This blog post is a continuation in a series on the recovery of men’s natural testosterone production and fertility after the use of anabolic and androgenic steroids.
To watch the video that accompanies this article, click here.
To review the previous article in this series, click here.
THE PREVENTION OF EXCESSIVE HPG DYSFUNCTION
Before considering the development of a recovery protocol, it would be astute to note some observations made in the literature. First, clinicians speculate that the duration of AAS use and the variety of AAS used are factors that complicate recovery. This confirms experiences in the bodybuilding and power sport communities. I have noticed that the more androgenic a compound is (e.g. trenbolone) and the longer that AAS are used continuously, the further the hypogonadism experienced by users. And hypogonadism is a useful heuristic tool to judge HPG axis dysfunction, as research uses the length of testis as an approximation to how likely protocols are to succeed. The smaller the testis, the less likelihood of success.
I speculate that when medium or high doses are involved, the duration of use is more significant than the androgenic nature of the compound overall. Though clinical research indicates that low-dose testosterone replacement therapy’s effect on semen quality can be totally inhibited with every-other-day dosing of 500 IU of hCG, it is tempting to speculate that this is not true for higher dosed testosterone regimens. Nonetheless, use of hCG concurrent to AAS is desirable, according to the use-it-or-lose-it theory that is applicable to so many concerns in biology.
AN ADVANCED, AND VARIABLE, PROTOCOL
Synthesizing the clinical research across hypogonadal men with specific attention given to the few clinical studies of men recovering from AAS use, we can indicate a program that differs from those suggested by bodybuilding gurus Dave Palumbo and Bostin Loyd in some parameters. This program is only speculative and discussed for educational purposes.
First, hCG should be administered as a monotherapy for 2-3 weeks, beginning at a lower dose of 1000 IU. The dose should then be titrated up to a maximum of 3,000 IU every-other-day. The dose should be titrated according to serum testosterone levels. As the dose is titrated upwards, anastrozole should be added at 0.5 mg daily combined with either clomiphene citrate (CC) or enclomiphene citrate (EC). EC is certainly preferable to CC, if it can be procured. Both should be administered at about 25 mg for this period.
After 6 months, hMG or rFSH should be added, though rFSH should certainly be preferred. Dosing parameters between the two compounds are similar in clinic, with doses ranging from 75 IU up to 450 IU thrice weekly. The dose should be titrated until desirable semen parameters are attained or conception is achieved. As the dose is titrated upwards, the dose of hCG can be raised from 3000 IU up to 5000 IU, thrice weekly. During this phase, CC/EC should be raised to at least 50 mg daily, while anastrozole is kept at 0.5mg.
WHAT’S THE DIFFERENCE BETWEEN FERTILITY AND RECOVERY?
While AAS will damage the body is ways that cannot be recovered from (see my video on how AAS changes the brain), including by creating fibrosis in the testes, the recovery that I am most often asked about is the recovery of endogenous testosterone production. While testosterone levels can rise with the use of CC/EC and hCG alone, the HPG axis will recover more fully with the use of a full protocol. I speculate that there is a therapeutic effect of simulating FSH in the body.
In either case, a long (at least 6 month, and likely 9 or 12 month) regimen is necessary to recover in a timely fashion from any extended use of AAS. The popular post-cycle therapies (PCT) are too short to produce a serious enhancement to recovery.
To return to the first article in this series, click here.
 Darke, S., Torok, M., & Duflou, J. (2014). Sudden or unnatural deaths involving anabolic‐androgenic steroids. Journal of forensic sciences, 59(4), 1025-1028.