How to attempt HPTA restart before or after TRT.
Please do not ask about methods that you read about elsewhere that have high doses of SERMs, stacked SERMs or SERMS+hCG. There is a lot of bad bro-science that is really bad advice. The idea that more is better is totally stupid.
- restore form and function of testes with hCG or SERM induced normal levels of LH/FSH.
- avoid over stimulation of testicular LH receptors which can desensitize LH receptors.
- avoid over stimulation of testicular LH receptors which can cause high levels of T-->E2 inside the testes [which cannot be managed with anastrozole].
- keep E2 levels managed during and after this protocol
-- avoid E2 rebound-->shutdown, see above
- get the top end of the HPTA in the game, releasing LH/FSH
Looking for points of failure:
- if hCG does not increase T levels, testes have failed - STOP and go to TRT
- if SERM does not increase LH/FSH levels, hypothalamus/pituitary failed in this regard -STOP and go to TRT
Avoid Clomid: Clomid was the first SERM and the first born always gets more baby pictures. Many papers exploring the effect of SERMs were written and Clomid was the agent. So the literature always points to Clomid. However, Clomid creates some very nasty estrogenic side effects for some guys. Nolvadex is a SERM that does not have those bad side effects and has the same desired effects as Clomid at a the same dosing amounts. You may need to butt heads with your doctor to get from Clomid to Nolvadex.
SERMs and Aromatase inhibitors were developed to address female estrogen positive cancers. Some docs freak out because these are cancer drugs. SERMs also increase LH/FSH and are useful in fertility work, so docs can get past the cancer thing.
SERMs and fertility:
Fertility doc will give guys insane doses of SERMs because this will increase LH/FSH. The context is often very low LH/FSH and low T levels. If you give a low T guys high SERM doses, LH will go very high and E2 will typically be very high. When SERM is stopped, LH receptors can be desensitized and now things are worse and the high E2 levels can cause shutdown and/or make secondary hypogonadism worse.
Anastrozole: The prescribing info and clinical data is almost entirely in a female cancer context and the dosing is 1mg/day. The objective for female cancer patients is E2=zero. In males the objective is modulation of E2 levels and getting near E2=22pg/ml [80pmol/L] works very well for TRT guys. We see docs prescribe 1mg/day which illustrates their stupidity. Most guys on TRT need 1.0mg/week in divided doses. Anastrozole is a competitive drug, which competes for the aromatase enzyme reaction sites with free testosterone FT. That for reasons that may not be clear to you creates some very nice linear dose-response actions that are easy to utilize in dose refinement after you get E2 lab results.
There are multiple paths to the same end point. You may not have all of the drug choices to take advantage of. As long as you understand these things, you can make good choices and might be able to educate your doctor too.
1a) Inject 250iu hCG SC EOD then do labs for TT, FT, E2 after 4-6 weeks. If things have not improved, stop and go to TRT.
1b) Now if T levels acceptable, now do Nolvadex below to get hypothalamus and pituitary in the game.
Now hypothalamus and pituitary are active.
1a) 20 mg Nolvadex EOD [Clomid if only option]. Then do labs for LH/FSH, TT, FT, E2 after 4-6 weeks. If LH/FSH low, stop and go to TRT. If LH/FSH good and T levels still low, stop and go to TRT.
Now tests, hypothalamus and pituitary are active.
If you get this far, your HPTA is working. If you are stopping TRT and going back to where you were, in most cases you will not be better than before TRT.
Some younger guys with low-T can restart. Not always going to work often fails.
So this is the way that PCT should be done for those who have been doing gear or got in trouble along the way.
You need to be taking anastrozole as required to keep E2 near the 22pg/ml [80pmol/L] target. For mid range T levels during the above, 0.5mg/week in EOD dosing would be a good start. Typically this should be maintained after this process is complete to prevent estrogen rebound. So cruise on anastrozole afterwards for a few weeks then taper out. You need to have a liquid solution of anastrozole in vodka to dispense by the drop for small dose increments. Dissolve tablets 1mg/ml in a dropper bottle, count drops per ml and do the math. Always shaken, not stirred before dispensing.
We have things working, now we need to slowly taper off of the SERM and see if the HPTA can stand on its own feet. We have E2 managed to prevent estrogen rebound. As SERM levels drop, SERM induced T-->E2 will drop. The hypothalamus will now see the estrogen levels in your blood and the hypothalamus will start to tell the pituitary what to do based on the combined negative feedback of estrogens and testosterone. After you taper off of anastrozole and a few weeks later, do your labs. Hopefully the result after few weeks is favorable.
Older guys will probably never benefit from the above, its a younger guys' game. There is no fix for age related secondary hypogonadism and with primary hypogonadism, there is nothing to restart!