Wow. Okay brother, I've been there. Bear with me while I ask a question. If you just got your arm out of a cast and it was shrunk down to 1/2 normal, would you stop going to therapy when it got back to 3/4? NO. I have seen a bunch of posts now concerning post cycle therapy (pct), and I am confused and concerned at some chosen approaches. I hope you take this to heart, because this information will help you minimize these challenges in the future. There is nothing worse than having a sex drive that you know is well below yoru normal. Like I said...been there.
Your testicle mass is regulated by your pituitary which is regulated by your hypothalamus. I know most of us know this, but it doesn't seem like anyone is applying this to our poor boy here. Your Hypothalamus sends a signal to your pituitary (GRH-gonadotropin releasing hormone) to release LH which directly travels from the pituitary to your leydig cells of the testicles which also comprise the majority of the mass of the testis and are your testosterone factory.
Rule 1: shrunken balls, balls not okay. balls not okay, testosterone levels not okay. Selective Estrogen Receptor Modulators (SERMS) like clomid and nolvadex only work in one way-they remove the negative feedback of estrogen on your pituitary, thereby allowing the release of LH. This assumes your problem is due to estrogen excess. If it isn't, these drugs will take forever to seem like they are helping you. Even if you had high post-cycle estradiol, these drugs alone would not be sufficient after a cycle of decent duration and relatively hefty doses (as far as negative feedback is concerned-it only takes 200mg of test cyp or enth or 100mg of nandrolone to greatly decrease LH within two weeks of first injection).
What the testis need is to take a few hefty shots of HCG at the end of your cycle to shock the leydig cells back to producing testosterone. The beta subunit (active portion) of HCG fits into the LH receptor and acts just like LH. This is its clinical use in men. Then, the leydig cells immediately kick out testosterone-biphasically-once within a 2-4 hours, and again about 48 hours later. Your balls will begin to blow up. Wait for the biphasic effect so that you get the most from your HCG shot, then shoot HCG again.
You probably won't notice anything around the time of the second effect, but the effect is taking place on the leydig cells. If you do notice anything, your balls may feel "heavy". This is what happens to me everytime and what the majority of our patients who are former juicers have said.
With the doses you were taking of AAS, you need a good 500iu minimum to get the effect. Probably more like 1000iu. The degree of atrophy and length of your cycle will have much to do with how resistant your testis are to the Human Chorionic Gonadotropin (HCG), but HCG is the only drug that will shock them back to life in this immediate manner.
You should be on a SERM like clomid or nolvadex at this time, because HCG is known to stimulate aromatase activity even though it raises testosterone. The increased testosterone will also allow more estrogen to be converted. By taking a SERM, you are able to block this effect which would otherwise partially defeat the purpose of HCG due to estrogen's negative feedback on your pituitary.
However...
Do not use an anti-aromatase at this time like arimidex or femara, because they affect aromatase as well as down-regulate cortisol and adrenals, which you need to be healthy in order to have a good sex drive. You will also keep estrogen extremely low and you need the active form-estradiol in the brain for sexual desire. Aromatization of testosterone in the male brain is essential for libido in a healthy male with normal function. The way to keep the correct balance is to block estrogen at the receptor, but leave aromatase alone.
Four days after your first shot of HCG the second kick is well over (biphasic), and you can take another. Use the same dose. Clinical studies have shown that the first shot of HCG sensitizes the leydig cells to the second shot in hypogonadal males (which unfortunately is you at the moment brother).
Stay on your SERM-20-40mg of novadex or 50mg of clomid is all you need.
You will most likely notice another increase in testis size a few hours after your second shot. You may even begin to get hints of desire back. If you feel that your testis are still not blowing up significantly after four days from this second shot, take a third. This time cut the dose to 1/2. Research has shown antibodies to HCG may develop after the 3 injection and higher doses do not further stimulate the leydig cells at this point. Now stay on your SERM for 2-3 weeks after your third HCG shot. Your testis should be at least 80% when you stop "post cycle therapy (pct)".
The 2-3 weeks that you stay on the SERMS will be to stimulate and allow the pituitary to continue to release LH on its own. When it does, your HPTA will be corrected and your testosterone will be normalized and you can taper off by taking the same dose every other day, then every third day, then you will know when you no longer need to take them.
MAIN POINT:
You do not want to stop your post cycle therapy (pct) with super shrunken testis. And HCG is the only drug that directly impacts the leydig cells and brings them back ASAP. Unless there is minimal to no shrinking, HCG should be used. It is the only way make to sure the leydig cells are active. All anti-aromatases and anti-estrogens will only weakly stimulate testosterone by removal of negative feedback on your pituitary. But whatever LH you get from this naturally from antagonizing estrogen will be no where close to what 500-1000iu or even 250iu of HCG will do as far as bringing your testis back quickly. I hope this makes sense.
I would personally do one cycle of what I described above right now. One month of logical post cycle therapy (pct). I hope this helps make things more sensible to everyone reading this who has ever had this challenge. 10 weeks maximum is the longesst I have been challenged without being able to balance libido in a male client.
Even if all these steps in a proper post cycle therapy (pct) go well, you will have some level of lag time while your hypothatlamus catches up with the pituitary and corrects the HPTA. You may or may not have lower than normal sex drive at this point but it should not be dramatic.
If after a solid week to two weeks off all drugs you do not feel more like yourself (not saying "fully") do one more course of post cycle therapy (pct) the way we described in the first few paragraphs. If you add up timelines, you will have the first complete course of HCG done within 2 weeks, and SERMS stop at about the month mark. Then a abreak of 1-2 weeks where you are assessing your recovery. If you were to need a second run, you would then do the same for 2 weeks (HCG 3 shots and SERMS), followed by 1-2 weeks of low dose SERMS. So, all in all, a max time of 10 weeks or less should do it and have you back to normal.
If you are still not recovered after two full rounds, then you have to rough it out. At that point, you would have to come into the clinic for additional testing. But I have never seen this not work when done to the T. Good luck.
