HPTA Restart Protocol

[dhickey]

If you know you’re secondary, you might as well just start with the SERM. If we’re going to sticky something, it probably needs to be a bit more detailed and cover those of us that really are sure of Primary/Secondary status. When restarting a system that worked before a steriod cycle, the kitchen sink approach is probably valid. No so if you attempting diagnostic work and might need to stay on T, HCG or SERM long term.

[quote]KSman wrote:
Scally is bogus and because many refer to his PCT does not mean that it is correct, safe or effective. You have to watch out for bro-science. Scally is in that crowd.
[/quote]
Maybe we should add some detail to the below so that it’s not bro science as well.

Most important is understanding what you are trying to achieve and what the agents do.

High dose hCG was discredited years ago. High continued stimulation of the LH receptors by LH and/or hCG can desensitize the receptors. So when you are done, what good is your own LH when the receptors are tired of listening?

What’s high dose and what’s long term? You refer to common TRT doses of HCG below. Doses that barely keep my testes at a normal size. You think the same dose is effective in jump starting adequate levels of T after being shut down? What if someone is Primary at normal LH levels but not at higher doses of HCG?

It would be good to add detail on high dose HCG being discredited and evidence of desensitization being real. I don’t have anything in my admittedly small e-library.

High LH and/or hCG can create very high intratesticular testosterone levels. That is turn drives high T–>E2 inside the testes. Anastrozole or any competitive AI drug cannot control that. So one can take relatively high anastrozole doses and still have high serum E2.

The key work here is ‘can’ and only an issue if you end up producing more T than you intended. How often is that going to happen on a restart and how long are we exposed?

Most restarts I’ve seen include pretty short spans with high dose HCG. The intent is jump start production and get off. So there’s a chance you could have high E2 for a few weeks if T levels were higher than needed. I’d take high E2 for a couple weeks in return for a blood work that showed my testes make more T than I needed. That would be easy to correct.

If you have high FSH/LH, you are primary and there is nothing to restart.

I’ve fallen into this category, but I’m not convinced this statement is 100% accurate. If you’ve been shut down for a long period of time, how long do you have to be at high normal LH/FSH for your testes to start producing adequate amounts of T? I tested after three weeks on a SERM. May not have been long enough to jump-start adequate production. Maybe I need a signal much higher than high normal LH for a few weeks? Maybe I need a signal higher than normal to produce long term. Enter high dose HCG.

If hCG does not work, you are primary. Stop and do TRT.

Yes, but how long on HCG and how much? Even Shippen suggests higher doses to assess response. He also suggested adjusting dose to get appropriate response, not some hard fast rule like 250IU EOD. Take as much as you need, and no more than you need to get the appropriate response. What if someone needed more to produce adequate T levels? How would they every know without a high dose test phase?

If SERM does not create good LH/FSH levels, you are secondary, stop and do TRT.

Or HCG. If you can’t get your pituitary to work but your testes do work, wouldn’t HCG be worth a shot?

You can do a restart [or PCT] with SERM or hCG then SERM. Never take multiple SERMs or SERM and hCG at the same time.

I just can’t rationalize why HCG and SERM at the same time is all that bad. If you are trying to restart two different systems at the same time, or keep one going while to restart the other, it seems logical. Unless you assume the first time you take an HCG shot or dose of the SERM, you’ll get the appropriate response. I’m assuming that’s not the case and the restart takes time. You’ll need many doses to get the desired response. Maybe that’s incorrect. I’d have to test LH/FSH after my first SERM dose.

SERM’s increase E2 levels, aromatase inhibitors are needed if the SERM’s are effective.

1a) get testes physically recovered with 4-6 weeks of hCG or SERM [suggest nolvadex, not clomid]. You do not want high doses as you want the testes to be functioning on normal LH receptor stimulation. 250iu hCG SC EOD or 12.5 mg nolvadex ED.

How do we know 250IU HCG EOD is going to = normal LH for everyone? How do we know normal LH is enough for everyone to get to desirable T levels in 4-6 weeks if at all?

1b)) If you start on hCG, time to switch to SERM [nolvadex]. Just stop hCG and start SERM. When using hCG, if the testes have been making decent amounts of T, then the top end of your HPTA has not been active. With the SERM, it will now be. Take SERM for two weeks, if you did 1a), you can skip this.

1c) Take 1.0 - 0.5 mg anastrozole per week in EOD divided doses. You will need a liquid product to get by-the-drop dose increments. Read about anastrozole over-responders, understand the signs and recourse.

2a) Slowly taper off of the SERM, do not stop suddenly or your HPTA may shutdown.

2b) You will want to be on 0.5 mg anastrozole and cruise on that for a few weeks, then taper.

Can you do PCT/restart without SERM? Yes, but may not be effective as the top end of your HPTA has not had a dress rehearsal. Can you do a SERM only PCT/restart? Yes. Note that some can obtain SERM’s but not hCG.

The duration’s and timing are all flexible. Nothing is carved in stone. Everyone’s responses and problems are unique. So seeking the perfect PCT/restart can be a bit misguided.

The last two sentences are key. The Scally restart assumes we started with a functioning system before a steriod cycle. It’s not the best solution if you’re trying to determine where you system is failing. We need to take a different approach if we’re trying to determine Primary or Secondary status.

Primary at normal LH levels - HCG mono might be an option, but we’d never know with the 250IU EOD protocol.
Primary at high HCG doses - Need TRT.
Secondary but not with a SERM - Long term SERM might work, or at least until you figure out why you’re secondary.
Secondary with a SERM - Need TRT

Labs [optional]: With SERM or hCG, your T and E2 levels should be uncreased [else do TRT]. If high normal, 1.0 mg anastrozole per week. If mid range, 0.5mg

If E2 is high, LH may be high, cut SERM by 50%, anastrozole can be ineffective

With SERM, your LH/FSH numbers should be good. Else do TRT.

If your T levels are good, no real point in checking for LH/FSH, as they will be good. However, if they are high, you will need to reduce SERM dose.

Your testes need DHEA to make T. Supplementing DHEA will help if your DHEA-S levels are low [deficient]; otherwise no advantage. High DHEA supplements can drive high E2 levels in some guys.

You can tell if T levels are good, so need for labs is not always needed to know T levels or that LH/FSH levels are up. But you can’t feel high LH.

During PCT if you start feeling better for a short while, that can be from elevated E2 levels. But when taking an AI, you can get same effect from E2 levels that are too low. So you can get lost. But if your thyroid is a mess, feeling good may not be achievable.

We know that hypothyroid states can lead to low LH and low T. So the prospects of a HPTA restart may be poor in such states. There is more to sexual functioning than your T levels. Do not have T tunnel vision. Note the other health issues and causes in the advice for new guys sticky. If there is a cause for low T, you need to identify and fix that.

Testicular response to hCG or LH is age dependent. HPTA restarts for old guys is silly. HPTA restarts can work very well for younger men if there are no other complication.

Some young guys have brittle HPTA’s that just fail. Sometimes this is spontaneous and idiopathic. However, adventures with 5-alpha reductase inhibitors [hair loss drugs], or stupid cycles can cause irreversible damage. A deca only cycle is a good way to get seriously messed up. So some of these HPTA failures can be caused by drugs/gear; but in some cases these events might just be bringing a future failure forward in time. I have to throw over-training, extreme low fat diets and starvation diets into the risk pool.

This all seems reasonable in general, but the doses you suggest of HCG and Nolva seem to be what one would end up on or cruise at if Primary or Secondary. If we’re trying to get an exaggerated response to jump start production, I think higher doses for a few weeks are a logical start with not much risk. You’ll get a definitive answer and can adjust the dose down. If you start low, you’ll either have run it for much longer and test more, or always wonder if you should have given it more time or a higher dose.

These are just the ramblings of someone that’s taken a general interest in their own health issues. I’ve not treated anyone else or been involved in any real studies. What I plan to try soon:

HCG ramp - While on T, increase HCG from 250IU to 500IU MWF for two weeks. 250IU is barely enough to keep my testes at full size. Still feel like they’re a tad smaller at that dose.

Higher dose HCG - Something in the same vein as the Scally PCT or Shippen challenge. 1000IU ED for a couple weeks and test. I know I’m E dominant so probably 6mg of Aromasin EOD like I’m doing now. If free T isn’t at a reasonable level after a couple weeks of 1000IU HCG ED, I think it’s clear I’m primary. Seems better than waiting 6 weeks or wondering if I need more than 250IU EOD.

If I get a reasonable T response from HCG (doubt it, but we’ll see)…

SERM - I’ll start a SERM while tapering HCG so that T levels and stimulation remain while the SERMs do their job. I have Clomid, so I’ll start with that. If I get any sides from that, I know Torem will get me the LH response I need at 60mg ED. That put me at high normal before. 20mg of Nolva ED had me quite a bit lower on LF/FSH. Anacdotal proof not all SERM work the same for eveyone at the same dose.

I’ll test after 3 weeks on the SERM. I know that was enough time to get LH/FSH to high normal before. If T levels are still good, I’ll taper the SERM to take only as much as I need for the appropriate dose. Lower the dose a bit and test two weeks later.

So…

Week 1/2 - 500IU HCG MWF - Still on T
Week 3/4 - 1000IU HCG ED
Blood work - Continue if T levels adequate.
Week 5 - 500IU HCG MWF, SERM
Week 6 - 250IU HCG MWF, SERM
Week 7 - SERM
Blood work. If T levels adequate, taper SERM. If not, run (try taper) HCG as long as it will work.