Enclomiphene vs Clomid for Post-Cycle Therapy
For post-cycle therapy after anabolic steroid use, use standard clomiphene citrate (Clomid) at 25-50 mg every other day, as this is the only formulation with established evidence for restoring the hypothalamic-pituitary-testicular axis after exogenous testosterone suppression. 1
Why Clomiphene Citrate (Clomid) is the Evidence-Based Choice
Proven Efficacy in Steroid-Induced Hypogonadism
- Clomiphene citrate has documented success in reversing hypogonadism specifically caused by anabolic steroid abuse, with restoration of testosterone levels, LH surge, and normalization of the pituitary-gonadal axis 1
- The drug successfully restored testosterone production in a 30-year-old male with symptomatic hypogonadism from multiple steroid preparations using 100 mg daily for 2 months 1
- In hypogonadal men, clomiphene increased testosterone from 9 to 16 nmol/L with 89% achieving biochemical improvement and 74% experiencing symptom resolution 2
Mechanism Supporting PCT Use
- Clomiphene works by stimulating endogenous testosterone production through the hypothalamic-pituitary-testicular axis, increasing LH, FSH, and testosterone levels simultaneously 3, 4
- This mechanism directly addresses the suppressed axis that occurs after anabolic steroid use 1
- The drug restores sperm production effectively, with 7/7 men showing elevated sperm counts at 3 months and sustained improvement at 6 months (75-334 × 10⁶/mL range) 3
Practical Dosing Protocol
Starting Regimen
- Begin with 25 mg every other day and titrate to 50 mg every other day if needed 5
- In the steroid abuse case, 100 mg daily was used successfully, though this is higher than typical maintenance dosing 1
- 70% of patients achieve target testosterone levels (550 ± 50 ng/dL) on just 25 mg every other day 5
Duration and Monitoring
- Treatment duration averaged 19 months in the largest prospective study, demonstrating long-term safety and efficacy 5
- Testosterone levels remain elevated for up to 8 years of continuous treatment 2
- Monitor total testosterone, free testosterone, LH, and FSH at baseline and during treatment 3, 5
Why Not Pure Enclomiphene
Limited Evidence Base
- Enclomiphene is only one isomer of clomiphene citrate (the other being zuclomiphene), and while it shows promise for secondary hypogonadism, there is no published evidence specifically for post-steroid-cycle recovery 3
- The single enclomiphene study evaluated men with secondary hypogonadism, not steroid-induced suppression 3
- All case reports and studies demonstrating reversal of steroid-induced hypogonadism used standard clomiphene citrate, not isolated enclomiphene 1
Availability and Regulatory Status
- Clomiphene citrate is widely available and has decades of safety data 5, 2
- Enclomiphene as a standalone product has limited availability and is not FDA-approved for male hypogonadism 3
Safety Considerations
Contraindications
- Avoid in patients with liver disease, especially decompensated cirrhosis 6, 7
- Only use when sufficient endogenous estrogen levels are present 6
Monitoring for Adverse Effects
- Watch for ovarian hyperstimulation syndrome (though rare in males) 6, 7
- Monitor lipid profiles as clomiphene can alter serum lipids 6, 7
- No major side effects were recorded in the 86-patient prospective study over 19 months 5
- PSA, hemoglobin, and hematocrit showed no clinically important changes during treatment 2