Pct

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Hypogonadotropic Hypogonadism:

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

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

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

Gonadotropin Therapy:

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

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

HCG is administered by subcutaneous (SC) or intramuscular (IM) injection. The average (3ml 22-25G x ⅝-1½”) syringe is adequate for IM injections but insulin syringes (½-1ml 28-30G x ½-1”) are recommended for SC injections. In regards to effectiveness, there should be no discernable difference between either of the techniques. The individual should opt for the most comfortable and/or convenient form of administration.

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

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

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

Other manufacturers are available and preparations may vary.

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

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

Selective Estrogen Receptor Modulators:

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

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

Before Beginning PCT:

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

The following are Fasting blood values:

Hormone

1. Cortisol, Total
2. Estradiol, Extraction
3. Prolactin
4. LH
5. FSH
6. T3, Free
7. T4, Free
8. TSH
9. Testosterone, Total, Free and Weakly Bound
10. Hemoglobin A1C
11. Fasting Insulin
12. Somatomedian C (optional)

Cardiovascular

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

Other

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

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