# One of the ONLY  PCT clinically documented - by Dr. Michael Scally (a must read)



## Vision (Sep 13, 2013)

Below is a read/study conducted by Dr Michael Scally.  Some may contest that it's out dated info, I'll disagree with that notion!
There's a NEW'er version available, I'll post that soon enough.

After this study, I will also include a Protocol/advice on PCT by Dr Swale.
_*Thanks, Vision


*_​[h=2]The famous PoWeR PCT Program by Dr. Michael Scally[/h]_The PoWer PCT study ABSTRACT: AEGIS Security & Investigations - Los Angeles Private Investigator
A more detailed ABSTRACT in PDF: http://www.medibolics.com/ScallyVergelAstractHPGA.pdf
(HYPOTHALAMIC PITUITARY GONADAL AXIS NORMALIZATION PROTOCOL AFTER ANDROGEN TREATMENT)


*The PoWeR PCT Program **

The PCT program outlined below represents what I consider to be an ideal and effective post-cycle program. It was developed by the doctors at the Program for Wellness Restoration (PoWeR), who have a formidable history helping patients recover normal hormonal functioning following steroid therapy. One of the key doctors on this program, Dr. Michael Scally, claims to have successfully treated more than 100 cases of hypogonadism/hypogonadotrophic hypogonadism, and is very well known in the field of androgen replacement therapy. PoWeR published this program as part of a recent clinical study, which involved 19 healthy male subjects who were taking supraphysiological (highly suppressive) doses of testosterone cypionate and nandrolone decanoate for 12 weeks. Their HPGA Normalization Protocol focuses on the combined use of HCG, Nolvadex' and Clomid, and is perhaps the only clinically documented post-cycle therapy program to be found in the medical literature (it is amazing how little attention has been paid to hormone normalization in clinical medicine). The most notable variation from a classic PCT stack, such that I have( been a longtime supporter of, is the combined use of two anti-estrogens. In this case I cannot say that there is disadvantage to such use; perhaps it is indeed the better option.

Examining the program closely, we note that the teste are hit hard with HCG at the onset of therapy. Its intake however, is limited to only 16 days. The doctor, undoubtedly recognize that when HCG is taken for too long or at too high a dosage, it can desensitize the LH receptor. This would only further exacerbate the post cycle problem, not help it. Anti-estrogens are used during and after HCG, with a dosage of 10 mg of Nolvadex and 100 mg of Clomid per day rounding out this compliment of drugs. Clomid is used for a shorter period of time than Nolvadex, likely because of the desensitizing effect it too' can have (on the pituitary gland) with continued use. Among other things, these two anti-estrogens will continue to foster LH release as testosterone levels start to go back up, as well as combat any potential estrogenic side effects that may be caused by HCG's up-regulation and testicular aromatase activity. Although in the first couple of weeks the anti-estrogens probably do very Iittlle as they should be much more helpful towards the middle and end of the program. During this clinical investigation: normal hormonal function was restored in all subjects,I within 45 days of drug cessation. This is a definite success far more favorable than the protracted recovery window noted in studies without post-cycle therapy, such as the 250 mg/week testosterone enanthate investigation, highlighted in Figure I. For me, I believe such a detailed recovery program should follow any serious steroid cycle It is the best way to maintain your gains at their maximun and that is, after all, what we are after.

Figure 2: 
	

	
	
		
		

		
			





Note 1:
According to Dr. Michael Scally, the protocol described in Llewelly?s book has been updated. ? But it has changed minimally, he said. ? Now I extend the hCG duration by using 2,000 IU, now 10 shots total. The tamoxifen is 20 MG PO BID. 

Note 2:
About Dr. Michael Scally

Dr. Scally?s education includes a double degree major in Chemistry (1975) and Life Sciences (1975) from the Massachusetts Institute of Technology (M.I.T.) Cambridge, MA. Following, from 1975-1980, in the M.I.T. Division of Brain Sciences & Neuroendocrinology Dr. Scally researched and published investigations on neurotransmitter relationships.1 Dr. Scally's research included involvement and participation in the earliest studies detailing the role of tryptophan, serotonin, and depression. During this time, he entered the prestigious Health Sciences & Technology Program, a collaboration of M.I.T. and Harvard Medical School. In June 1980, Dr. Scally was awarded by Harvard Medical School a Doctorate of Medicine, M.D. Continuing his education, Dr. Scally trained at Parkland Memorial Hospital, Southwestern Medical School. Scally completed the first year of postgraduate medical residency in general surgery followed by postgraduate medical residency in anesthesiology.

Consultations. Contact Dr. Scally at mscally@alum.mit.edu or mscally@hptaxis.com. Dr. Scally has personally cared for thousands of individuals using AAS, particularly for anabolic steroid-induced hypogonadism. DONATIONS ARE NEEDED AND APPRECIATED AT WWW.ASIH.NET.

Buy his book: http://www.amazon.com/Anabolic-Stero...6978014&sr=8-3

Note 3:
About William Llewellyn

William Llewellyn is a world-renowned foremost authority on anabolic substances and its effects on muscular performance. An accomplished research scientist, author, publisher, inventor, columnist, and company CEO in the field of sports nutrition and anabolic substances, Llewellyn has been featured in ESPN Magazine, Washington Post, Fox News Channel, ESPN Television, NPR News, ESPN Radio and other national and regional TV / Radio news programs.
In addition to writing the Anabolics books, Llewellyn also publishes Body of Science Magazine, a quarterly publication dedicated to the "understanding of sports enhancement." He writes a monthly column for Muscular Development, and has written numerous articles for other bodybuilding publications including Ironman Magazine, Exercise for Men Only, and Natural Muscle.
During his fifteen years of anabolic research, Llewellyn has made several important scientific discoveries. His latest discovery of arachidonic acid has been patented for its anabolic properties and its "use as a method of increasing skeletal muscle mass."

Buy his book: http://www.amazon.com/William-Llewel...t_at_ep_dpi_10

Note 4:
PoWeR : Program for Wellness Restoration website - http://www.powerusa.org


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More info



HPGA Normalization Protocol After Androgen Treatment
N Vergel, AL Hodge, MC Scally
Program for Wellness Restoration, PoWeR


Objective Results Discussion

To develop an approach to cycle androgens that would result in significant changes in body composition and accelerate the normalization of the hypothalamic pituitary gonadal axis (HPGA) after cessation of androgens.

Methods

An uncontrolled study of 19 HIV-negative eugonadal men, ages 23 ? 57 years, administered testosterone cypionate and nandrolone decanoate for 12 weeks, and then were treated simultaneously with a combined regimen of human chorionic gonadotropin (hCG) (2500 IU/QODx16d), clomiphene citrate (50 mg PO BID x 30d) and tamoxifen (20 mg PO QD x 45d), to restore the HPGA.

Results

Mean FFM by DEXA increased from 64.1 to 69.8 kg (p<.001); percent body fat decreased from 23.6 to 20.9 (p<.01); strength increased significantly from 357.4 lb to 406.4 lb (p=.02). No significant changes in serum chemistries and liver function tests were found. HDL-C decreased from a mean value of 44.3 to 38.0 (p=.02). Mean values for luteinizing hormone (LH) and total testosterone (T) were 4.5 and 460, respectively prior to androgen treatment. At the conclusion of the 12-week treatment with androgens the mean LH <0.7 (p<.001) and total testosterone was 1568 (p<.001). The mean values after treatment with the combined regimen were LH=6.2 and testosterone=458.

Discussion

The use of androgens has been reported to improve lean body mass, strength, sexual function, and mood accompanied by side effects caused by continuous uninterrupted use of these compounds (polycythemia, testicular atrophy, hypertension, liver dysfunction [oral androgens] and alopecia.) Androgen-induced HPGA suppression causes a severe hypogonadal state in most patients that often require an extensive period of considerable duration for normalization. This prevents most if not all individuals from cycling off these medications due to the adverse impact of this state on their previously gained LBM and quality of life. The protocol of hCG-clomiphene-tamoxifen was successful in restoring the HPGA within 45 days after androgen cessation. Further controlled studies are needed to determine if these results can be duplicated in HIV positive subjects. 


PRACTICAL APPLICATION 

The esters used in the abstract were cypionate and deconate however the administration of the PCT medications were started the day after aas cessation. Essentially the aas esters were still active when PCT began. The first 16 days a large amount of HCG was used in order to increase the mass of the testes so that they could sustain output of testosterone sooner. The HCG was stopped about the time the esters cleared so that estrogenic activity from the HCG would be reduced. During those first 16 days 2 different SERM?s were also employed (Clomid and Nolvadex) This protocol is contrary to what is typically recommended in many forums but regardless the protocol was effective in all 19 men. This is a 100% success rate! After the HCG was discontinued both SERM?s were continued. The following is the exact protocol in laymen?s terms.

Day 1-16 : 2500iu HCG every other day.
Day 1-30 : Nolva 20mg/day; Clomid 100mg/day (50mg was taken twice per day)
Day 31-45 : Nolva 20mg/day



I now strongly believe that an AI should be used as long as there is an aromatizing compound being administered. In this case Testosterone and HCG aromatize therefore using an AI until these meds clear is now what I am recommending. There is some evidence that adding Nolva to an AI does not increase the effectiveness of estro control therefore Nolva has no real advantage alongside an AI unless one is experiencing gyno. Additionally Nolva has been shown to reduce IGF-1 and GH levels. This is not a big deal on cycle as testosterone increases IGF-1 in a dose dependant relationship. However off cycle this is a problem. PCT is a fragile time and lower IGF-1 and GH levels is not desireable as I am sure you can appreciate. The last few days I have been relooking at AI's to find one that is specific to men that can be used on cycle and during PCT. It is my conclusion that Aromasin is the obvious choice. 

Aromasin (Exemestane) is a Type-I aromatase inhibitor, or suicidal aromatase inhibitor. It?s called this because it lowers estrogen production in the body by attaching to the aromatase enzyme, and permanently deactivating it. (1)

Personally, I find this to be a very interesting mechanism of action when compared to type-II aromatase inhibitors, which bind competitively to the aromatase enzyme, and eventually unbind, rendering it active again. In the case of Aromasin, this doesn?t happen, and once it does its job on the enzyme, those particular enzymes will no longer function.

Because the enzyme is permanently deactivated there is no estrogen rebound with Aromasin. Estrogen rebound at this critical time during PCT is undesirable so using Arimidex would be inferior. Therefore I believe Aromasin is the AI of choice during PCT. 

Reference: 

1. A predictive model for exemestane pharmacokinetics/pharmacodynamics incorporating the effect of food and formulation.Br J Clin Pharmacol. 2005 Mar;59(3):355-64.


The following is a study done in men with Aromasin that shows significant effect on estrogen and testosterone;

Pharmacokinetics and Dose Finding of a Potent Aromatase Inhibitor, Aromasin (Exemestane), in Young Males 

Suppression of estrogen, via estrogen receptor or aromatase blockade, is being investigated in the treatment of different conditions. Exemestane (Aromasin) is a potent and selective irreversible aromatase inhibitor. To characterize its suppression of estrogen and its pharmacokinetic (PK) properties in males, healthy eugonadal subjects (14?26 yr of age) were recruited. In a cross-over study, 12 were randomly assigned to 25 and 50 mg exemestane daily, orally, for 10 d with a 14-d washout period. Blood was withdrawn before and 24 h after the last dose of each treatment period. A PK study was performed (n = 10) using a 25-mg dose. Exemestane suppressed plasma estradiol comparably with either dose [25 mg, 38% (P 0.002); 50 mg, 32% (P 0.008)], with a reciprocal increase in testosterone concentrations (60% and 56%; P 0.003 for both). Plasma lipids and IGF-I concentrations were unaffected by treatment. The PK properties of the 25-mg dose showed the highest exemestane concentrations 1 h after administration, indicating rapid absorption. The terminal half-life was 8.9 h. Maximal estradiol suppression of 62 ? 14% was observed at 12 h. The drug was well tolerated. In conclusion, exemestane is a potent aromatase inhibitor in men and an alternative to the choice of available inhibitors. Long-term efficacy and safety will need further study.*_​


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## Vision (Sep 13, 2013)

*Below is a PCT protocol by Cr Swale


*​
Swales HCG protocol
Swale's HCG advice

by swale (MD / hrt specailist). originally posted at steroidology

I advise my AAS patients to use small amounts of HCG (250IU to 500IU) two days each week, right from the beginning of the cycle. This serves to maintain testicular form and function. It makes more sense to me to keep the horse in the barn, so to speak, then to have to chase it across three counties later on. I am also a big fan of maintaining estrogen within physiological ranges. Both therapies have been shown to hasten recovery.

Any more than 500IU of HCG per day causes too much aromatase activity. Some feel aromatase is actually toxic to the Leydig cells of the testes. You are then inducing primary hypogonadism (which is permanent) while treating steroid-induced secondary (hypogonadotrophic) hypogonadism (which is temporary--hopefully).

If 250IU or 500IU on two days each week isn't enough to stave off testicular atrophy, then I recommend using it more days each week (as opposed to taking larger doses). In fact, I wouldn't mind having a guy use 250IU per day ALL THROUGH the cycle. Those that have tell me they thus avoid that edgy, burned-out feeling they usually get. They also say they simply feel better each day. Subjective reports, to be sure, but they are hard not to appreciate. Especially when HCG is so inexpensive.

The testes are then ready, willing and able to again produce testosterone at the end of the cycle. LH levels rise fairly rapidly, but endogenous testosterone production is limited by lack of use. I also want to make sure a SERM, such as Clomid or Nolvadex, is at effective serum dosage (around 100mg QD for Clomid, 20-40mg QD for Nolvadex) when serum androgen levels drop to a concentration roughly equal to 200mg of testosterone per week. That is when androgenic inhibition at the HP no longer dominates over estrogenic antagonism with respect to inducing LH production. Of course, if the fellow has been doing Clomid or Nolvadex all along the way (and I now prefer Nolvadex over Clomid, due to the possibility of negative sides from the Clomid), he is all set to simply continue it at the end (no need to switch from one to the other). BTW, I see no evidence of any benefit in using BOTH SERMs at the same time. I used to think a couple of weeks of the SERM was enough; now I like to see an entire month after the last shot of AAS (and migration of long to short esters as the cycle matures). Tapering the SERM is probably a good idea during the last week, as well.

I want my patients to stop taking HCG within a week after the end of the cycle. The testosterone production it induces will further inhibit recovery, as will using Androgel, or any other testosterone preparation, while in recovery. There is no escaping this, as there is no such thing as a "bridge". Just because you are not inhibiting the HPTA for the entire 24 hours does not mean you are not suppressing it at all. IOW, you can't "fool" the body? it is smarter than you are.

I like Arimidex during the cycle (in fact, consider use of an AI while taking aromatisables a necessity) but it ABSOLUTELY should not be used post cycle (even though it has been shown to increase LH production) because the risk of driving estrogen too low, and therefore further damaging an already compromised Lipid Profile, is too great (this also drives libido back into the ground?and we don?t want that, do we?).

All this is meant to get my guys through recovery as fast as possible (the real goal, yes?). So far, all of them who have tried it have reported they are recovering faster than when they have tried other


JC: Dr. John has updated the original paper you published. Here it is:

My New HCG Protocol Paper
This paper is about to be published in The American Academy of Anti-Aging Medicine 2004 Clinical Updates:

AN UPDATE TO THE CRISLER HCG PROTOCOL

By John Crisler, DO

In my paper ?My Current Best Thoughts on How to Administer TRT for Men?, published in A4M?s 2004/5 Anti-Aging Clinical Protocols, I introduced a new protocol where small doses of Human Chorionic Gonadotrophin (HCG) are regularly added to traditional TRT (either weekly IM testosterone cypionate or daily cream/gel). The reasons and benefits of this protocol are as follows, along with a new improvement I wish to share:

Any physician who administers TRT will, within the first few months of doing so, field complaints from their patients because they are now experiencing troubling testicular atrophy. Irrespective of the numerous and abundant benefits of TRT, men never enjoy seeing their genitals shrinking! Testicular atrophy occurs because the depressed LH level, secondary to the HPTA suppression TRT induces, no longer supports them. It is well known that HCG?a Luteinizing Hormone (LH) analog?will effectively, and dramatically, restore the testicles to previous form and function. It accomplishes this due to shared moiety between the alpha subunits of both hormones.

So, that satisfies an aesthetic consideration which should not be ignored. Now let?s delve into the pharmacodynamics of the TRT medications. For those employing injectable
testosterone cypionate, the cypionate ester provides a 5-8 day half-life, depending upon the specific metabolism, activity level, and overall health of the patient. It is now well-established that appropriate TRT using IM injections must be dosed at weekly intervals, in order to avoid seating the patient on a hormonal, and emotional, roller coaster. Adding in some HCG toward the end of the weekly ?cycle? compensates for the drop in serum androgen levels by the half-life of the cypionate ester. Certainly the body thrives on regularity, and supplementing the TRT with endogenous testosterone production at just the right time?without inappropriately raising androgen OR estrogen (more on that later)?approximates the excellent performance stability of transdermal testosterone delivery systems for those who, for whatever reason or reasons, prefer test cyp.

But there?s another metabolic reason to employ this protocol. The P450 Side Chain Cleavage enzyme, which converts CHOL into pregnenolone at the initiation of all three metabolic pathways CHOL serves as precursor (the sex hormones, glucocorticoids and mineralcorticoids), is actively stimulated, or depressed, by LH concentrations. It is intuitively consistent that during conditions of lowered testosterone levels, commensurate increases in LH production would serve to stimulate this conversion from CHOL into these pathways, thereby feeding more raw material for increased hormone production. And vice versa. Thus the addition of HCG (which also stimulates the P450scc enzyme) helps restore a more natural balance of the hormones within this pathway in patients who are entirely, or even partially, HPTA-suppressed.

It is important that no more than 500IU of HCG be administered on any given day. There is only just so much stimulation possible, and exceeding that not only is wasteful, doing so has important negative consequences. Higher doses overly stimulate testicular aromatase, which inappropriately raises estrogen levels, and brings on the detrimental effects of same. It also causes Leydig cell desentization to LH, and we are therefore inducing primary hypogonadism while perhaps treating secondary hypogonadism. 250IU QD is an effective, and safe, dose. After all, we are merely replacing that which is lost to inhibition.

In my previous report I recommended 250IU of HCG twice per week for all TRT patients, taken the day of, along with the day before, the weekly test cyp injection. After looking at countless lab printouts, listening to subjective reports from patients, and learning more about HCG, I am now shifting that regimen forward one day. In other words, my test cyp TRT patients now take their HCG at 250IU two days before, as well as the day immediately previous to, their IM shot. All administer their HCG subcutaneously, and dosage may be adjusted as necessary (I have yet to see more than 350IU per dose required).

I made this change after realizing that the previous HCG protocol was boosting serum testosterone levels too much, as the test cyp serum concentrations rise, approaching its peak at roughly the 72 hour mark. The original goal of supporting serum androgen levels with HCG had overshot its mark.

Those TRT patients who prefer a transdermal testosterone, or even testosterone pellets (although I am not in favor of same), take their HCG every third day. They needn???t concern themselves with diminishing serum androgen levels from their testosterone delivery system. These patients will, of course, notice an increase in serum androgen levels above baseline.

While HCG, as sole TRT, is still considered treatment of choice for hypogonadotrophic hypogonadism by many , my experience is that it just does not bring the same subjective benefits as pure testosterone delivery systems do?even when similar serum androgen levels are produced from comparable baseline values. However, supplementing the more ?traditional? TRT of transdermal, or injected, testosterone with HCG stabilizes serum levels, prevents testicular atrophy, helps rebalance expression of other hormones, and brings reports of greatly increased sense of well-being and libido. My patients absolutely love it. As time goes on, we are coming to appreciate HCG as a much more powerful--and wonderful--hormone than previously given credit.


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## J.thom (Sep 14, 2013)

interesting read, thank you


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