An in depth look at PCT from a qualified physicians point of view

“Hi Mate. Hope you had a great New Year. I am just finishing up my test e and dbol cycle. Could you recommend me a PCT?”

I really wish I could answer a question like this in a single paragraph—and I probably could—and I probably have before. But, enough is enough. My moral compass has been a little off course and it is time to set the record straight. It is my job—no, it is my duty to discover and inform the community of the right answers, not so I can be right. And if that right answer is later proven to be wrong, then I must inform the community again. And if that answer requires a lengthy discussion, then so be it. Well today, I am having that discussion on Post Cycle Therapy (PCT) after an anabolic steroid cycle. So, what is the best PCT? Well, in order to answer that question accurately, I am going to have to ask some questions myself first.

The success of a PCT will ultimately be determined on the timing of the PCT and that timing will depend on the compounds and doses of those compounds the user has chosen for his cycle. What do I mean by this? Let’s use the cycle in the title as our hypothetical for this explanation. A user will email me the question:

“I am just finishing up my test e and dbol cycle. Could you recommend me a PCT?”

How do I respond? Or better, how should any educated advisor respond? Here is what I will ask:

“Hello. In order to recommend a PCT for you, I will need some more information from you. Could you please answer these questions for me below:”

1.) What dose of testosterone enanthate and dianabol have you been using?
2.) How long have you been using these two compounds?
3.) How are you dosing them? (daily? Weekly? SubQ, IM?)
4.) Any previous AAS cycle history?
5.) Any pre-cycle or mid-cycle lab work?
6.) Any other medications or relevant information?
7.) Are you on a budget or is cost not an issue?

These 7 important pieces of information I need to know in order to construct an appropriate PCT. So, how did the client answer?

1.) What dose of testosterone enanthate and dianabol have you been using?

I am using 500 mg weekly of test e and 50 mg daily of dbol with 0.5 mg of arimidex twice a week.

2.) How long have you been using these two compounds?

I am just about to finish my 10^th week this Monday.

3.) How are you dosing them? (daily? Weekly? SubQ, IM?)

I take 50 mg dbol 3 hours before training everyday and on rest days I take them around the same I would train. I am injecting 250 mg of test e on Monday and 250 mg of test e on Thursday in my glutes.

4.) Any previous AAS cycle history?

This is my second cycle.

5.) Any pre-cycle or mid-cycle lab work?

I have some blood work I can email through before my cycle. My Testosterone was 15.6 nmol/L and all my other lab values are within normal ranges. It took me a long time to get my testosterone up after my last PCT, which was a nolva only PCT. That is why I am asking you Mate. It was a horrible time my last PCT and I suffered some mood issues and lost a lot of muscle I had gained from my first cycle.

6.) Any other medications or relevant information?

I am taking Ipamorelin with CJC-1295 w/DAC. Will that affect my recovery? I do not drink, smoke or take any recs. I eat pretty well and I am always relatively lean.

7.) Are you on a budget or is cost not an issue?

I just want the right PCT for me. I am not rich either but so keep that in mind aha.

Now I have all the information I need to construct a PCT for this client. First off, we know that previously to starting this cycle, the client did not have low testosterone to begin with, which is a factor often not considered before beginning PCT. There have been countless cases of those who have cycled on and off for years without checking their lab work and have potentially not recovered since their first cycle. It is important to note that to accurately check whether or not you have recovered from a cycle, you should check your blood work only after all PCT meds have cleared, which is at least 3-4 weeks after your last SERM (nolva/clomid) dose. Many users check their blood work while they are using hCG or during SERM treatment to determine their recovery. Simply put, this approach is worthless. However, there are some benefits for checking blood work at various points during a PCT to see if a user is responding. We will get to that a bit later on.

We know the client is otherwise healthy and is not taking any other medications that may negatively affect the HPTA. A quick definition of the HPTA for any of the newbies reading on:

HPTA: An abbreviation for Hypothalamic-Pituitary-Testicular Axis. The axis that regulates endogenous testosterone through the relationship of these glands.

This is why there is another term for PCT which is called HPTA restoration, because the goal is to restore the HPTA which was once shut down due to the use of anabolic steroids. When you use anabolic steroids, your brain identifies the supra-physiological levels of circulating androgens and replies by shutting down its own production of natural testosterone, luteinizing hormone and follicle stimulating hormone. PCT or HPTA restoration is an effort to re-establish homeostasis (aka return to normal).

We also know the anabolic steroid history of the client. He has cycled once before and struggled to recover with nolva only as his PCT. This is a great point of discussion and one that people often confuse me with. Now, absolutely do I strongly believe that a nolva only or SERM only PCT is not the best choice for any PCT. Even for a first cycle. Even for a short cycle. Does that mean that a SERM only PCT will not work? No, it does not. In fact, some users have recovered without a PCT at all. What I recommend is a series of medications that have been shown to work in 1000’s of users in my experience and others, plus there is some weak data on a similar protocol to mine out there on the web. The medications have been chosen by me based on theory and mechanistic data, because the funds required for the official research needed to discover the best PCT is likely not to surface within the scientific community anytime soon. Why is that? Ethics and politics. The same story as always. So, with that preface, by all means, do the PCT you feel is right for you. I am merely explaining my approach that is backed by my experience as a coach. With that said, to me there are some obvious pitfalls with a SERM only PCT and with my “leave no stone unturned” protocol, I am yet to fail even the most challenging of HPTA dysfunction cases. I am confident that if you use my protocol, then you will successfully restore your natural testosterone to healthy levels.

Back to our hypothetical example. We know he is injecting 500 mg of testosterone weekly, split into two even intramuscular injections and he is also using 50 mg of dianabol daily in a single dose.

[Note: Intramuscular injections and sub-cutaneous injections differ slightly in drug metabolism as IM injections enter and exit faster than SC injections. Still though, in this context we can only guesstimate at best, so I do not recommend any differences for PCT timing with SC vs IM. SC injections are growing more popular, so if that changes, I will be sure to let everyone know.]

For estrogen control he is using 0.5 mg of arimidex twice per week. Now, this is where timing comes into work. The goal is to never let the user experience a bout of low testosterone, so we must transition the user from his steroid cycle to his PCT by overlapping the medications. As the anabolic steroids are almost cleared, the PCT begins—but not after the anabolic steroids clear. During, not after. So, when do testosterone enanthate and dianabol clear? A few definitions we need to know first:

Elimination Half Life: A biological half–life or elimination half–life is the time it takes for a substance (drug, radioactive nuclide, or other) to lose one-half of its pharmacologic, physiologic, or radiological activity.

Mean Residence Time (MRT): the mean residence time is the average time the drug stays at the site of action

Testosterone enanthate has an elimination half-life of 4.5 days and a mean residence time of 8.5 days when used as a depot intramuscular injection. Most of the time, I use the half-life only with drug elimination and it seems to be accurate enough if that is the metric you want to use, however with some AAS I have found to consider the MRT also. In my experience, for most users, their dose of testosterone enanthate halves every week or so. It is important to realise that from person to person the elimination time of the drug can vary, so we can accurately guesstimate at best. However, from a clinical standpoint, guesstimating is good enough in the context of PCT. Dianabol has an elimination half-life of just a few hours (3-5 hours) so you can be sure that no dianabol will be left in your body at even the highest dose, provided you stop 72 hours before your intended clearance time.

The dose is equally as important as knowing the compound itself.

“The success of a PCT will ultimately be determined on the timing of the PCT and that timing will depend on the compounds and doses of those compounds the user has chosen for his cycle.”

A dose of 1000 mg testosterone enanthate weekly is going to stay in the body longer than a dose of 500 mg of testosterone—and therefore, the PCT will be timed differently also. Now we know a dose of 500 mg of testosterone enanthate weekly will halve approximately every 7 days, so we will have an elimination process like this:

Last week of cycle: 500 mg testosterone enanthate remains
7 days later: 250 mg testosterone enanthate remains

14 days later: 125 mg testosterone enanthate remains

[Note: if the dose was 1000 mg of testosterone enanthate, to arrive at a dose of 125 mg, the user would need to wait an extra week. Timing is everything.]

After 14 days, the dose of testosterone will be close to physiological levels of testosterone, so this is a good time to start the overlap with the commencement of PCT. We will stop the dianabol 72 hours before we commence PCT also.

Human Chorionic Gonadotropin (hCG)

I chose hCG as the first medication I use in my PCT protocol. Why? Let’s take a brief look at what hCG does first. In men, hCG acts as a LH mimic to produce endogenous testosterone within the testes. However, it is not to get confused that hCG restores your HPTA. In many respects, hCG is as suppressive as anabolic steroids are to your HPTA.

“If hCG is as suppressive to the HPTA as anabolic steroids are, then why on this planet would we use hCG in a HPTA restoration protocol?”
It sounds counterproductive to HPTA restoration, but there is a critical path and timeline of which hCG seems beneficial as a “kick-start” for your HPTA reboot. Imagine an old car that needs a push start. The people pushing the car at the back are hardly a replacement for a healthy engine and if they were to push for much longer without any ignition success, they will quickly tire. Well hCG can be seen in this way—a push start for the ignition. The theory behind hCG’s role in PCT is to remind the testes of the critical path that is the HPTA by mimicking LH. So, we go in hard and we go in fast, then we get out before we tire. There is a rumour that has floated around the bro community for years about chronic, high dose hCG causing desensitisation of the Leydig cells and in turn permanently damaging your ability to restore your HPTA forever! MoohoohaHAH! Thankfully, this rumour is a myth like many other bro rules out there. There is however, a potential price to pay for chronic, high dose hCG use and that is excessive estrogen that may cause unwanted side effects or health concerns for some. In my experience, I see hCG aromatising at a significantly higher rate than conventional testosterone esters—so I do believe excessive estrogen can be a point of concern with hCG use. It is at this point I like to remind someone prior to undergoing their PCT protocol I give them:

“Remember, PCT is temporary. The PCT medications are tolerated well by most, but the PCT blues are common in some users also. There is no free lunch in this life. Side effects often come with the territory of wanting to surpass nature. Once again, remember PCT is temporary, not a life sentence.”

I will often receive emails about those who fear estrogen about wanting to add an aromatise inhibitor to their PCT protocol as a prophylactic medication alongside hCG. My answer is, “if you can refrain from using an AI during PCT, then that is my recommendation.” The more medications you add, the more complicated the determining cause of success or failure will be. Of course, if you simply cannot go on using hCG in the absence of an AI, then I recommend to start very low with your AI dose. Perhaps 0.25 mg of arimidex E3D or 6.25 mg of aromasin daily. Adjust up if needed, but I do not recommend to start high as this may be counterproductive to the success of your PCT. For most, I rarely see issues with hCG at even the highest doses. Gyno symptoms are rare. Some even enjoy their experience with hCG—like me. Now to the fun stuff.

“How much hCG to take, when to take it and how long for?”

Back to that word timing. We know our user in the above example will have physiological (normal) levels of testosterone at approximately 14 days after his last injection of 500 mg of testosterone enanthate weekly. I recommend to start hCG therapy on this date so there are no days where testosterone is below a physiological baseline and hence—reducing the chance of low testosterone side effects.

After the correct timing has been established, I recommend 2000 iu of hCG, every three days for 10 consecutive shots. For those on a budget, I have seen 1000 iu to work also. However, the lower doses may not work for all. Unfortunately, hCG can be expensive in Australia, so I can understand the choice for choosing a lower dose.

I recommend to reconstitute your hCG with bacteriostatic water for injection preserved with benzyl alcohol 0.9%. Store your hCG within the fridge in a sealed container and use within 30 days. I believe hCG will last much longer than 60 days so if time has passed, do not throw it out. I would bet my left nut that even 60 days after hCG has been reconstituted it would still be good to go.

[Note: Claims that oral or sublingual HCG are as effective as when hCG is given by injection are marketing attempts intended to deceive scientifically unsophisticated consumers. As added proof of its effectiveness, people point to a patent(s).  Bottom line, the only effective and safe way to receive the benefits of hCG is by injection.]

After the 10 x consecutive shots every three days, 30 days would have passed. For those who have the budget and do not find it inconvenient, I recommend a blood test after the 5^th shot of hCG to see if the user is responding. Total Testosterone (TT) is all I request. If TT is within range, then this is a good sign the HPTA is fully intact and is responsive. This blood test is particularly valuable for older users and users who have been on anabolic and androgenic steroids (AAS) for years at a time without any breaks. I have restored users who have been on AAS for 10 + years, so do not fear a reboot. It is never too late for most.


Selective Estrogen Receptor Modulators (SERM)s

What is the role of a SERM during PCT? HCG’s effect is centralized at the Leydig cells of the testicles and stimulates hormone function at the testicular level, but does not reverse hypothalamic-pituitary suppression (in the brain).  For this reason, hCG use alone is not advised for HPTA restoration. The theory is that after hCG has provided the push start, now it is the SERM’s role to complete the ignition and take us home. Estradiol (estrogen) is a key objective for HPTA restoration since it plays a critical role in HPTA regulation. This can be done by blocking the receptor through the action of a SERM (or reducing the available estradiol by impeding its production from testosterone with an aromatise inhibitor (AI)). In either event, the effect at the CNS level results in a significant increase of gonadotropin levels. In turn, LH stimulates Leydig cells in the testes, and this leads to increased local testosterone production. That probably sounds like a lot of gibberish to many of you reading, but the key take home point here is that the SERM’s role is to remind the HPTA axis of what to do at the hypothalamic-pituitary level. As mentioned, an AI can be used for the same purpose but I advise against AI use for first line treatment as I have noticed the chance of side effects to be greater and also the effectiveness to be lesser than SERMs. Context is important as always though. I have used an AI in place of SERMs where a user is particularly sensitive to a given SERM, where there is a drug contraindication with a SERM and another medication they are using, or simply if they do not have access to a SERM.

There are a number of SERMs one could utilise in a PCT but the most commonly sourced SERMs in Australia go by the brand names Clomid (Clomiphene citrate) and Nolva (Tamoxifen citrate). If on a budget or you are sensitive to a particular SERM, you may choose one or the other. In my experience, I have seen for both Nolva and Clomid together to work best. Once again, this further reinforces my “leave no stone unturned” methodology. It surprises me how many men do not value the restoration of their natural testosterone and “half-ass” their PCT. I mean, it is only your very manhood at stake? Onward to the next question:

“How much Clomid and Nolva to take, when to take it and for how long to take it?”

Some of the original inventors of the PCT theory would suggest a much higher dose than what I now prescribe. Over time, I noticed that high doses of SERMS, especially Clomid, were contributing to negative mood changes in users. When I looked at the data, I was never sure how these original PCT theorisers arrived at those higher doses? What I found was that because Clomid came in a 50 mg pill, 50 mg seemed like a good idea. Same with Nolva. 20 mg of Nolva seemed like a good idea. These SERMs were originally invented for women, not men. Instead of the 50 mg Clomid twice daily and 20 mg Nolva twice daily, I decided to start at half of those doses and more recently, even less. Of course, the only way for me to figure this out was the trial and error of 1000 + users. When posed with the challenge of restoring AAS users that seemed to be traumatised by their last PCT experience where high doses of SERMs were used—I did not have much of a choice but to experiment with lower doses. What I discovered was the same success without the severity of side effects. I now recommend to start your SERM therapy on the last day of your hCG dose so that again, we can overlap these medications in the hopes of maintaining physiological levels of testosterone throughout the entirety of the PCT.

I now recommend a dose of 25 mg of Clomid once daily and 10-20 mg of Nolva once daily. I have never understood the twice daily dosing for these SERMs either? They both have a half-life of approximately a week, so to dose twice daily makes little sense.

For how long these SERMs should be dosed will depend on the user’s cycle and cycle history. If a user cycles infrequently, then I will suggest 4 weeks of SERM therapy. If a user is over the age of 40, has been using AAS longer than 6 months at a time or I suspect there may be previous HPTA dysfunction, then I will suggest 2-3 months of SERM therapy. After the SERM therapy, D-Day approaches. As I mentioned, the half-life of these SERMS is long, so at least 3 weeks should pass before following up with blood work to see if the HPTA has been restored. After further investigation with regards to the pharmacokinetics of these two SERMs, I would go as far as saying that 4 + weeks after SERM use is an even better schedule before following up with blood work. To check blood work before this would be an inaccurate ruling. In other texts I have wrote about what markers to examine to see if the HPTA is restored, but essentially if all sex hormones are within reference ranges, then you have successfully restored your HPTA and your PCT has been a success. If the user’s PCT follow up blood work shows as unsuccessful or partially successful, then I will recommend a second reboot with an extended period of SERM use, upwards of 6 months. Today’s blog carried on a little longer than I expected. I am over-caffeinated and Cannabis stimulated so my fingers were on a mission today. None the less, a question answered as concisely as I could without leaving anything important out. At least I don’t think I did? Let me know if I have.