Getting Off Gear
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Some guys and girls use anabolic steroids (sometimes called androgens) to build muscle, burn fat, and get stronger and faster. In terms of pharmaceutical interventions for achieving those goals, no class of drug even comes close to the results seen with anabolic steroids—period. Ultimately, though, most athletes and even bodybuilders make the decision to come off, whether it’s for financial, legal, or personal reasons.
But when an athlete goes off anabolic steroids, there’s a period of time when the body is still expecting hormones to be supplied from an outside source and doesn’t realize that it needs to begin producing its own hormones again. That’s bad news because this is when steroid users can become steroid losers—and lose most of their gains. This feature is written to help users safely get off gear, hence the title.
Kick-Start the Testes
So how do steroid users kickstart their own natural hormones and hang on to their gains? By doing a proper post-cycle therapy (PCT), whether that means pharmaceutical intervention or stealing a page from natural athletes and maximizing their supplements, training, and nutrition to produce an ideal hormonal environment. Alternatively, natural bodybuilders can follow this protocol to get the most out of their bodies without resorting to anabolic steroids.
Why Do Steroids Cause the Body to Stop Producing Testosterone?
When gonadotropin-releasing hormone (GnRH) is released from the hypothalamus, the body reacts by secreting the luteinizing hormone (LH) from the pituitary, which in turn triggers the release of testosterone from the gonads. Follicle-stimulating hormone (FSH) is also secreted, which is necessary for sperm production.
Downstream a bit farther, that testosterone triggers something called the negative feedback loop, which as you can probably guess, results in negative feedback, i.e., the sending of a signal to your body to stop producing testosterone. This isn’t a bad thing, per se; it’s how the body maintains hormonal balance. When you take steroids, you skip all of that noise and get to the end result, which causes your body to respond by building muscle, increasing libido, etc., and triggers the negative feedback loop. But while you’re on steroids, the negative feedback loop isn’t a big deal, because even though your body stops producing testosterone, you’re supplying it with an alternative.
The Need For PCT
But when you cut off that supply, it takes a while for your body to adapt. Let’s shift gears for a second: Steroids are like a suntan. Here in New Jersey, we go to the shore—yes, that Jersey Shore—from the beginning of summer (Memorial Day weekend) through the end (Labor Day weekend), which is roughly three months. During those three beach-going months, we get progressively darker (and drunker). But when we’re no longer out in the sun every weekend, our tans begin to fade. We don’t go from bronze to white in a day or even a week. It takes our skin some time to return to normal once we aren’t in the sun as much. That’s what happens with steroids; when you stop taking them, your natural hormones don’t come back right away … they slowly trickle back in. Remove the external stimulus, and the body takes a while to return things to the way they were before.
The more slowly those natural hormones return, the more of your steroid-assisted gains you’re likely to lose. Instead of just allowing nature to take its course, most steroid users will opt to jump-start their hormone production. That’s what PCT is about.
How Do I Know If My Testosterone Levels Are Low?
There are a lot of potential indicators in diagnosing low (hypogonadal) testosterone levels. One is libido: If you’re not interested in sex, your test levels might be in the gutter. The same goes for energy levels: If you’re feeling sluggish after a cycle, it’s probably because your testosterone is way down. There are a lot of symptoms associated with lowered testosterone.
But the only way to know if testosterone levels are low is to get blood work. Anyone considering a cycle should get blood work before, during, and after, and we’d want to look at several areas. Obviously, we want to see where our total and free testosterone is. Total testosterone is, as you’ve likely guessed, the total amount of testosterone you have in your body. Free testosterone is the amount of biologically active (i.e., unbound and “free”) testosterone you have. The latter, the free testosterone, is what exerts the majority of the biological effects that we associate with testosterone. Clearly, we’d want to see where our FSH and LH are at, too.
Check For Cardiovascular Issues & Risk Factors
Get an ECG and follow up with an MRI and CT scan; leave no stone unturned. Address high LDL cholesterol, blood pressure, hematocrit, and homocysteine levels. All are significant risk factors/predictors for normal people, let alone someone with a heart the size of a small country! I forgot to mention that’s one of the reasons for the MRI. Renal function and fasting glucose should also be examined, as excessive GH use will often result in prolonged insulin resistance.
— Brian Batcheldor
Get a Doctor
The usual parameters that we need to stay healthy also need to be
checked out. I’m talking about cholesterol, triglycerides, liver function, etc. If your cholesterol is dangerously high, you need to do something about it. If you’re not monitoring your health, you could do permanent damage to yourself. Additionally, we don’t want estrogen getting out of control, so it’s a good idea to keep an eye on that too. Or buy a bra. Whatever.
The ideal way we’d get these tests done is to go to your doctor and tell him (or her) what’s up—“Hey doc, I’m going to do come off steroids….” In my experience, most doctors are usually willing to oblige with some blood work and monitoring. If not, you can try another doctor until you find one willing to monitor your health. Remember, your doctor works for you, not the other way around.
I always start by getting labs at the beginning of the process and again in six to eight months after the last steroid dose. I do a quick i-STAT profile in my office, where I get a Chem-8 panel. It’s fast and cheap and gives me sodium, potassium, chloride, total carbon dioxide, anion gap, calcium, glucose, blood urea nitrogen, creatine, and lactate. I also do an in-office cholesterol test for LDL/HDL ratio since I have the equipment for studies and it’s inexpensive. I send a sample initially and at six to eight months for serum testosterone and estradiol, and, if he’s over age 35, I do a prostate-specific antigen (PSA). When I’m following athletes, the serum testosterone is my key guide to when normal levels have been reached. Normal serum testosterone in my lab is 241 to 847ng/dL, but I find most men under 55 will feel normal around 350 to450 ng/dL. I don’t usually follow free testosterone since it’s so variable. I will prescribe a course of 60 milligrams Evista (raloxifene) or 20 milligrams Nolvadex (tamifoxen). I usually begin this in the last week or two of the taper period. Anti-estrogens help avoid a large estrogen surplus during this interval. I also will use Proviron (mesterolone) in those with high estrogen levels since it has some androgenic effect and helps increase the androgen level, which helps the androgen/ estrogen ratio. If the estradiol level is still elevated at six to eight months, I will repeat a course of Evista at that time or earlier if the athlete has symptoms.
— Dr. Marvin A. Heuer, M.D. F.A.A.F.P.
Training And Diet
If you got big and strong doing squats, why in the world would you take them out of your routine and replace them with the Yes/No machine? If the 6–10 rep range is where you make the most gains, then why would you start doing sets of 15 when you cycle off steroids? If a high-protein, low-carb diet has made you huge and ripped, why would you do anything differently? Not only is it counterintuitive, but it’s going to put you in the worst situation possible. You’ve come off steroids, and now you’re taking the stuff that works out of your training program and off your dinner table. You’ve created the perfect storm of catabolism. The only cautionary note I’d give is that steroids have been shown to increase work capacity, so you may need to sacrifice some volume for the maintenance of intensity.
Deja Vu All Over Again
Back in 2005, I wrote an article that ended up being the most popular one I’d ever written. It was on PCT, and it’s been posted and published more times than I care to mention. But that was then, and it’s time to revisit some of those ideas, now that we have six more years of data to examine.
Originally, I had recommended three drugs—exemestane, tamoxifen, and human chorionic gonadotropin (HCG)—that had been proven to elevate testosterone levels in hypogonadal men. Those three drugs still work and probably represent a very good drug-based protocol, but they still put you on borrowed time: Ultimately, even though you’re not taking steroids, you’re still taking a drug. Our hope is that they kick-start the body into producing enough natural testosterone, that it “remembers” to keep it up once we’re off them. (If you want to see that full protocol, I’m sure you already know how to use Google—it’s the most widely published and republished PCT article on the web, so you shouldn’t have much difficulty in finding it.)
Summary
By now, you get the idea: Your transition into steroid-free gains should be as safe and healthy as possible. First, get your testosterone levels checked by a doctor. You’ll probably undergo a physical to determine your overall health and be monitored for your cholesterol level, triglycerides, and liver functions. Don’t change your training program, even if you feel that initial loss/dip of strength once you go steroid-free. Besides, that’s what a proper PCT is for.