What is the recommended dosage of Nolvadex (Tamoxifen) for Post Cycle Therapy (PCT) in a young to middle-aged male patient with a history of anabolic steroid use?

Nolvadex (Tamoxifen) for Post-Cycle Therapy After Anabolic Steroid Use

For young to middle-aged males recovering from anabolic steroid use, tamoxifen (Nolvadex) at 25 mg daily is the most commonly studied selective estrogen receptor modulator (SERM) for post-cycle therapy, though no official medical guidelines endorse this practice and significant cardiovascular risks exist. 1, 2

Critical Safety Warning

• Anabolic steroid use combined with post-cycle therapy drugs including tamoxifen has been directly associated with ischemic stroke in young patients, with case reports documenting stroke in a 34-year-old bodybuilder following tamoxifen and clomiphene use after AAS cessation 1
• Massive anabolic steroid use causes serious cardiovascular complications including ventricular fibrillation, heart failure, cardiac hypertrophy, and arterial thrombosis 3
• The combination of AAS-induced prothrombotic states and SERM therapy may create paradoxical embolic risk 1

Evidence on Post-Cycle Therapy Effectiveness

Hormonal Recovery Data

• In a retrospective study of 641 men, post-cycle therapy use was associated with faster biochemical recovery at 13 weeks (median) versus 26 weeks without PCT, with 48.2% achieving normalized reproductive hormones overall 2
• PCT showed benefit only in men who stopped AAS ≤3 months previously (OR 3.80), with no association with recovery in those stopping >3 months prior 2
• A dual-center study of 79 males found that clomiphene citrate monotherapy (25 mg/day) accelerated hormonal recovery compared to no treatment, with normozoospermia rates of 69.2% at 12 months versus 58.6% with expectant management 4

Practical Dosing Considerations

• Clomiphene citrate 25 mg daily is the most studied SERM monotherapy regimen for post-AAS recovery 4
• Tamoxifen dosing in the bodybuilding literature typically ranges from 20-40 mg daily, though this lacks formal clinical validation 5
• Combined therapy with clomiphene + hCG (1500 IU subcutaneously three times weekly) showed superior outcomes compared to SERM monotherapy, achieving 87.5% normozoospermia at 12 months 4

Major Clinical Pitfalls

Illicit Drug Quality Issues

• Among 63 samples of PCT drugs seized from illegal markets, only 65.1% contained the declared active ingredient 5
• 34.9% of samples either contained no active ingredient (20.6%) or had undeclared substituted drugs (14.3%) 5
• Falsified medicines pose direct health threats beyond the cardiovascular risks of the drugs themselves 5

Predictors of Poor Recovery

• Use of 2 or more concurrent AAS compounds significantly reduces recovery odds: 2 drugs (OR 0.55), 3 drugs (OR 0.46), 4 drugs (OR 0.25) compared to single-agent use 2
• Longer AAS cycles (>6 months) are associated with reduced recovery probability (OR 0.34) 2
• At baseline after AAS cessation, 89.9% of patients had erectile dysfunction and 69.7% exhibited azoospermia or severe oligozoospermia 4

Alternative Approach: Expectant Management

• Spontaneous hormonal recovery occurs within 6-12 months after AAS cessation in most men with normal pre-cycle profiles, even without pharmacological intervention 4
• Approximately 67-90% of men eventually recover spermatogenesis after TRT cessation, though this can take 6-24 months 6
• The American Urological Association recommends against supraphysiologic dosing of hormonal agents, as this can cause Leydig cell desensitization 6

Medically Supervised Alternative Protocol

If medical supervision is available and the patient insists on pharmacological support:

• Start with clomiphene citrate 25 mg daily rather than tamoxifen, as it has more robust evidence in the post-AAS recovery literature 2, 4
• Consider adding hCG 500 IU subcutaneously 3 times weekly (1,500 IU weekly total) if testosterone remains suppressed after 2-3 months 6
• Monitor testosterone, LH, and FSH at 2-3 month intervals to assess recovery 6
• For FSH <1.5 IU/L with persistent azoospermia, recombinant FSH 75 IU subcutaneously three times weekly may promote spermatogenesis 4

Bottom Line

No medical society endorses post-cycle therapy protocols for recreational anabolic steroid users. The practice involves illicit drug procurement with high rates of falsification, documented cardiovascular risks including stroke, and uncertain benefit beyond natural recovery. If a patient has already used AAS and seeks medical guidance, expectant management with serial hormone monitoring is the safest approach, with consideration of medically prescribed clomiphene (not illicit tamoxifen) only if recovery fails after 3-6 months. 1, 2, 4