One of the major advances in anabolic pharmacology over the past 10-20 years is the almost mandatory use of post cycle therapy (PCT) at the end of an anabolic steroid cycle. In the 1970s and 1980s, bodybuilders didn’t really know about PCT. Beginning in the 1990s, some progressive athletes and bodybuilders figured out that the use of certain drugs could hasten the recovery of natural testosterone levels upon steroid cessation.
The medical research community even joined the pursuit of harm reduction for steroid users. More accurately, a few forward-thinking medical doctors sought to help bodybuilders who were suffering from anabolic steroid-induced hypogonadism (ASIH).
In particular, Dr. Michael Scally, M.D. pioneered the use of three drugs in the world’s first clinically-tested PCT treatment protocol. Scally successfully applied his ASIH treatment protocol to over 1,000 non-medical steroid users seeking to restore the full functioning of their hypothalmic-pituitary-testicular axis (HPTA).
Dr. Scally is a physician in the greater Houston-area. Houston has its fair share of champion amateur and professional bodybuilder who have consulted Scally for his expertise in the area. It didn’t take too long before other bodybuilders around the country looked up to Scally for his medically-supervised PCT protocols. Thanks to the Internet, bodybuilders at all levels and expertise have access the same information today.
Scally’s drug combination included the off-label use of three FDA-approved medications. These medications included human chorionic gonadotropic (hCG), clomiphene citrate (Clomid) and tamoxifen (Nolvadex). Scally’s PCT protocol has also been called the PoWeR Protocol thanks to work of HIV activist and TRT expert Nelson Vergel with the Program for Wellness Restoration (PoWeR).
The objective of the PoWeR protocol was identified as follows:
“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 (HPCA) after cessation of androgens.”
The first phase of the PoWeR PCT protocol involved the use of hCG. HCG directly stimulates the testicles to produced testosterone. The hCG-induced increase in testosterone levels is well into the normal range for serum testosterone and often exceeds the normal range into supraphysiological levels in a healthy male.
The first phase is not always a necessary component of PCT. However, for steroid cycles involving high dosages (e.g. in excess of one gram of total androgens per week) or steroid cycles of extended time periods (e.g. over 16 weeks), hCG is usually recommended.
The second phase of the PoWeR PCT protocol includes a combination of two selective estrogen receptor modulators (SERMs) – Clomid and Nolvadex. While the first phase (hCG) acts on the testicles, the second phase (Clomid + Nolvadex) includes drugs that act on the estrogen receptors in the pituitary.
The successful use a single SERM in PCT has been effective in many cases. Other SERMs such as toremifine has been used with reported success as well. So, it is not always necessary to use a combination of two SERMs in PCT.
However, the combination of the Clomid and Nolvadex has been shown to be advantageous thanks to the pioneering work by Dr. Scally. Thus, in cases of severe ASIH or heavy steroid use, the combination is highly recommended.
Clomid and Nolvadex are both SERMs. However they each act somewhat differently. Nolvadex has an anti-estrogenic effect in most places in the body and leads to a reduction in the overall effects of estrogens in the body as a whole. As such, Nolvadex acts strictly as an anti-estrogen. On the other hand, Clomid has more of a dual effect in the body. In addition its general anti-estrogenic effects, Clomid has a notably estrogenic effect in the brain where it stimulates the estrogen receptors in the pituitary.
The co-administration of Clomid and Nolvadex produces a more pronounced elevation of luteinizing hormone (LH)
Dr. Scally’s recent PCT program looks something like this.
- hCG 2,000 I.U. every other day for 20 days
- Clomid 50mg twice daily for 30 days
- Nolvadex 20mg once daily for 45 days
Thanks to the work of Dr. Scally and other steroid harm reduction advocates, PCT has become widely-accepted and commonplace within the bodybuilding community. The available body of knowledge regarding steroid use and ASIH treatment allows the conscientious steroid user to take greater care in reducing the negative side effects associated with anabolic steroid use.