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A concern about anabolic steroid use is the resulting suppression of natural testosterone production. During an anabolic steroid cycle itself, this suppression is unavoidable and isn’t necessarily a problem. However, extended post-cycle suppression results in loss of gains and can result in adverse side effects such as depression and loss of libido. In contrast, where recovery of natural testosterone production is rapid, adverse effects on mood or libido can be reduced or eliminated, and retention of gains can be excellent. Post-cycle therapy (PCT) with Nolvadex was introduced specifically to enable faster recovery.
To understand how Nolvadex can speed recovery, it’s important to understand how inhibition occurs, and how it may be reversed by a selective estrogen receptor modulator (SERM) such as Nolvadex.
Testosterone production is regulated in a chain process. The testes produce testosterone according to the amount of LH the pituitary produces. The pituitary produces LH according to the amount of LHRH the hypothalamus produces, as well as other factors. And the hypothalamus produces LHRH according to the current amount of estrogen and androgen in the blood, as well as other factors.
Off-cycle, estradiol will typically be the most important estrogen in this process and testosterone the most important androgen, but in an anabolic steroid cycle, the androgen could be any anabolic steroid.
For the moment, we’re going to assume that in an individual testosterone and estradiol are in a fixed ratio to each other. This usually is approximately true, because estradiol is produced from testosterone. When we look at things this way, then we’ll take it that when testosterone rises or falls, estradiol will rise or fall as well.
In the normal condition - while not using anabolic steroids and being in good health - this process results in a balance where testosterone and estradiol remain in the normal range. If briefly they were to go relatively high for the individual, LHRH and LH production would decrease, reducing testosterone production and normalizing the levels.
It’s also the case that if estradiol level is low - or more precisely is activity at the estrogen receptor is low - the hypothalamus will produce more LHRH in response. This gives more LH, and more testosterone.
What happens in an anabolic steroid cycle? Here, the hypothalamus will always sense abnormally high androgen, and may sense abnormally high estrogen as well. It therefore shuts down LH production, so testosterone production shuts down as well.
Again, that’s inevitably going to happen, and in and of itself doesn’t have to be a problem.
But what about post-cycle? After levels of injected or oral androgen have dropped, shouldn’t LH production promptly resume? Androgenic inhibition will have ended.
Unfortunately, often that won’t happen. As mentioned, besides the current androgen and estrogen levels there are other factors involved in the regulation of LHRH and LH production. The androgen and estrogen levels of preceding weeks are important as well. After the exposures involved in a steroid cycle, androgen and estrogen levels falling back to normal may not by itself be enough for LH production to restart, even if estradiol levels are normal.
Now - finally! - is where Nolvadex comes in.
By occupying the binding site of estrogen receptors of a cell without activating them, Nolvadex prevents these receptors from being activated by estradiol. The cell then “thinks” that estradiol levels are very low, and responds accordingly.
In the case of the hypothalamus, it then produces more LHRH in response to apparently very low estrogen. This stimulates the pituitary to produce LH, which in turn stimulates the testes, restoring testosterone production.
All of the good protocols first use a higher dose, and then an ongoing lower dose of 20 mg/day. The reason for this is that when taking the drug, the amount in one’s system isn’t simply the amount just taken, but also a buildup of about six days’ worth from previous dosings. At the start of usage that buildup isn’t there, and neither will the efficacy unless this is accounted for. If not accounted for, it takes weeks for levels to build up.
One method of correcting for this is to take a total of 120 mg on the first day, as three doses of 40 mg. This promptly gets levels to about the same as would eventually be arrived at with 20 mg/day dosing. After this, dosing is the standard 20 mg/day.
Another method to quickly obtain proper levels is to use double dosing for a limited time. I recommend only four days of it, as that is all that is needed, but many authors recommend two weeks. (This however overshoots the levels that result from ongoing 20 mg/day use.)
Dosing should continue until confident that natural testosterone production has been fully restored. It’s reasonable to plan for 30 days’ use, but more or less may be needed.
Please do realize that using more Nolvadex than the above does not give better results. Thee is absolutely no reason to use more than I’ve recommended. Doing so can only worsen side effects.
Side effects even at correct dosing can include vision disturbance and reduction of libido. If vision disturbance is experienced, Nolvadex use should be discontinued immediately and an anti-aromatase such as Arimidex or letrozole should be used instead.
If libido is reduced, the problem is only temporary. On future occasions, Clomid might be tried as an alternate SERM, because it can be more favorable in this regard.
There is generally no reason to combine SERMs: for example, generally Clomid or Nolvadex should be used as the sole SERM, rather than in combination with each other. However, in some difficult cases it can be beneficial to use both Clomid and Nolvadex simultaneously, but at half-doses of each. While at the hypothalamus there is likely no difference between Clomid alone, Nolvadex alone, or both together at half dose, at the pituitary Clomid and Nolvadex work oppositely, so the combination differs from either alone. (It is from Dr. Scally that I learned the benefit of combining in some instances.)
Prior to the advent of affordable anti-aromatases, Nolvadex was also popular as an anti-gynecomastia agent. Today, it’s best to use an anti-aromatase as a preventative, but if gyno symptoms flare up during a cycle, immediate treatment with Nolvadex can be helpful. Dosing for this use is as with PCT.
Tamoxifen citrate is the chemical name of active ingredient in Nolvadex. Nolvadex is a registered trademark of AstraZeneca UK Limited in the United States and/or other countries.
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