Post-cycle therapy after short-term anabolic-androgenic steroid use: comparative outcomes in recreational...

To evaluate the clinical necessity and optimal pharmacological strategy for post-cycle therapy (PCT) in recreational anabolic-androgenic steroid (AAS) users with normal pre-cycle reproductive profiles.

This retrospective, dual-centre cohort study included 79 males who had completed ≤6 months of AAS use and had documented normal pre-cycle reproductive hormone levels and semen parameters. Participants were managed with no treatment (NT; expectant monitoring), clomiphene citrate (CC) monotherapy (25 mg/day; selective oestrogen receptor modulation to stimulate gonadotrophin release), or CC + human chorionic gonadotrophin (hCG) (25 mg/day CC + hCG 1500 IU subcutaneously three times weekly; rapid androgen repletion and testicular stimulation). In patients with follicle-stimulating hormone (FSH) <1.5 IU/L, recombinant FSH (rFSH; 75 IU subcutaneously three times weekly) was suggested to promote spermatogenesis. Linear mixed models and logistic regression analyses were used to evaluate group differences and predictors of recovery.

At baseline (T0), 89.9% of patients had erectile dysfunction and 69.7% exhibited azoospermia or severe oligozoospermia. Both pharmacological regimens accelerated hormonal recovery vs NT, with normalisation across groups by Month 6. Seminal recovery was significantly earlier in treated groups: at 12 months (T12), normozoospermia rates were 87.5% in CC + hCG, 69.2% in CC, and 58.6% in NT. Testicular volume increased ≥20% in 70.8% of CC + hCG vs 6.9% of NT. Combined therapy independently predicted normozoospermia (odds ratio [OR] 6.23, 95% confidence interval [CI] 1.32-29.4) and motility recovery (OR 4.85, 95% CI 1.27-18.4). All five men receiving rFSH achieved normozoospermia by T12. Sexual function improved across groups, with faster recovery in treated patients.

Spontaneous hormonal recovery occurs within 6-12 months after AAS cessation, yet PCT facilitates earlier hormonal normalisation. The addition of hCG to CC was associated with superior recovery of semen parameters and testicular volume. These findings underscore the potential short-term benefits of PCT and highlight the need for prospective randomised trials to establish evidence-based treatment protocols.