A Review of the treatment options for men who want to stop Testosterone and other Anabolic Steroids safely.
Keywords: Testosterone, Anabolic Steroids, Anabolic Steroid Side Effects, HCG, Clomid, FSH, LH, recombinant FSH, Treatment of Testosterone Side Effects,
Anabolic steroids are well known to be misused in competitive sports. Now more than ever, anabolic steroids are becoming more of a “social drug” and used among gym athletes to improve lifestyle and physique appearance. The vast majority of these illegal anabolic drugs are obtained without a doctor’s prescription, without a valid medical indication and without proper physician oversight and follow up management. While testing of athletes in professional sports has provided a unique insight into their widespread use, in the private life of gym goers who are not subject to rigorous testing provided by organized sporting authorities, little is known about health risks of anabolic steroids. It is reported that 50% of all illegal anabolic steroids are obtained without a valid medical prescription or indication. The majority of medication obtained in a such matter, contain ingredients that do match the label according to several studies.
In a study conducted in the Netherlands, an internal medicine department established an anabolic androgenic steroid clinic to better study young patients taking steroids and the associated health risks. 160 male patients visited the clinic between May of 2011 and May 2016. The average age of patients was 34, and all were strength athletes. Each male patient presented to the clinic having been on a median steroid cycle of 6 -18 weeks. The theory behind cycling medication is too allow the body to rapidly build muscle and strength then recover from the toxicity of anabolic steroids. Most common steroids used by young male athletes included testosterone, nandrolone and trenbolone. The most common side effects reported with anabolic steroid use included the following:
o Testicular atrophy
o Mood changes
o Decrease in sex drive
o Erectile dysfunction
o Addictive behavior
o Sleep Apnea
o Infection at injection site (most sever complication experience by users)
o Fluid retention
Most male patients self-treated their side effects with a variety of medication that most commonly included clomiphene citrate, anastrozole, HCG and tamoxifen. These medications in particular were used for 2-4 weeks post cycle and were used to reduce increases in estrogen, reduce gynecomastia, improve testicular testosterone production and raise fertility potential.
Treatment of Anabolic Steroid Side Effects
Persistent and Painful Gynecomastia ( Male Breast Enlargement)
Tamoxifen 20mg daily. Surgery may be recommended if pain is persisting and failure of medical therapy to provide resolution of symptoms.
Post Anabolic Androgenic Steroid Hypogonadism
The persistence of low testosterone can occur in men who have abused or taken anabolic steroids for a prolonged period of time. Anabolic steroids can suppress natural testosterone production from the testicles and pituitary function. Goals of therapy to are to improve testicular production of testosterone with HCG, recombinant FSH, and Clomiphene Citrate (Clomid). Medication is aimed to restart the hypothalamo-pituitary- gonadal axis. Tamoxifen can also be used and acts as an estrogen antagonist on the hypothalamus and pituitary. Tamoxifen can stimulate LH and FSH to improve endogenous testosterone production. HCG 1500 IU( or even large doses) twice weekly is often prescribed in such clinical cases, and can improve endogenous testosterone levels.
Restoring Spermatogenesis and Testicular Atrophy
To improve sperm function, quantity and quality and improve testicular volume in men who have used anabolic steroids or testosterone, the use of HCG can improve such a condition. HCG is a naturally occurring protein, produced by the human placenta, and mimics the actions of luteinizing hormone (LH). LH is secreted by the pituitary and is responsible for testicular production of testosterone and necessary for proper sperm maturation. High doses of HCG are often prescribed to men who need to improve sperm count post anabolic steroids in comparison to the HCG dosage men take to maintain sperm function while on anabolic steroids and testosterone.
Typically, men who are prescribed testosterone and desire to maintain testicular volume and fertility are provided HCG 500 IU three times weekly. There a variety of studies that have used variable amounts of HCG to induce spermatogenesis in post cycle conditions. Studies by Boulous etl. al., 2003 used HCG 1500-3000 IU twice weekly, while other studies Farhat et. al., investigated using HCG 1500 -5000 IU three times weekly. Typically, if no improvement in sperm count is witnessed by 3 months the addition of rFSH 75 IU three times weekly can be considered.
There is no gold standard or guideline on how to improve or prescribe HCG for men who desire to improve spermatogenesis post cycle of anabolic steroids. Yet the HCG dosages mentioned prior, pregnancy rates approached 56%, and in some cases 72%. Times for recovery of full sperm production and fertility can take up to 2 years.
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The following content is not intended or should be considered a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
Smit DL, de Ronde W. Outpatient clinic for users of anabolic androgenic steroids: an overview. Neth J Med. 2018;76(4):167.