1. Introduction to Steroid Cycles

Steroids are most often used for two main purposes. They are used by athletes, gym-goers, and bodybuilders in off-label ways to enhance performance, promote muscle repair and growth, and improve physical appearance. Steroids, particularly androgens like testosterone, are also used in medicine. Steroid cycles are when users use multiple steroids in conjunction with one another, or even combine steroids with other drugs. Either act creates a synergistic environment, which increases their abilities to be ergogenic. In this regard, a steroid cycle is either an on- or off-label medical treatment or a health-related procedure.

Using steroids improperly, regardless of mode, creates a potential for adverse side effects. These can be effectively, and often mostly safely, managed by professionals. With or without professional management, the risks are generally minimized by using the lowest effective doses for the shortest effective time. For these reasons, precautions are put in place by both athletes and physicians or manufacturers. Steroid users adopt complicated regimens and stacks aimed to reduce or eliminate side effects as much as safely possible. Manipulating a steroid cycle schedule in a way that does not increase or decrease steroid dosage over time is called pyramiding, while crossing several different steroids cyclically by stacking them can offer theoretically greater results with less overall use and potentially, though not necessarily, reduced side effects over time.

Intriguingly, and due to a confluence of factors, some prescriptions and guidelines for off- and on-label measures either avoid post cycle therapy or recommend divergent measures to mitigate side effects. Post cycle therapy is obviously necessary for effective and responsible androgen or steroid use in literally all scenarios. A keyword search in all available references for the same guideline or drug shows that the occurrence of "PCT" is generally very low.

1.1. Definition and Purpose of Steroid Cycles

Steroid cycles define the strategic approach of using multiple steroids in an organized manner for a certain period of time to achieve specific bodybuilding, athletic, or aesthetic goals. Generally, the completion of the on-cycle is followed by a Post Cycle Therapy regimen to mitigate potential adverse effects associated with the use of anabolic steroids, rising endogenous hormone levels, and enabling the natural hypothalamic-pituitary-gonadal axis to recover from a period of inactivity resulting from steroid use. Anabolic steroids are commonly used as part of these cycles to primarily increase muscle growth, body strength, and physical capabilities.

There are various types of steroid cycles that range from short cycles of 4 weeks to long cycles of 8-12 weeks. Members also commonly stack different types of anabolic steroids to work together in achieving a desired outcome, such as bulking, cutting, increasing strength and size, etc. The use of one main steroid supplemented by another one or two is common, and each stack combination is specific for a certain goal or target. Steroids considered include testosterone derivatives, dihydrotestosterone derivatives, nandrolone derivatives, drostanolone, stanozolol, methandienone, oxandrolone, and more. Because of the types of results anabolic steroids produce, their use is popular across various demographics—from competitive athletes seeking enhancement for performance and physique to individuals attempting to improve their body aesthetics through physique changes. These forms of abuse are illegal and can have serious legal and health implications. In terms of bodybuilding and athletic preparations, individuals are advised to maximize benefits while controlling for side effects through proper planning and execution of anabolic steroid cycles.

2. Mechanism of Action of Anabolic Steroids

Anabolic steroids are a group of synthetic derivatives of testosterone that exert their effects on the human body through interaction with androgen receptors. The most beneficial effects exerted by these drugs are androgenic, such as the increase of muscle mass and strength, as well as the reduction in body fat. One of the most important concerns during their use is the systemic alteration of multiple hormonal functions for which they are responsible. Every steroid has its own steroid receptor formation action.

The most important hormone is testosterone, which is called the king hormone. It is aromatized to 17-beta estrogen or to dihydrotestosterone by an aromatase enzyme. Dihydrotestosterone is a more powerful androgen than testosterone. The action of steroid hormones destroys the anabolic enzymes in the lysosome of the muscle membrane. Lipid systems produce the structure of the lysosome. So anabolic steroids can lead to more anabolic effects, that is, growth, because of the increase in the number of cell constituents, such as protein. In a sense, this effect is like consuming amino acid preparations. Protein is the fundamental basis for muscle and body growth, and anabolic steroids are a vital means of promoting protein synthesis.

2.1. How Anabolic Steroids Affect Hormone Levels

Anabolic steroid use can raise the individual’s free and total testosterone levels. The steroid user experiences these elevated testosterone levels in various tissues, such as muscle and brain cells. Testosterone is a primary sex hormone, with testosterone-receptor complexes exerting varied positive effects on physiology, ergogenic performance, subjective well-being, and body composition. Anabolic steroid-induced changes in testosterone levels initiate negative feedback mechanisms in the endocrine system, which generally function to regulate or oppose hormonal fluctuations. The primary feedback mechanisms are known as the hypothalamic-pituitary-gonadal axis. The hypothalamus, pituitary, and testes form distinct circulatory, cellular, and hormonal feedback loops, all of which regulate circulating gonadal hormones.

Hormonal imbalances can occur if the feedback loops are interrupted or unopposed, either during steroid administration or after withdrawal from steroid use. The longer the exposure to elevated and/or super-physiological testosterone levels, the greater the risk for super-suppressed testosterone levels upon steroid exposure cessation. Furthermore, long-term anabolic steroid users may experience difficulty in regaining the physiological baseline if steroids were used peripherally in adults when exogenous steroids are triggering negative feedback primarily in the hypothalamus. Hormonal changes in steroid users could have implications not only for their reproductive health but also for multiple other systems in the user’s body. Understanding the physiological basis for hormone and feedback alterations in steroid users provides context for early intervention and prevention of permanent alterations to the endocrine system. In addition, it helps to justify and rationalize post-cycle therapy after steroid cessation in the clinical population.

3. The Concept of Post Cycle Therapy (PCT)

When running a course of anabolic steroids, many believe that the moment you finish the last injection or take the last tablet, that is the end of the cycle. This is completely false, as there is one final aspect of the process to consider, and possibly the most important of all: post cycle therapy, or simply PCT. It must be understood that the use of anabolic steroids can suppress the natural endogenous production of hormones. As these exogenous hormones dissipate from the body, the user will remain in a suppressed state as the body’s pituitary gland will be instructed to suppress the release of endogenous LH and FSH. These hormones are very important as they are the signal to instruct the testicles to produce testosterone. Without this signal, testosterone production will be suppressed considerably. The purpose of PCT is to stimulate the natural production of these hormones and signal the beginning of their recovery. By doing so, one will be able to maintain any gains made on the cycle, as well as reduce potential side effects from the suppression.

As with everything in life, timing is imperative, and this is especially so when it comes to PCT. Many will ask themselves what the ideal time period is to wait before commencing the therapy, and the answer is simply that as soon as the exogenous hormones used in the cycle have cleared, PCT can and should be commenced. The ideal protocols of PCT will depend greatly on various factors. This means that users must learn the traditional protocol for their forms of anabolic steroids, how they are 'supposed' to perform, and the impact that such steroids might have on half-life and therefore clearance times of the drugs before engaging in PCT. It’s not just about hormone levels; psychologically, the user may need to work towards making the transition from a state of enhanced 'highs' back down to the natural state.

3.1. Definition and Goals of PCT

Post Cycle Therapy (PCT) is the recovery phase that follows anabolic steroid use. This time span is primarily focused on restoring the natural hormonal background of a person who used anabolic steroids and preventing, to the maximum possible extent, various side effects of anabolic steroid use. Although there are no concrete clinical definitions of PCT, there are various signals that can be used to gauge when to start this recovery phase. The closure of the pituitary-hypothalamus-testes axis by a cycle of steroids is usually the main signal for starting PCT.

The primary purpose of Post Cycle Therapy is simplistically restoring the body’s natural hormonal settings to their standards. There are two fluctuating hormones, namely estrogen and testosterone, the equilibrium of which should be pivotal for overall health and well-being. As noted, the target of PCT is hormonal balance. In the restoration of steady hormone levels, the treatment focuses on preventing the aromatase enzyme that catalyzes the biosynthesis of estrogen and also on the rejuvenation of testosterone production. The timing of the two components is not exactly the same as stopping the steroid. After the steroid, gonadotropin-releasing hormone (GnRH) release is halted, and the luteinizing hormone (LH) decreases due to the hypothalamic stage of steroids, which signals the end of natural testosterone production. Then, the hormonal decline could proceed to the luteinizing hormone (LH) lineage, as a 'father' of natural testosterone, thus dropping testosterone levels. PCT should be begun only if the bodily system stimulated by hormones is finally empty and able to return to normal.

It is complicated and generally individualized therapy. It takes time for the body's natural processes to spring back, depending on the quantity, the drug form, and the duration. A 2,000 to 8,000-milligram dose begins its own creation and returns to a typical 100 mg stage for the interval studied in the body, but the result varies widely among individuals. An initial time period of 25-30 percent of the duration of the preceding steroid cycle is proposed for most people. If, for instance, a person utilizes steroids for three months, it would be possible for the central nervous system (CNS) to be affected at any time following the end of the third phase to respond, with frequent care beginning about a month after that. Estimating the condition of the person at this stage, also three weeks, is a good timetable, but other possibilities can also be predicted. A qualitatively based approach to the protocol of post-cycle therapy is suggested. Keep in mind that the drug should absolutely be stopped until the post-cycle therapy starts. Trying to restore testosterone development while drugs are eliminated from the system has a strictly altered hormone production effect. The body normally creates substantial amounts, thus decreasing the total clinical gain. If large extracellular estrogen levels are filtered into the receptors, there is minimal chance.

4. Benefits of Post Cycle Therapy

Post Cycle Therapy (PCT) is accompanied by a number of benefits that recuperate the system over time and contribute to leading a healthy and progressive life. Given below are some benefits of PCT that ought not to be overlooked at any cost.

1. It Protects Hormonal Balance

After the function-suppressing run of steroids is over, post cycle therapy holds its fort, helping the entire system to perform in the same way as it has always been. It transforms a man coming off hormones into a man whose system is recuperating on the road to recovery.

2. It Keeps the Gains Made Sustainable

So, even after cutting off all the hormone additives, the user will notice a little loophole in the system called the “PCT time.” Three months down the line, one will find the hormone system to be in a much better place.

3. It Alleviates Hormone Withdrawal Psychosis

Like when doing anything abruptly, the body is not going to understand what has hit it. And so, a man comes off steroids, and the body releases its own hormone factory but feels suspended because it’s not receiving any more steroid support. None of that happens while a person is doing post cycle therapy, allowing the system to sink into ebbs and flows at appropriate times.

4. Speedy Restoration of General Well-Being

When the suppressed hormone therapy is brought back, the user’s interest levels drop down. In other words, the hormone gives the user his appetite levels back at week three. Hence, it is additionally responsible for letting go of attached toxins passing out via a sense of desire for food.

5. Health Benefits for the Long Term

Missing out on the benefits of post cycle therapy, if left untreated, will definitely blossom into a myriad of unknown issues, one being cardiac attacks in old age. Lastly, to sum it up, these reviews have provided a wide understanding of the term in complete abundance. As far as further suggestions are concerned, the word of advice for all-around awareness is to take care with steroid therapy. With many processes involving drugs or undesirable steroids, care must be taken to use cutting-edge research-backed options in PCT. Yes, it is mandatory, not merely optional.

4.1. Protecting Hormonal Balance

The accomplishment of post cycle therapy following exogenous steroid use is fundamentally vital for the proper restoration of the hormonal production of the body. When steroid use is carried out, the androgenic-anabolic steroid compounds suppress the normal production of natural hormones to a significant extent. Various hormonal disturbances may occur that require proper intervention over time, leading to a full hormonal restoration of the body. The main goal of post cycle therapy is to use medications and compounds to restore the proper levels of endogenous hormones during the recovery phase. While the primary focus will be on the HPTA, the endocrine system as a whole must be assessed on a regular basis during post cycle therapy.

Restoring proper testosterone production can take a prolonged period of time and puts an individual at considerable medical risk if the process is haphazardly taken. Post cycle therapy is a combination of medications used during or after a steroid cycle to protect a user's hormonal balance and regularize their metabolism. Overall, PCT and post cycle therapy are basically the same; the terms simply differentiate when recovery is suffused within the regime. More specifically, putting someone's hormones back to their pre-steroid levels signifies a hormone restoration cycle, one in which the body should function as it did prior to the anabolic steroid consumption that initially placed the person's endocrine system into a suppressed state that required recovery in the first place. The use of some form of exogenous testosterone treatment overpowers a post cycle therapy goal and cannot rightly be called a PCT due to this reason.

5. Common Strategies and Medications Used in PCT

Post cycle therapy (PCT) commonly involves the use of drugs to help kickstart the body’s natural testosterone production after a cycle. Drugs such as Clomiphene citrate and Tamoxifen citrate, which are selective estrogen receptor modulators (SERMs), are usually administered for this purpose. SERMs have strong anti-estrogenic properties in some tissues but act as estrogen agonists in others. They encourage an increase in follicle stimulating hormone (FSH) and luteinizing hormone (LH) in the pituitary, which are hormones that act on the Leydig cells in the testes, stimulating the production of testosterone. The administration of an aromatizable steroid or HCG during the cycle may also stimulate natural testosterone production.

There are many different strategies that can be used in post cycle therapy. The timing of the PCT will vary with the ester of the esterified steroid and the release of its active ingredients in the body. The composition and length of the steroid cycle will also play a big role in the strategy of the PCT. The dosages of the medications used and the length of their administration will also vary depending on the steroid treatment used, the dose of the steroid taken, the length of the steroid cycle, the metabolic processing of the individual, the experience of usage, and the body's tendency to produce natural testosterone in the absence of anabolic/androgenic steroid stimulation. Some people are quick to recover, while others find it a little harder. It is important to remember that the recovery of the HPTA after a steroid cycle is very complex and each individual will recover at their own pace. In fact, even after waiting and eating properly, some individuals will need a lot of medical treatments and some will even have to do two or three PCT cycles with different drugs to maintain what was started in the first post cycle therapy cycle.

5.1. Selective Estrogen Receptor Modulators (SERMs)

Selective Estrogen Receptor Modulators (SERMs) have become extremely popular in recent decades as basic tools for post cycle therapy (PCT), performing one of the most vital tasks during the recovery period. SERMs act by selectively binding to estrogen receptors, inhibiting the effects of estrogen production and helping in the restoration of testosterone levels in men who have temporarily shut down endogenous production by using anabolic steroids. Especially during a recovery period, a suppression of estrogen will lower the likelihood of a user experiencing the common side effects of carrying too low estrogen levels. By inhibiting the undesired estrogen effects, these compounds lower the risks a user faces when coming back to his natural physiological settings. It is for this reason that the use of SERMs has become extremely common. The use of anabolic steroids shuts down the natural production of testosterone that belongs to the consumers. Post Cycle Therapy at that time is essential to bring your body back to its normal state, and it includes different types of SERMs.

By suppressing excessive estrogen production in the course of recovery, side effects such as gynecomastia (abnormal enlargement of the mammary glands), water retention, and increased fat deposits can be significantly minimized. After coming off anabolic steroids, the body takes time to recover natural testosterone production. The inhibition produced by anabolic steroids might lead to a low testosterone level at which it eventually converts to estrogen in the male body. This is called estrogen rebound; prolonged retention of excessive estrogen might lead to insufficient recovery of testosterone levels. Ultimately, this will lead to minimal therapeutic results. They can help to stimulate the necessary hormones and nullify this problem. These are vital because they suppress the production of testosterone by prohibiting adverse issues such as gynecomastia, depression, and water retention. The most common SERMs are Nolvadex and Clomid. Both substances possess unique features which can help a person recover from an anabolic steroid cycle by employing one of them together with a highly effective protocol. Most look to draw from these stimulant-like benefits.

6. Conclusion and Future Perspectives

The present literature has deliberated the importance of post-cycle therapy (PCT) to understand the hormonal impacts of anabolic-androgenic steroids (AAS) and to familiarize gym-goers, bodybuilders, and steroid users with the significance of an equipoised PCT protocol to recover their hypothalamic-pituitary-testicular axis (HPTA) functioning, sex hormone production, and metabolic capacity. From the early 20th century to today, AAS use is very common for achieving physical, professional, and physiological targets. The prolonged and heavy doses and duration of AAS disturb the natural feedback regulation of the HPTA and reduce the endogenous sex steroid levels. PCT protocols help to normalize the HPTA axis and natural sex steroid production after stopping long-term steroid use. Equipoised PCT helps to recover normal hormonal levels, which improve recovery, reduce infertility, metabolic syndrome, and cardiovascular problems.

A large amount of AAS is used by sportsmen for doping and reproductive benefits. Many sports governing bodies and regulations discourage AAS abuse and ban them. This manuscript aims to motivate all concerned stakeholders from gyms, rehabilitation centers, and sports governing bodies to engage in the development of clearer HPTA functions and additional recovery techniques and investigations on AAS users. In the near future, it is mandatory to make athletes aware of the latest trends and hazards of anabolic steroid abuse, as only limited evidence is available on different populations. A more comprehensive analysis with reference to target populations is needed to improve the benefits of AAS, measure patient modality needs, and discuss the ethical problems and side effects of long-term AAS use or withdrawal. Simultaneously, the evaluation of more PCT agents and hormones, as well as modifying hormones to improve HPTA recovery and natural steroid status in gym users and bodybuilders, is the need of the time.