Clomid®* for PCT: Can It Restore Testosterone After Quitting Steroids?

For nearly two decades, Jason Carr took steroids—unmonitored, anabolic hormones—to achieve his dream physique. Back then, Carr didn’t worry about the increased risk of cardiovascular disease, hormone imbalances, and mental health disorders that came with the injections. But when he quit steroids cold turkey seven years ago, he learned his years of steroid use had wrecked his body’s testosterone production. He started feeling unshakeable fatigue, insomnia, and depression. He believes that this hormone crash may have been dampened by doing post-cycle therapy (PCT) with a medication like clomiphene citrate (sold under the brand name Clomid®*). 

Like many men who take anabolic steroids, Carr, now 46, periodically “cycled” on and off the illicit injections. This strategy can minimize short-term side effects, but it doesn’t offset the damage from long-term use. Anabolic steroid abuse disrupts the body’s hypothalamic-pituitary-gonadal (HPG) axis, the system that regulates testosterone production. This leaves some men permanently unable to produce testosterone, even after quitting steroids.

“The longer you’ve been on anabolic steroids and the higher the dose, the harder it is for you to recover naturally,” urologist Thomas Masterson, M.D., says.

Post-cycle therapy (PCT) with clomiphene citrate jumpstarts testosterone production—and may even help men leave steroids behind for good.

Carr regrets not turning to PCT after quitting steroids. “I destroyed my endocrine system,” Carr says. “I knew I had caused [low testosterone] by not going to a doctor to make sure my hormones were healthy.”

About the Experts

Thomas Masterson, M.D., is a board-certified urologist specializing in male reproductive and sexual medicine.

James R. Staheli, D.O., is the Medical Director for Broad Health, Hone Health’s affiliated medical practice, and a family medicine doctor specializing in men’s hormone health.

Anabolic Steroids and Testosterone Production

To understand how your body produces testosterone, think of your brain as a thermostat and your testicles as a heater, Masterson suggests. When your house gets cold, the thermostat signals the heater to turn on. When your testosterone levels drop,  your brain signals your testicles to make more. But if you’re getting heat from another source—like a fireplace—the thermostat senses it and doesn’t signal the heater. 

“The same thing happens when you’re doing steroids,” Masterson explains. “Your brain senses that the testosterone levels are high, so it’s no longer sending the signal to the testicles to work,” Masterson says. 

Over time, this shutdown can cause your testicles to atrophy and stop producing testosterone altogether. Once that happens, it can take months—or years—for the HPG axis to recover. In some cases, testicles never regain full function. 

The most common side effect experienced by former steroid users is Anabolic steroid-induced hypogonadism (ASIH), also known as chronic low testosterone, or low T, says men’s hormone specialist James Staheli, D.O. A 2023 study in the journal Substance Abuse Treatment, Prevention, and Policy found that 91 percent of men who stop anabolic steroids develop at least one symptom of low testosterone. The most common are fatigue, low libido, and low mood (1). “If you just quit steroids cold turkey, you’re going to feel pretty terrible,” Masterson says. 

For many men, these symptoms can lead to work performance issues, relationship problems, depression, and extreme weight gain. These challenging mental and physical tolls can make it even more difficult for men to decide that quitting steroids—for good—is the right decision. 

Clomid® for PCT: How Does it Work?

If you are thinking about stopping steroids and worried about developing low testosterone symptoms, clomiphene citrate may help. The same 2023 Substance Abuse Treatment, Prevention, and Policy study found that post-cycle therapy with the medication reduced the urge to restart steroids and curbed withdrawal symptoms by 60 percent (1).

Clomiphene citrate is a selective estrogen receptor modulator (SERMs) (2), which means it blocks estrogen receptors in the brain. “It tricks your brain into thinking that your estrogen and, by proxy, testosterone levels are lower than they actually are,” Masterson says.

When your brain detects low estrogen and testosterone levels, it starts producing luteinizing hormone (LH) and follicle-stimulating hormone (FSH) (2). These hormones—which are part of the HPG axis—tell your testicles to start making testosterone and sperm. “Clomiphene citrate can help restore the HPG axis, leading to higher testosterone levels (3),” Staheli says. 

The Journal of the Endocrine Society study found that men who used post-cycle therapy with SERMs achieved normal testosterone levels faster than those who quit steroids without them  (4). Whether you can maintain those levels without medication depends on how much permanent HPG axis damage has been done, Staheli notes. 

TRT AFTER STEROIDS

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Risks of Post-Cycle Therapy

When prescribed and monitored by a doctor, taking clomiphene citrate to restore healthy testosterone levels has no long-term risks (5). However, short-term side effects like blurred vision, mood changes, and breast tenderness can happen while your body adjusts to the medication. 

It’s important to understand that post-cycle therapy won’t reduce the risks that come with continuing to take steroids. It can only help you recover once you’ve fully quit, Staheli says.

Other Post-Cycle Options

Clomiphene citrate is one of the most common medications used in post-cycle therapy to boost low testosterone. But it’s not the only choice for balancing hormones after anabolic steroid use. 

Testosterone replacement therapy (TRT)

Testosterone replacement therapy (TRT) can also raise testosterone levels impacted by steroid use. TRT gives hormone levels a direct boost and is more effective at treating low testosterone than clomiphene, according to a 2017 study (6). For most men who have low testosterone because of previous anabolic steroid use, TRT can bring testosterone levels into a healthy range and relieve symptoms of ASIH. 

TRT, which has to be prescribed and monitored by a doctor, doesn’t carry the increased risks of overall mortality, cardiovascular disease, and mental health issues that steroids do (7). 

One instance where clomiphene is a better option for PCT than testosterone replacement therapy? If you’re thinking of starting a family. TRT suppresses sperm production, which can make it difficult to conceive. On the other hand, clomiphene citrate boosts sperm production by kicking your body’s natural testosterone production into gear. 

Clomid® with testosterone replacement therapy

In most cases, clomiphene works well on its own to boost testosterone levels in men with ASIH, according to Staheli. But if the HPTA axis is severely damaged, the medication may be prescribed alongside TRT. 

On twice-weekly TRT injections, Carr’s total testosterone increased to 300 ng/dL, but he still had low testosterone symptoms. Once his Hone doctor added clomiphene citrate to his protocol, his levels stabilized between 400 and 600 ng/dL, and his symptoms completely resolved. “I’m alert. I’m focused. I’m awake, and I’m energized for the first time in a long time,” Carr says. 

*CLOMID is a registered trademark of Cosette Pharmaceuticals and is not affiliated with Hone Health.