From the Guidelines
The recommended post-cycle therapy (PCT) regimen after long-term testosterone therapy using Human Chorionic Gonadotropin (HCG) and Clomid (clomiphene citrate) involves a sequential approach, starting with HCG at 1000-2000 IU every other day for 1-2 weeks before ending testosterone, then continuing for another 1-2 weeks after stopping testosterone, followed by Clomid at 50mg daily for 2 weeks, and finally 25mg daily for another 2 weeks. This approach is based on the understanding that exogenous testosterone has inhibitory effects on the production of intratesticular testosterone, which is imperative to maintain normal spermatogenesis, as noted in the AUA guideline on testosterone deficiency 1.
The use of HCG, which has been approved by the FDA for use in males, helps to stimulate the testes and maintain testicular function, while Clomid works to block estrogen receptors at the hypothalamus, increasing the body's production of luteinizing hormone and follicle-stimulating hormone. Key points to consider in this regimen include:
- Starting HCG before ending testosterone therapy to minimize the impact on testicular function
- Adjusting the dosage and duration of HCG and Clomid based on individual response and hormone levels
- Monitoring for signs of estrogen rebound and considering the addition of an aromatase inhibitor like Arimidex (anastrozole) if necessary
- Conducting regular blood tests to monitor hormone levels and adjust the PCT regimen as needed, as the effectiveness of this approach can vary based on the duration of testosterone use and individual patient factors, as suggested by the guideline on evaluation and management of testosterone deficiency 1.
It's crucial to prioritize the restoration of natural testosterone production and minimize potential side effects, such as virilization, precocious puberty, and hyperandrogenism, especially in women and children who may be at higher risk for adverse events 1. By following this sequential approach and closely monitoring hormone levels, individuals can effectively recover from long-term testosterone therapy and restore their natural hormonal balance.
From the Research
Post-Cycle Therapy (PCT) Regimen
The recommended PCT regimen after long-term testosterone therapy using Human Chorionic Gonadotropin (HCG) and Clomid (clomiphene citrate) is as follows:
- Clomiphene citrate is a commonly used medication for PCT, with a typical dosage of 25-50 mg every other day 2, 3
- HCG is also used in PCT, typically at a dosage of 5000 IU injections twice weekly 3
- The combination of Clomid and HCG may be used for PCT, with a typical dosage of Clomid 25-50 mg every other day and HCG 5000 IU injections twice weekly 3
Dosing and Duration
The dosing and duration of PCT may vary depending on individual needs and circumstances. Some studies suggest the following:
- Clomiphene citrate: 25-50 mg every other day for 3-6 months 2, 4
- HCG: 5000 IU injections twice weekly for 3-6 months 3
- Combination therapy: Clomid 25-50 mg every other day and HCG 5000 IU injections twice weekly for 3-6 months 3
Efficacy and Safety
The efficacy and safety of Clomid and HCG for PCT have been studied in several trials:
- Clomiphene citrate has been shown to be effective in restoring testosterone levels and improving symptoms of hypogonadism 2, 3, 4
- HCG has also been shown to be effective in restoring testosterone levels and improving symptoms of hypogonadism 3
- The combination of Clomid and HCG may be more effective than either medication alone in some cases 3
- Clomiphene citrate and HCG have been shown to be safe and well-tolerated in most patients, with few side effects reported 2, 3, 4