ANDROGEN INDUCED HYPOGONADOTROPHIC HYPOGONADISM:
TREATMENT PROTOCOL INVOLVING COMBINED DRUG THERAPY
M.C. Scally, C. Street, and A. Hodge
Houston, TX
The clinical application of androgens in the treatment of various
medical conditions has increased in the last five years. Because of the
novelty of applying these agents, especially in wasting syndrome,
investigations have focused largely on the anabolic actions and side
effects during the course of therapy itself. To date, no consideration
has been given to the endocrine status of patients post-treatment,
particularly development of iatrogenic hypogonadotrophic
hypogonadism. The negative impact of hypogonadism on physical and
mental well-being should be of major concern for HIV/AIDS patients
upon cessation of androgen therapy. Hypogonadism is characterized
by: a negative alteration in protein kinetics, decreased fat oxidation,
malaise, depression, compromised immune system integrity, and loss
of lean body mass. Thirty-two adult males who had self- administered
androgens presented with acquired hypogonadotrophic hypogonadism
(total testosterone (TT) <240 ng/dl, luteinizing hormone (LH) <1.5
IU/ml). Upon diagnosis, patients were administered the following
agents: (a) human chorionic gonadotropin, (2000-2500 IU/QODx16d);
(b) clomiphene citrate (50mg POBIDx30d); and (c) tamoxifen (20mg
POQDx45d). All medications were started simultaneously with HCG
stopped after 16 days, followed by discontinuation of clomiphene at
day 30, then tamoxifen stopped on day 45. HCG, a glycopeptide whose
alpha subunit is identical to the alpha subunit of LH and FSH, mimics
LH action in the leydig cells. The other compounds rounding out the
pharmacotherapeutic compliment are two long acting derivatives of
triphenylethylene, clomiphene and tamoxifen, both of which act as
mixed agonists-antagonists of the estrogen receptor complex, and
stimulate the pituitary gonadal axis (HPGA). Two weeks after last dose
of tamoxifen, blood work revealed an average LH increase from 1.15
to 5.0 mIU/ml with a concomitant average increase in TT from 140 to
476 ng/dl. In our sample, combined pharmacotherapy was extremely
effective in restoring normal function of the HPGA during this brief
evaluation period. Further investigation in the form of long-term
controlled clinical studies is warranted.
Everything like we thought basically. They did adminster clomid AND Nolvadex post cycle. That interested me. Once again , even though we have debated over and over again, I see HCG being used POST cycle. Makes you think sometimes.
Guys drop some fuckin opinions on this post. Im interested in hearing other peoples comments
I can see how the use of hcg post cycle would be benificial, as long as you continue with clomid and nolvadex long after the last dose of hcg.
You give the hcg to get the testicles functioning at maximum capacity, then focus on restoring production of LH. I think however that it would be better to have a lower dose of hcg to (avoid risking desensitization of the testicles) and administer it throughout the week, instead of all in one shot.
Nice post… quite a bit of techincal info for me to digest. But in response to the use of HCG post cycle, I feel it is a must for everyone. Simply for the fact that while clomid does a “ok” job it does not give the testes the jump start they need. With T levels being supressed for so long, clomid in my research, is too slow in getting the T levels back to where they need to be in order to help keep as much as the gains as possible. HCG & Clomid need to be used together. HCG should only be used for 3 weeks … 4 at the complete max, no more. 7,500 iu - 10,000 iu each dosage max.
Great… they gave his balls a boost with HCG post cycle… they could have given him the same damn boost 16days before his cycle ended so that he could start actually recovering his own LH when use of HCG and androgens stopped. They can suck my dick.
Squatty, right on. They should have given the hCG during the cycle. Post-cycle hCG only prolonged the time until the onset of recovery. Obviously, the less time under suppression the better. This was a good protocol, but not the best.
Well it also depends on what steroid was being used. If it was an enantate, or sustenon type that takes 3 weeks for levels to fall off, then starting hcg at the last injection is still not a bad idea- because you still have 3 weeks of suppression left.