# Study suggests pct is useless



## RiR0 (Apr 6, 2022)

I’ve said this for a long time you’ll recover with or without a pct if you’re going to









						The HAARLEM study suggests post-cycle therapy (PCT) doesn't work
					






					peterbond.org
				




HAARLEM study suggests post-cycle therapy (PCT) doesn't work
07-03-2021

Introduction
During anabolic steroid use in high dosages, the endogenous production of testosterone will come to a screeching halt. Once halted, testosterone production will remain (severely) suppressed for a transient period of time after cessation of anabolic steroid use. During this period of time, the person will be hypogonadal, i.e. testosterone deficient. Anabolic steroid users commonly use certain drugs after their “cycle” in order to—presumably—speed up this process of recovering testosterone production. This practice is commonly referred to as post-cycle therapy (PCT).

Three types of drugs are frequently used for post-cycle therapy, namely:

Selective estrogen receptor modulators (SERMs, e.g. tamoxifen and clomiphene)
Aromatase inhibitors (AIs, e.g. letrozole, anastrozole, and exemestane)
Human chorionic gonadotropin (hCG, commonly also called Pregnyl)
The reasoning behind the usage of these drugs is quite simple. SERMs counteract the suppressive action estrogen has on testosterone production by blocking its receptors at the hypothalamus and pituitary. Similarly, aromatase inhibitors counteract it by decreasing the production of estrogen itself. Finally; hCG increases testosterone production directly by stimulating the testes to do so.

Of these drugs, SERMs are usually the mainstay in the ‘PCT world’. And, indeed, SERMs have proven to increase testosterone in various states of hypogonadism. However, no study to date had actually prospectively examined its efficacy in AAS-induced hypogonadism. Until now: let me introduce you to the HAARLEM study [1].

 Book on Steroids Want to learn more about anabolic steroids, PCT, and how they affect your endogenous testosterone production? Take a peek at my brand-new book 'Book on Steroids'. Chock-full of evidence-based information with well over 500 references to the scientific literature. A must-have on the bookshelf for anyone with a keen interest in anabolic steroids.
The HAARLEM study: a prospective and observational study in which 100 anabolic steroid users participated
The HAARLEM study is an initiative by the outpatient clinic for anabolic steroids users in Haarlem, the Netherlands. The outpatient clinic was established in 2010 and is run by the two endocrinologists dr. de Ronde and dr. Smit. (Dr. Smit has been so kind to proofread Book on Steroids and has provided me with invaluable feedback on the manuscript.)

The goal of the HAARLEM study was to obtain valuable information about the health risks involved in anabolic steroid use. Baseline characteristics of this cohort have been published previously [2].

In brief: a total of 100 subjects (all men) that were intending to start an anabolic steroid cycle within 2 weeks were included in the trial. Various health measurements, including blood tests, were performed on all participants before the cycle (T0), in the last week of the cycle (T1), 3 months after the end of the cycle (T2), and 1 year after the start of the cycle (T3). To be clear: subjects were using their own AAS, the endocrinologists didn’t prescribe it of course.

What’s of particular relevance for this article, is that they also measured testosterone levels and thus could see how it would recover after a cycle. Additionally, 80 of the subjects did PCT (and therefore, 20 didn’t). So this would be the first prospective trial in which the efficacy of PCT might become apparent. (In the end, data was available for 79 subjects doing PCT and 19 subjects not doing PCT).

PCT drugs also weren’t provided by the endocrinologists. People did their own thing. The authors noted that most PCT regimes consisted of tamoxifen (70% of the time) and/or clomiphene (55% of the time) for 4 weeks post-cycle. Which, indeed, would also be my guess as a stereotypical example of PCT.

Post-cycle therapy (PCT) did not aid in recovery of endogenous testosterone production after anabolic steroid use
I’m sure this rustles some jimmies, but here are the data:

Results from the HAARLEM study [1].
Testosterone (nmol/L)	T0	T1	T2	T3
PCT (n=79)	16.6	81.6	14.4	15.8
No PCT (n=19)	16.5	68.8	16.3	15.6
Baseline (T0) testosterone values were pretty much identical, and, as to be expected, they were increased to supraphysiological levels during the last week of the cycle (T1). Then, 3 months after the end of the cycle, values were pretty much normalized in both groups again (albeit slightly, but not statistically significantly, lower in the PCT group).

Was this research perfect and thus the ultimate evidence to dispel PCT? No, it wasn’t. It wasn’t a double-blind placebo-controlled trial. But hey, it’s unlikely that such a trial will ever be performed. This is pretty much as good as it gets, they did a great job. So what kind of pitfalls are there? For one, there might have been a form of selection bias. That is, subjects who “know” they recover more easily, might’ve opted for not using a PCT. Although I consider it somewhat doubtful that it would lead to meaningful differences. Another reason could be that the average dosage was higher in the PCT group—which it was, 1.110 vs. 839 mg/week. However, both are well above the dosages required for maximal suppression of endogenous testosterone production (the minimum required dosage as a inclusion criteria was also 200 mg weekly). Moreover, the group that didn’t do PCT actually on average had a longer cycle duration (20 weeks vs. 18 weeks).

So, what else? In principle, perhaps the PCT group had recovered a bit earlier, which would've been visible if they had measured it 2 months after stopping anabolic steroid usage instead of 3. But yeah, I wouldn’t expect much of a difference either way still. If only because it would've taken most of these guys probably about a month before recovery would even start. After all, with high dosages and the long half-lives of the esters it will simply take this long before the AAS are cleared.

I’m also sure a lot of people will say that (most of) these subjects simply did their PCT wrong. But how would one know what would be a “good” PCT and what would constitute a “bad” PCT if there’s no evidence available that has examined the efficacies of various types of PCT? Of course, it might be that a certain type of PCT might have resulted in beneficial results. Nevertheless, this trial shows that when you follow a group of people who perform PCT as done in practice (SERMs for about a month) it simply doesn’t show to be effective. Or, in a sense, there's little to speed up if the non PCT group recovers in 3 months anyhow.

As a final note, some good news, the authors found that when gonadal function was normal at baseline, there was a 90% chance of having a normal total testosterone concentration after 3 months of recovery, and a 100% chance at the end of follow-up (on average about 8 months after stopping the cycle). Yay.

But why? Why isn’t a PCT working? SERMs show such good results in various types of hypogonadism! I’ll just paste a snippet here of a paragraph I had written about this in my book:

“Unfortunately, there's currently no good-quality evidence available in which SERMs are evaluated as a treatment for AAS-induced hypogonadism. The following sections below will therefore mainly focus on their use in hypogonadism due to other causes. But a word of caution is in place, as it's currently unknown how well these results translate to those suffering from AAS-induced hypogonadism. For the following sections, it's important to consider this difference with the populations of the studies I'm about to describe. The underlying cause of hypogonadism is vastly different. In principle, AAS-induced hypogonadism is a transient state post-cycle in which the hypothalamus and pituitary fail to adequately respond to decreased androgen and estrogen concentrations. After all, post-cycle, testosterone and estradiol concentrations are (very) low and thus the negative feedback they usually impose on the hypothalamus and pituitary is greatly diminished. So, while the stimulus (low estradiol and testosterone) to produce LH and FSH is there, the endocrine cells temporarily fail to respond adequately to this. It's unsure how making this stimulus larger by using a SERM will aid in HPGA recovery. Unlike AAS-induced hypogonadism, the hypogonadal study populations I'm going to cover are in a steady state of testosterone deficiency. Herein it would make sense that you can shift the steady state by making the stimulus larger with a SERM in order to increase testosterone. So again, be cautious when translating these studies into the post-cycle situation.”

Conclusion
The HAARLEM study was a prospective trial in which a large cohort of AAS users was followed over time. Several measurements, including testosterone levels, were performed before, during, and at two points after cessation of AAS usage. By comparing those subjects who performed a PCT to those who didn’t, some initial good evidence about PCT has finally surfaced. Unfortunately, the practice as commonly done, seems to be a bit useless.

Addendum 08-03-2021
I've heard this trial has gotten some criticism, I'll walk through a few of these:

"Olivier de Hon is one of the authors. He's with the Dutch Doping authority." Yes, how does this exactly invalidate the results? Please point me what part got influenced by him. Moreover, I suspect the Doping authority would've loved to see the steroid users NOT recover at all after 3 months already. But they did. Jesus.
"They didn't instruct the steroid users to do [x], [y], [z], which would've led to better results." Yes, it's an OBSERVATIONAL study, not an interventional study. If they would've instructed the AAS users to do certain things with the compounds they were using, it would be pretty hard to get it passed the medical ethical committee in the first place. The only way you get an intervention passed them is if the intervention encourages the users to take less steroids. The goal of this trial was to assess the health risks involved with androgen abuse in practice. An observational setup like this is EXACTLY what you would want to do in that case.
"All androgens have been made equal on a milligram per milligram basis." Of course, there's no evidence to do otherwise. You could arbitrarily assign something like "2 mg testosterone = 1 mg trenbolone" or whatever, but that would be utter broscience. What would that number mean? Trenbolone is twice as potent in muscle-building? Twice as potent in suppressing the HPGA? Twice as potent in causing acne? Where the hell would you base these numbers on? Extremely flawed androgen assays? And how would this have affected the results anyway? ALL users had their endogenous testosterone production COMPLETELY suppressed during their cycles.
"The subjects did their PCT wrong lulz." Well, first, back to point 2, they couldn't tell them to do otherwise in the first place. And second, please tell me which research can tell us what a "good PCT" entails. There is none. It's all broscience and guesswork based on extrapolating studies from study populations with different causes of hypogonadism. The guys in the trial simply did PCT like most people do: take SERM(s) for roughly a month.
"They should've started PCT later." Ok, so what difference would you expect? The no-PCT group had the same testosterone levels that they had at baseline 3 months after their last injection anyways. How about just wait 3 months? That seems to work pretty well.
"Lulz they didn't make a subanalysis based on who used compound [x] and who used compound [y]". Good luck with doing that, because only in 13% of the samples the vial exclusively contained the AAS that was on the label, and in 47% of the cases the vial didn't even contain the steroid claimed on the label at all but contained a different one (or ones): https://pubmed.ncbi.nlm.nih.gov/31663164/
References
Smit, D. L., et al. "Disruption and recovery of testicular function during and after androgen abuse: the HAARLEM study." Human Reproduction (2021).
Smit, Diederik L., et al. "Baseline characteristics of the HAARLEM study: 100 male amateur athletes using anabolic androgenic steroids." Scandinavian journal of medicine & science in sports 30.3 (2020): 531-539.


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## The Phoenix (Apr 6, 2022)

That’s a lot of good information. I still pct cos it works for me at my age. 


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## RiR0 (Apr 6, 2022)

The Phoenix said:


> That’s a lot of good information. I still pct cos it works for me at my age.
> 
> 
> Sent from my iPhone using Tapatalk Pro


How do you know it works vs not taking the drugs? 
As far I know there’s no evidence that it’s effective. 
Guys take it and recover but that doesn’t mean it was the drugs that helped with recovery


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## Test_subject (Apr 6, 2022)

It’s an interesting study, but the controls are almost nonexistent.


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## Send0 (Apr 6, 2022)

When I was young I didn't PCT at first, but I did bloods.. I was stupid, yes.

Anecdotally, based on blood work at that time, I can say I "recovered" faster with PCT than I did without.

Luckily, or unluckily depending on perspective, I will never have to PCT again.


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## TomJ (Apr 6, 2022)

So what im understanding form the above study is that a pct protocol was not a factor on whether a user would recover or not. 
If someone's natural production is going to resume, its going to regardless of pct protocol or lack there of. 

however, it doesn't seem that this study is very indicative on speed of recovery, making it seem that the currently accepted pct practices COULD result in a faster return to baseline, than no pct.


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## JuiceTrain (Apr 6, 2022)

PCT is for quitters - P.O.B.


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## RiR0 (Apr 6, 2022)

TomJ said:


> So what im understanding form the above study is that a pct protocol was not a factor on whether a user would recover or not.
> If someone's natural production is going to resume, its going to regardless of pct protocol or lack there of.
> 
> however, it doesn't seem that this study is very indicative on speed of recovery, making it seem that the currently accepted pct practices COULD result in a faster return to baseline, than no pct.


Yes. It could.
There’s also a chance that people are taking drugs which have their own set of effects and side effects that may not be needed


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## The Phoenix (Apr 6, 2022)

RiR0 said:


> How do you know it works vs not taking the drugs?
> As far I know there’s no evidence that it’s effective.
> Guys take it and recover but that doesn’t mean it was the drugs that helped with recovery



I can tell when it’s effective and when it isn’t. My favorite is HCG PCT. 


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## Bro Bundy (Apr 6, 2022)

it doesnt do shit to keep gains ..thats all that matters to me


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## RiR0 (Apr 6, 2022)

The Phoenix said:


> I can tell when it’s effective and when it isn’t. My favorite is HCG PCT.
> 
> 
> Sent from my iPhone using Tapatalk Pro


Based on feeling? If so there’s no way to know if it’s placebo or not.
There’s a reason with sources we don’t say a lab is gtg based on feelings
You take hcg post cycle?


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## Seeker (Apr 6, 2022)

I have never did pct. After a few cycles of certain compounds, or less even,  and you won't be needing pct anyway youll be needing trt.


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## lifter6973 (Apr 6, 2022)

All I know is my endo had me come off TRT for 6 months and no PCT to retest. I bounced back in that 6 months but at a 320 total test level which is about where I was before I started TRT and which those fucks think is fine.

It seems that indeed PCT may not be needed but when I have come off I have done it recently even though I am old. I'm at the point of trying to decide TRT for life or still cycle OR stop it all completely.


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## RiR0 (Apr 6, 2022)

lifter6973 said:


> All I know is my endo had me come off TRT for 6 months and no PCT to retest. I bounced back in that 6 months but at a 320 total test level which is about where I was before I started TRT and which those fucks think is fine.
> 
> It seems that indeed PCT may not be needed but when I have come off I have done it recently even though I am old. I'm at the point of trying to decide TRT for life or still cycle OR stop it all completely.


How old are you buddy? 

I think the reference ranges for normal test levels are absolute trash.


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## Test_subject (Apr 6, 2022)

The study makes for interesting discussion, but there are a few huge flaws:

— No control for PCT protocols

— No control for the legitimacy or accurate dosing of the PCT drugs used

— The 3 month re-testing period doesn’t effectively allow the study to show if the PCT group recovered faster

— There’s no control for which compounds or doses the users took during their cycle. A guy taking 500 test for 12 weeks will recover a hell of a lot easier than some dude banging 1.5g of test and 1g of deca every week for 20 weeks

I’m not discounting the study entirely, but I’d be wary of drawing absolute conclusions from it.


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## RiR0 (Apr 6, 2022)

Test_subject said:


> The study makes for interesting discussion, but there are a few huge flaws:
> 
> — No control for PCT protocols
> 
> ...


True but shut down is shut down and they all recovered within 3 months. 
There’s a response to all of these in the addendum


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## Test_subject (Apr 6, 2022)

RiR0 said:


> True but shut down is shut down and they all recovered within 3 months.
> There’s a response to all of these


Peter Bond does respond to a lot of the issues, but “meh, it’s all we have” doesn’t make the study any less flawed.

Like I said, it’s great as a starting point for discussion; it’s just not a study that I’m ready to take at face value.


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## Skullcrusher (Apr 6, 2022)

TRT for life...it's the way of the new world.


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## RiR0 (Apr 6, 2022)

Test_subject said:


> Peter Bond does respond to a lot of the issues, but “meh, it’s all we have” doesn’t make the study any less flawed.
> 
> Like I said, it’s great as a starting point for discussion; it’s just not a study that I’m ready to take at face value.


That’s fair. Unfortunately because of a government that parents adults and makes laws to protect the lowest common denominator of stupid people we will most likely never have these studies.


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## Test_subject (Apr 6, 2022)

RiR0 said:


> That’s fair. Unfortunately because of a government that parents adults and makes laws to protect the lowest common denominator of stupid people we will most likely never have these studies.


You won’t get any argument from me on that point. The government’s role is to keep the country functioning properly, not to legislate people’s personal lives.


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## The Phoenix (Apr 6, 2022)

RiR0 said:


> Based on feeling? If so there’s no way to know if it’s placebo or not.
> There’s a reason with sources we don’t say a lab is gtg based on feelings
> You take hcg post cycle?



I can tell by hormone levels in blood test and yes I do feel a rush of test “power” when I am on it. You have your perspectives based on your experience and studies, but don’t take everything as gospel. Medical staff are practicing their area of expertise just like I practice my discipline of engineering. There are other scientific differences of opinion; you are entitled to them. 


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## RiR0 (Apr 6, 2022)

The Phoenix said:


> I can tell by hormone levels in blood test and yes I do feel a rush of test “power” when I am on it. You have your perspectives based on your experience and studies, but don’t take everything as gospel. Medical staff are practicing their area of expertise just like I practice my discipline of engineering. There are other scientific differences of opinion; you are entitled to them.
> 
> 
> Sent from my iPhone using Tapatalk Pro


I’m sure they are shown on blood tests because they’re artificially elevated by the hcg. 
So by questioning your “feelz of power” I’m taking something as gospel?


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## Joliver (Apr 6, 2022)

One of the best reasons to "PCT" (if you are a cycler) is that the drugs used to "bring you back" are more or less the same drugs (SERM/AI) that would combat that nagging post cycle gyno flare up. 

Whether it works for restoring test levels may be up for debate, but when your androgen to estrogen levels get out of whack after the cycle...those "PCT" type drugs really shine.


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## lifter6973 (Apr 6, 2022)

RiR0 said:


> How old are you buddy?
> 
> I think the reference ranges for normal test levels are absolute trash.


In my 40s. My test levels have been in range of 290 to 330 off any PEDs basically since my late 30s. Not a good number for that age IMO


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## The Phoenix (Apr 6, 2022)

RiR0 said:


> I’m sure they are shown on blood tests because they’re artificially elevated by the hcg.
> So by questioning your “feelz of power” I’m taking something as gospel?



No sir, not trying to convince you to anything but also, I’m not trying to convince anyone; otherwise. 


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## BRICKS (Apr 9, 2022)

Joliver said:


> One of the best reasons to "PCT" (if you are a cycler) is that the drugs used to "bring you back" are more or less the same drugs (SERM/AI) that would combat that nagging post cycle gyno flare up.
> 
> Whether it works for restoring test levels may be up for debate, but when your androgen to estrogen levels get out of whack after the cycle...those "PCT" type drugs really shine.


Interesting that you say that.  When I was 19, 38 years ago I did the stupid and ran an 8 week dbol only cycle.  Didn't get sore nips until _*after *_I stopped the dbol.  Couple weeks after that kinda sucked.


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## Oldbastard (Jul 14, 2022)

Studies need too be validated 100s of times . One study means absolutely nothing . Could be valid ? Was it set up properly? Was the participants all healthy etc?  I'm just glad I been doing this for 20 years


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## Oldbastard (Jul 14, 2022)

RiR0 said:


> That’s fair. Unfortunately because of a government that parents adults and makes laws to protect the lowest common denominator of stupid people we will most likely never have these studies.


Awesome! Well put I think I love you lol


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## MarlonHart (Nov 17, 2022)

What exactly is a PCT? I haven't come across a similar term yet.


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## shackleford (Nov 17, 2022)

MarlonHart said:


> What exactly is a PCT? I haven't come across a similar term yet.


how much are you getting paid to post here?


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## The Phoenix (Nov 18, 2022)

MarlonHart said:


> What exactly is a PCT? I haven't come across a similar term yet.


post-cycle therapy


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## lifter6973 (Nov 18, 2022)




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## dirtys1x (Nov 21, 2022)

Not a controlled trial, and realistically can’t be due to the ethics imposed on something like that. I don’t think this data is compelling enough to say that you shouldn’t use a PCT. If anything, I would see a PCT as sort of “preventative”.

Personally, if I wasn’t on TRT I would still PCT.  When I was using a PCT I always recovered. This is also the case for thousands of others who have chosen to use a PCT. So what harm is there in choosing to do so besides the fact that it costs a LITTLE extra money?

There is one thing I’ll agree with. Homeostatic mechanisms in the body are way more powerful than any pharmacological intervention. The body will try extremely hard to restart your endogenous testosterone. So yes, regardless of PCT, your body is still fighting to bring you back to normal hormonal levels.


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## crido887 (Nov 21, 2022)

Isn't one of the issues with this is discussion of muscle retention with no PCT?


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## Clyde (Nov 21, 2022)

When I cycled on, off in the 1990's, I did it with and without PCT. I view PCT as a method to reduce the amount of time suffering from low T symptoms.

This is based on my personal anecdotal experiences (feels) without lab tests. My cycles also never exceeded 12 weeks, and I spent more time off gear than on. My T production always seemed to come back.

I'm 60 now with a 20+ year break from lifting and gear, earlier this year my free T was 422.


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