properly run HCG to reverse hypogonadism. If you search through the literature you will find almost every dose and frequency of administration has been tried. To date, I have not found a study that has identified the most appropriate dose and frequency of administration. I was running 1,666iu 2x/week before I was told that was too much. I also read a study stating that any more than 500iu/day could lead to excess aromitization within the testes and reduced Leydig cell sensitivity. I'd really like a general consensus of what works for my particular situation. This is no post cycle after an 8-weeker of Test-E 500. This is working against years of almost continuous AAS use.

I'm off the Test-E and Dbol. Could you expound upon the refractory period of the Leydig cells?

You must have read my statement that I will be administering HCG @ 500iu/day as 5000iu/day. Never would I think it wise to use 5000iu of HCG daily.

1,666ius 2x week is a good dose, I thought you were running 16,000ius split twice per week for some reason...

When you inject HCG it stimulates the leydig cells to spike endogenous testosterone twice. Once in a matter of hours, then the later LARGER spike 48 or so hours after. This is why we dont use HCG more than this time frame. We blunt or reduce the larger second spike in endo. T.

After my first 100mg dose of clomiphene yesterday after a week without it I had return of morning wood this morning. Crazy how quick that worked. I am also sticking by my new HCG protocol of 500iu/day. This article details why:

A.G.H. SMALS, G.F.F.M. PIETERS, G.H.J. BOERS, J.M.M. RAEMAKERS, A.R.M.M HERMUS, Th. J. BENRAAD, and P.W.C KLOPPENBORG
Differential Effect of Single High Dose and Divided small Dose Administration of Human Chorionic Gonadotropin on Leydig Cell Steroidogenic Desensitization
JCEM 1984 58: 327-331; doi:10.1210/jcem-58-2-327

Read above on leydig cell refraction.

 

[Swifto]

Gries JM, Munafo A, Porchet HC, Verotta

D. Down-regulation models and modeling of testosterone production induced by recombinant human choriogonadotropin.

J Pharmacol Exp Ther 1999;289(1):371-7. Down-Regulation Models and Modeling of Testosterone Production Induced by Recombinant Human Choriogonadotropin

Chorionic gonadotropin (CG) is a glycoprotein hormone , whose action is mediated by the luteinizing hormone/CG receptor. Testosterone concentrations from six pituitary-desensitized, healthy male volunteers were obtained after four different administrations of recombinant-human CG (rhCG). We present a modeling study to provide a possible explanation for the observations that increased exposure to rhCG induces higher and then lower testosterone concentrations and that marked rebound effects are observed at the end of repeated administration of rhCG. We used semimechanistic models (in which flexible functions represent unknown parts of the models) to identify the relationship of rhCG concentrations to the testosterone levels . Based on the results obtained with the semimechanistic models, different mechanistic down-regulation models were devised and tested. The final model uses a one-compartment model to describe the endogenous production rate of testosterone; rhCG affects the production rate with a mechanism consistent with a two-site binding site, with effect proportional to one-site bound concentration. The modeling results indicate that when rhCG concentration increases, the testosterone production rate increases to 45 times the baseline value. However, at an rhCG concentration of more than about 30 IU/liter, the production rate decreases. Simulations showed that both dose and dosing interval profoundly influence testosterone response to rhCG.

 

[Swifto]

Acute responses of Ley dig cells to hCG : evidence for early hypertrophy of Leydig cells

Yvonne M. Hodgsona and D.M. De Kretsera

aDepartment of Anatomy, Monash University, Clayton, Victoria 3168 Australia
Received 15 August 1983; accepted 29 December 1983. Available online 10 January 2003.
Abstract
The cross-sectional area of Leydig cells has been studied in rats following a single injection of 100 IU hCG. Leydig cell size was not changed within 2 h of injection (89.73 ± 3.02 μm2) but had increased significantly by 12 h (114.76 ± 3.57 μm2). Leydig cell size continued to increase until 24 h when a maximum cross-sectional area of 186.30 ± 4.72 μm2 was measured. This area was significantly greater than that recorded after 1 week of daily hCG treatment (143.18 ± 6.25 μm2, P < 0.05). At 48 and 72 h Leydig cell size decreased slightly and was not significantly different from that seen after chronic hCG treatment.
A single injection of 100 IU hCG induced a biphasic serum testosterone response with peaks in serum testosterone at 2 h and 72 h, the intervening nadir suggesting a period of in vivo refractoriness. A corresponding period of Leydig cell refractoriness in vitro was also demonstrated 12 h following a single injection of 100 IU hCG and persisted for 48 h. Further injections of hCG on day 2 or 3 did not induce a second biphasic serum testosterone pattern or the accompanying period of refractoriness, indicating that Leydig cell refractoriness is a temporary phenomenon which cannot be maintained during persistent stimulation with hCG. The absence of further refractory periods to hCG during recurrent stimulation may be related to the trophic action of the hormone on Leydig cells.
Keywords: Leydig cells; hCG; hypertrophy; testosterone; refractoriness

Leydig cell refraction.

 

[AnAboliKPiKe]

Swifto,

Are you suggesting I return to my original HCG protocol of 1,666IU 2x/week? Would that be more beneficial than 500IU qd?

 

[sculptone82]

Refrac Period

Yes that is exactly what he is saying.

Every 4th day sounds about right. Feeling a little better by now?

Good luck bro.

 

[petersouth]

@petersouth
What research do you have to validate your claim that I am running clomiphene too high? If you review the literature I cited you will find numerous studies utilizing 100mg clomiphene/day. I do need to decide if I want to continue running it @ 100mg/day or drop down to 50mg/day.

@Simpllyhuge
Yes I just took my last shot of 100mg Test-E on Thursday. I will be dropping down to 50mg Test-E for the next few weeks, then 25mg/week, then off completely.
What protocol did you use to restore HPTA function after your years of AAS usage? How do I know that if I quit HCG/HMG now that my gonads have fully recovered? The literature I have cited uses both for extended periods of time to successfully overcome hypogonadism.

You're blowing your balls off with that dose man. Any doctor will tell you that.

I'm basing this on what is prescribed for HRT with clomid. Nothing over 25mg per day. Everybody uses too much clomid that's why there are side effects.

I think there is too much research and not enough common sense. Too much HCG as well, doses are too high.

And all that other shit you are running...time for wake up call. That "more is better" thinking is how you got messed up in the first place.

 

[MaineGuy]

You're blowing your balls off with that dose man. Any doctor will tell you that.

I'm basing this on what is prescribed for HRT with clomid. Nothing over 25mg per day. Everybody uses too much clomid.

I think there is too much research and not enough common sense. Too much HCG as well, doses are too high.

And all that other shit you are running...time for wake up call.

Many people on here run the first week of Clomid at 100, then drop to 50 starting second week. This is what I did, did not notice any sides. This protocol has actually been put out there by some doctors pertaining to steroid usage, will have to search for links later. Do you have any proof this protocal is not correct?

 

[petersouth]

Many people on here run the first week of Clomid at 100, then drop to 50 starting second week. This is what I did, did not notice any sides. This protocol has actually been put out there by some doctors pertaining to steroid usage, will have to search for links later. Do you have any proof this protocal is not correct?

Look at the dosage here and the results.

Jeffrey Dach MD Bio-Identical Hormone Blog: Clomid For Men With Low Testosterone by Jeffrey Dach MD

Clomid is going to kick up E levels so there is no reason to take more.

 

[Simpllyhuge]

I bet most people don't react that fast to 25 mg of clomid. I didn't see how much adex was used?

 

[petersouth]

Here's another

Using Clomid For HRT = 980 Testosterone Level

"He told me that by taking clomid at a low dose of 15mg. every other day I can avoid the negative side effects."

 

[AnAboliKPiKe]

You're blowing your balls off with that dose man. Any doctor will tell you that.

I'm basing this on what is prescribed for HRT with clomid. Nothing over 25mg per day. Everybody uses too much clomid that's why there are side effects.

I think there is too much research and not enough common sense. Too much HCG as well, doses are too high.

And all that other shit you are running...time for wake up call. That "more is better" thinking is how you got messed up in the first place.

Point taken. What are some of the side effects? I feel great and don't feel any side effects that I notice. I'll do some more reading and decide when to drop the clomid dose.

What is your personal recommendation on HCG dosage? I have heard anything and everything argued tooth and nail by now. I'd like some proof of which is better over bro-science.

Besides the clomid and HCG I am running HMG, tamoxifen, and exemestane. You feel this is overkill? I don't. Common sense is great, but I really don't feel it trumps proven research.

 

[MaineGuy]

Look at the dosage here and the results.

Jeffrey Dach MD Bio-Identical Hormone Blog: Clomid For Men With Low Testosterone by Jeffrey Dach MD

Clomid is going to kick up E levels so there is no reason to take more.

Thanks for the link, gives me more info to research. One thing though, it does not give any advantages or disadvantages of higher doses. I did not read where a higher dosage is detramental to anything, or if it speeds up the process or not.

 

[Dopamin]

what do you think abaout the HPGA restoration protocoll of Dr Scully?



HPGA Normalization Protocol After Androgen Treatment
N Vergel, AL Hodge, MC Scally
Program for Wellness Restoration, PoWeR


Objective Results Discussion

To develop an approach to cycle androgens that would result in significant changes in body composition and accelerate the normalization of the hypothalamic pituitary gonadal axis (HPGA) after cessation of androgens.

Methods

An uncontrolled study of 19 HIV-negative eugonadal men, ages 23 – 57 years, administered testosterone cypionate and nandrolone decanoate for 12 weeks, and then were treated simultaneously with a combined regimen of human chorionic gonadotropin (hCG) (2500 IU/QODx16d), clomiphene citrate (50 mg PO BID x 30d) and tamoxifen (20 mg PO QD x 45d), to restore the HPGA.

Results

Mean FFM by DEXA increased from 64.1 to 69.8 kg (p<.001); percent body fat decreased from 23.6 to 20.9 (p<.01); strength increased significantly from 357.4 lb to 406.4 lb (p=.02). No significant changes in serum chemistries and liver function tests were found. HDL-C decreased from a mean value of 44.3 to 38.0 (p=.02). Mean values for luteinizing hormone (LH) and total testosterone (T) were 4.5 and 460, respectively prior to androgen treatment. At the conclusion of the 12-week treatment with androgens the mean LH <0.7 (p<.001) and total testosterone was 1568 (p<.001). The mean values after treatment with the combined regimen were LH=6.2 and testosterone=458.

Discussion

The use of androgens has been reported to improve lean body mass, strength, sexual function, and mood accompanied by side effects caused by continuous uninterrupted use of these compounds (polycythemia, testicular atrophy, hypertension, liver dysfunction [oral androgens] and alopecia.) Androgen-induced HPGA suppression causes a severe hypogonadal state in most patients that often require an extensive period of considerable duration for normalization. This prevents most if not all individuals from cycling off these medications due to the adverse impact of this state on their previously gained LBM and quality of life. The protocol of hCG-clomiphene-tamoxifen was successful in restoring the HPGA within 45 days after androgen cessation. Further controlled studies are needed to determine if these results can be duplicated in HIV positive subjects.


PRACTICAL APPLICATION

The esters used in the abstract were cypionate and deconate however the administration of the PCT medications were started the day after aas cessation. Essentially the aas esters were still active when PCT began. The first 16 days a large amount of HCG was used in order to increase the mass of the testes so that they could sustain output of testosterone sooner. The HCG was stopped about the time the esters cleared so that estrogenic activity from the HCG would be reduced. During those first 16 days 2 different SERM’s were also employed (Clomid and Nolvadex) This protocol is contrary to what is typically recommended in many forums but regardless the protocol was effective in all 19 men. This is a 100% success rate! After the HCG was discontinued both SERM’s were continued. The following is the exact protocol in laymen’s terms.

Day 1-16 : 2500iu HCG every other day.
Day 1-30 : Nolva 20mg/day; Clomid 100mg/day (50mg was taken twice per day)
Day 31-45 : Nolva 20mg/day



I now strongly believe that an AI should be used as long as there is an aromatizing compound being administered. In this case testosterone and HCG aromatize therefore using an AI until these meds clear is now what I am recommending. There is some evidence that adding Nolva to an AI does not increase the effectiveness of estro control therefore Nolva has no real advantage alongside an AI unless one is experiencing gyno. Additionally Nolva has been shown to reduce IGF-1 and GH levels. This is not a big deal on cycle as testosterone increases IGF-1 in a dose dependant relationship. However off cycle this is a problem. PCT is a fragile time and lower IGF-1 and GH levels is not desireable as I am sure you can appreciate. The last few days I have been relooking at AI's to find one that is specific to men that can be used on cycle and during PCT. It is my conclusion that Aromasin is the obvious choice.

Aromasin (Exemestane) is a Type-I aromatase inhibitor, or suicidal aromatase inhibitor. It’s called this because it lowers estrogen production in the body by attaching to the aromatase enzyme, and permanently deactivating it. (1)

Personally, I find this to be a very interesting mechanism of action when compared to type-II aromatase inhibitors, which bind competitively to the aromatase enzyme, and eventually unbind, rendering it active again. In the case of Aromasin, this doesn’t happen, and once it does its job on the enzyme, those particular enzymes will no longer function.

Because the enzyme is permanently deactivated there is no estrogen rebound with Aromasin. Estrogen rebound at this critical time during PCT is undesirable so using Arimidex would be inferior. Therefore I believe Aromasin is the AI of choice during PCT.

Reference:

1. A predictive model for exemestane pharmacokinetics/pharmacodynamics incorporating the effect of food and formulation.Br J Clin Pharmacol. 2005 Mar;59(3):355-64.


The following is a study done in men with Aromasin that shows significant effect on estrogen and testosterone;

Pharmacokinetics and Dose Finding of a Potent Aromatase Inhibitor, Aromasin (Exemestane), in Young Males

Suppression of estrogen, via estrogen receptor or aromatase blockade, is being investigated in the treatment of different conditions. Exemestane (Aromasin) is a potent and selective irreversible aromatase inhibitor. To characterize its suppression of estrogen and its pharmacokinetic (PK) properties in males, healthy eugonadal subjects (14–26 yr of age) were recruited. In a cross-over study, 12 were randomly assigned to 25 and 50 mg exemestane daily, orally, for 10 d with a 14-d washout period. Blood was withdrawn before and 24 h after the last dose of each treatment period. A PK study was performed (n = 10) using a 25-mg dose. Exemestane suppressed plasma estradiol comparably with either dose [25 mg, 38% (P 0.002); 50 mg, 32% (P 0.008)], with a reciprocal increase in testosterone concentrations (60% and 56%; P 0.003 for both). Plasma lipids and IGF-I concentrations were unaffected by treatment. The PK properties of the 25-mg dose showed the highest exemestane concentrations 1 h after administration, indicating rapid absorption. The terminal half-life was 8.9 h. Maximal estradiol suppression of 62 ± 14% was observed at 12 h. The drug was well tolerated. In conclusion, exemestane is a potent aromatase inhibitor in men and an alternative to the choice of available inhibitors. Long-term efficacy and safety will need further study.

 

[AnAboliKPiKe]

I am familiar with Dr. Scully's protocol. Mine is based on his as well as many others who have cited success from the same protocol. Hard to tell what is exactly the best way to do things with all the contradictory research out there.

I injected 100mcg Triptorelin IV today. Sounds like some sort of crazy meth user shit but I have extensive practice with IV access in my field of study so it was not problem. Can't say I feel a thing, not that I expected to. Just hoping it's doing what it is supposed to inside of me.

Continuing with 100mg clomiphene, 20mg tamoxifen, 25mg exemestane, 500iu HCG, and 7.5iu HMG every day. We'll see how labs look in a few weeks.

 

[AnAboliKPiKe]

Hey guys, here's my latest labs.

Lipid panel is still looking alright, although I need to get HDL up a bit and bring LDL and cholesterol down some more.

Hormone panel is looking promising. T is at a decent level, LH & FSH have increased since last month's labs. Exemestane @ 25mg qd seems to be keeping estradiol in check.

These labs were taken on Monday morning. I had not administered any of my PCT drugs prior to the labs. On Sunday I took 20mg tamoxifen, 100mg clomiphene, 25mg exemestane, 1000iu HCG, 7.5iu HMG. My last shot of 100mg Test-E/week was on 10/18, so I'm just now a month steroid-free.

I'm still feeling so-so. Don't have a real drive to go to the gym although I force myself too. Sex drive just isn't there and I haven't been noticing nocturnal erections or morning wood lately. Can't even get very hard watching porno. I can ejaculate though, volume and strength is good. Been pretty lethargic and somewhat depressed feeling at times. It boosted my spirits to see that my labs are moving in the right direction though.

I've changed my HCG/HMG protocol to 1000iu/7.5iu qd, respectively. I should be done with these in a little under a month.

 

[eaglecall]

Interesting thread. I wish I was experienced or expert to put together the perfect PCT. And I'm sure a lot of us will be at some point of our lives in your shoes.

But I agree first that for a real recovery you have to be off every single steroid. Some people say "oh I'm using nothing. Just 10mg of dbol and 100mg of test" well, thats is something. Off is off. No anabolic chemicals at all. Zero. I see that now you've been off for a month and thats a good thing.

Also, I am completely aware that the recovery is slow and painful. It CANNOT be a transition from TRT to normal life just with a PCT. The PCT will speed up things and make them easier for your body. But eventually your own body is the one who has to stabilize everything over a long period of time; 6-10-12 months. And I understand is not easy mentally and physically. But is the only way.

I wish you the best and keep us posted. You are doing the right thing. Juicing feels great, makes you look great, but you know what? natural healthy life is always better. Theres so many other things more important to enjoy in life than looking yourself at the mirror. It's ok when we're young, but the real things that prevail in life have nothing to do with how we look.