Follicle Stimulating Hormone

On AAS (FSH suppressed <0.5 IU/L):

• Expected and unavoidable -- exogenous androgens/estrogens suppress pituitary FSH secretion
• FSH suppression is the primary mechanism behind AAS-induced infertility (FSH drives spermatogenesis via Sertoli cells)
• HCG on cycle maintains intratesticular testosterone but does NOT replace FSH signalling for sperm production

For fertility recovery (critical if planning conception):

• Enclomiphene -- 12.5-25mg/day (stimulates both LH and FSH from the pituitary; first-line for fertility recovery)
• Clomiphene (Clomid) -- 25-50mg/day (stimulates FSH/LH; effective but more side effects than enclomiphene)
• Tamoxifen (Nolvadex) -- 20mg/day (stimulates FSH/LH; can be used alongside or instead of clomiphene)
• HMG (Human Menopausal Gonadotropin) -- 75-150 IU 3x/week IM (contains both FSH and LH activity; used when SERMs alone fail to restore spermatogenesis; prescription-only, expensive)
• Recombinant FSH (Gonal-F) -- 75-150 IU 3x/week SC (pure FSH; used in severe cases under fertility specialist supervision)
• HCG -- 1000-1500 IU 3x/week alongside FSH/HMG (provides LH activity to complement exogenous FSH)

Supplements (supporting FSH recovery):

• Zinc -- 30mg/day (supports gonadotropin signalling)
• Vitamin D3 -- 5000 IU/day (deficiency impairs reproductive hormones)
• Folate -- 800mcg/day (supports spermatogenesis and DNA integrity)
• CoQ10 -- 200-400mg/day (improves sperm quality during recovery)

Timeline for fertility recovery:

• Spermatogenesis cycle is ~74 days; minimum 3-6 months for meaningful recovery
• FSH must recover before sperm production can resume
• Semen analysis at 3, 6, and 12 months post-PCT to track recovery
• Some men recover within 6 months; others may take 12-24 months after prolonged AAS use
• If FSH remains suppressed after 6 months of PCT, fertility specialist referral is warranted

Important notes:

• Never rely on HCG alone for fertility -- it does not provide FSH
• The longer and heavier the AAS use, the longer FSH/fertility recovery takes
• 19-nor compounds (Nandrolone, Trenbolone) are associated with the most prolonged suppression

References:

• McBride, J. A., & Coward, R. M. (2016). Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use. Asian Journal of Andrology, 18(3), 373-380. DOI: 10.4103/1008-682X.173938
• Lee, J. A., & Ramasamy, R. (2018). Indications for the use of human chorionic gonadotropic hormone for the management of infertility in hypogonadal men. Translational Andrology and Urology, 7(Suppl 3), S348-S352. DOI: 10.21037/tau.2018.04.11
• Huijben, M., Lock, M. T. W. T., de Kemp, V. F., de Kort, L. M. O., & van Breda, H. M. K. (2022). Clomiphene citrate for men with hypogonadism: A systematic review and meta-analysis. Andrology, 10(3), 451-469. DOI: 10.1111/andr.13146
• Garrido-Maraver, J., Cordero, M. D., Oropesa-Avila, M., et al. (2014). Coenzyme Q10 therapy. Molecular Syndromology, 5(3-4), 187-197. DOI: 10.1159/000360101