Corticotropin (natural ACTH, Acthar Gel)
Corticotropin (ACTH 1-39), Purified Cortrophin Gel, Repository corticotropin
Forms: Acthar Gel and Purified Cortrophin Gel: natural ACTH in gelatin for slow release. Synthetic tetracosactide (Synacthen) has its own card.
Other esters and forms: Tetracosactide (synthetic ACTH, Synacthen)
A purified pig-pituitary extract, mainly porcine ACTH (1–39), in a slow-release gel. It makes the adrenals release cortisol; not a glucocorticoid itself, but prolonged use can cause cortisol excess.
Legal status: Prescription medicine, sold in the US as Acthar Gel and Purified Cortrophin Gel; varies by country. WADA S2 (corticotrophins): prohibited at all times.
What it gives
What people use it for and what the sources report. Strength is a general category from the literature: mild, clear or strong.
Purpose
Medical: infantile spasms, multiple sclerosis relapses and some rheumatic, skin, eye and lung diseases. Misused in sport to raise one's own cortisol in the hope of more energy, less fatigue and faster recovery. Prescription only.
What people seek and what studies show
Sought effects: more energy, less fatigue and less inflammation through higher cortisol. No performance study used corticotropin itself. With synthetic ACTH (tetracosactide), 8 trained cyclists showed no change in time-trial performance or perceived exertion versus placebo; studies of glucocorticoids themselves in athletes give mixed results.
Effects
No clear training effect in the sources.
Evidence: Approved medicine — studied in people for its medical use
Possible side effects
Possible does not mean certain: whether they appear depends on dose, duration, individual response and monitoring. Below — what to watch for and how to notice it early.
10 possible side effects
level · how often it is reportedWhat the levels mean
Level: general category from the literature, not your personal risk
How often
- common
- reported often
- possible
- reported in some people
- rare
- reported occasionally
How to lower the risks
For 7 of 10 possible side effects there are specific ways to lower the chance: everyday measures, supplements and options a doctor may consider. For the rest — general advice. No measure removes a risk completely.
After more than a few weeks of use, never stop abruptly: a doctor plans a gradual taper and may check morning cortisol. Tell any doctor treating you, especially before surgery or with a serious illness.
Strength and impact training, enough calcium and vitamin D from food, no smoking, enough energy for the training load (RED-S causes bone loss and stress fractures); with long-term use a doctor may order a bone density scan.
How each option helps (2)
- Calcium — With vitamin D it lowered stress fractures in female recruits; the IOC names it for athletes with low energy availability or menstrual problems, where bone health is at risk.
- Vitamin D3 — Low levels go with more stress fractures; with calcium it cut them in female navy recruits. The IOC names it with calcium for athletes with low energy availability or missing periods.
Sterile technique, never share needles, vials or pens; see a doctor for a hot, swollen site. If equipment was ever shared, test for HIV and hepatitis B/C and ask about hepatitis B vaccination.
More daily movement, fewer fast carbs, check fasting glucose and HbA1c.
How each option helps (7)
- Glucose monitoring — Rising fasting readings reveal insulin resistance from GH or other drugs early.
- Regular blood tests — Fasting glucose, insulin and HbA1c catch rising blood sugar early — key with GH, its secretagogues and insulin.
- Regular cardio training — Improves insulin sensitivity — useful against the blood-sugar rise from GH and its secretagogues.
- Working with a doctor — Interprets glucose markers and treats early metabolic problems.
- Berberine — Meta-analyses: lower fasting glucose and HbA1c (about 0.6% in type 2 diabetes); smaller effect when glucose is normal.
- Alpha-lipoic acid — Small drops in fasting glucose, insulin and HbA1c in meta-analyses; no real counter to GH- or insulin-driven resistance.
- Psyllium husk fiber — Slows sugar absorption: lower fasting glucose and HbA1c, mostly in people with diabetes.
Less salt, regular cardio, good sleep, home readings; if it stays high — a doctor, and a talk about maximal lifts.
How each option helps (19)
- Home blood-pressure monitoring — Persistently high resting readings mean seeing a doctor. For athletes, guidance prefers ARBs or ACE inhibitors, which don't limit exercise capacity; diuretics are banned in sport.
- Regular cardio training — In a meta-analysis of trials, endurance training lowered resting BP by about 8/5 mmHg in people with high BP and only slightly in those with normal BP.
- Working with a doctor — Diagnoses persistent hypertension and prescribes treatment when needed.
- Avoiding alcohol and other liver stressors — Regular drinking raises blood pressure; cutting it out lowers it.
- Coenzyme Q10 — Inconsistent: some analyses show a small systolic drop in cardiometabolic disease, but a Cochrane review found no clinically meaningful effect.
- Magnesium — Meta-analysis of 34 trials in adults, not athletes: about 2 mmHg lower systolic pressure on average.
- Magnesium aspartate — On average magnesium lowers blood pressure only slightly — not a substitute for a doctor's assessment of high pressure found at a sports check.
- Magnesium chloride — On average magnesium lowers blood pressure only slightly — not a substitute for a doctor's assessment of high pressure found at a sports check.
- Magnesium citrate — On average magnesium lowers blood pressure only slightly — not a substitute for a doctor's assessment of high pressure found at a sports check.
- Magnesium gluconate — On average magnesium lowers blood pressure only slightly — not a substitute for a doctor's assessment of high pressure found at a sports check.
- Magnesium glycinate (bisglycinate) — On average magnesium lowers blood pressure only slightly — not a substitute for a doctor's assessment of high pressure found at a sports check.
- Magnesium lactate — On average magnesium lowers blood pressure only slightly — not a substitute for a doctor's assessment of high pressure found at a sports check.
- Magnesium malate — On average magnesium lowers blood pressure only slightly — not a substitute for a doctor's assessment of high pressure found at a sports check.
- Magnesium orotate — On average magnesium lowers blood pressure only slightly — not a substitute for a doctor's assessment of high pressure found at a sports check.
- Magnesium oxide — On average magnesium lowers blood pressure only slightly — not a substitute for a doctor's assessment of high pressure found at a sports check.
- Magnesium taurate — Meta-analysis of trials: about 2 mmHg lower systolic pressure on average — too small to replace a doctor's assessment of high pressure found at a sports check.
- Omega-3 (fish oil, EPA/DHA) — Small drop of a few mmHg, mainly in people with untreated high blood pressure.
- Potassium — Meta-analysis of trials: about 3.5 mmHg lower systolic pressure on average, seen only in people with hypertension.
- Taurine — Meta-analysis of 20 small trials: about 4 mmHg lower systolic pressure on average.
Hand hygiene, enough sleep, vaccinations kept up to date (ask a doctor); no hard training or competing with fever; see a doctor early with fever or a wound that gets worse.
Sleep routine, no stimulants or caffeine (pre-workouts too) late in the day, magnesium or melatonin; late sessions and travel also disturb sleep.
How each option helps (16)
- Sleep hygiene — A steady routine and no late caffeine ease stimulant- and steroid-related insomnia; night sweats on trenbolone persist regardless.
- Glycine — Small trials show slightly better sleep quality and less next-day fatigue; not a sedative and not for anxiety.
- L-theanine — Small gain in subjective sleep quality; effects on anxiety are inconsistent. May smooth caffeine jitters but won't offset strong stimulants like clenbuterol.
- Magnesium — Three small, low-quality trials in older adults: falling asleep about 17 minutes sooner. No good data in athletes.
- Magnesium aspartate — In active men a zinc–magnesium aspartate product did not change measured sleep; in older adults three small trials found falling asleep about 17 minutes sooner.
- Magnesium chloride — Three small, low-quality trials in older adults: falling asleep about 17 minutes sooner. No good sleep trials in athletes.
- Magnesium citrate — Evidence that it improves sleep is weak, and there are no good sleep trials in athletes.
- Magnesium gluconate — Evidence that it improves sleep is weak, and there are no good sleep trials in athletes.
- Magnesium glycinate (bisglycinate) — In 155 adults with poor sleep, self-rated insomnia improved slightly more than on placebo (small effect). No data in athletes; it does not replace sleep habits.
- Magnesium L-threonate — Small industry-funded trials: some self-rated sleep measures improved; one found no change in tracker-measured sleep. No data in athletes.
- Magnesium lactate — Three small, low-quality trials in older adults: falling asleep about 17 minutes sooner. No good sleep trials in athletes.
- Magnesium malate — Three small, low-quality trials in older adults: falling asleep about 17 minutes sooner. No good sleep trials in athletes.
- Magnesium orotate — Evidence that it improves sleep is weak, and there are no good sleep trials in athletes.
- Magnesium oxide — Evidence that it improves sleep is weak, and there are no good sleep trials in athletes.
- Magnesium taurate — Three small, low-quality trials in older adults: falling asleep about 17 minutes sooner. No good sleep trials in athletes.
- Melatonin — Helps you fall asleep a little faster, especially with a shifted body clock; does not treat anxiety or night sweats.
Smaller meals, enough fluid and fiber, test race-day food in training first; a doctor for severe abdominal pain.
How each option helps (2)
- Working with a doctor — Assesses persistent vomiting or severe belly pain (possible pancreatitis or gallstones) and adjusts prescribed GLP-1 treatment when nausea persists.
- Pancreatin + dimeticone (Pankreoflat) — May ease heaviness and gas after meals; can cause nausea or diarrhea. Not for pork or cow's milk protein allergy (anaphylaxis reported) or early acute pancreatitis.
Stop and see an ophthalmologist at any vision change.
How each option helps (1)
- Working with a doctor — Vision changes on clomiphene, tamoxifen, isotretinoin, PDE5 or GLP-1 drugs need prompt review; several labels advise stopping, which may limit lasting harm.
Enough protein and energy for the training load, keep heavy training, avoid overly aggressive deficits — they cost strength and recovery (RED-S).
How each option helps (2)
- Essential amino acids (EAA) — With low protein intake, may lower the chance of muscle loss by supporting protein synthesis; whole protein works as well, and neither removes the risk of drug-driven catabolism.
- Whey protein — In a calorie deficit, enough protein may lower the chance of muscle loss; it does not remove the risk, especially with drug-driven catabolism (e.g. thyroid hormone).
Check-ups and blood tests
Which tests and check-ups to do and when. This is a guide — agree the exact schedule with a sports physician.
Which doctors can help
At home
- Home blood pressure: 2–3 times a week in the morning, keep a log
Get medical help at once if
- After stopping or missing it: severe weakness, vomiting, belly pain, dizziness or fainting, confusion — this can be an adrenal crisis; seek urgent care.
- Bone pain that worsens with running or jumping — stop impact training and see a doctor soon; groin or hip pain on impact — urgent check for a femoral-neck stress fracture.
- Sudden severe headache, vision changes, numbness or weakness on one side, trouble speaking — call your local emergency number.
- Sudden loss or blurring of vision, flashes, a curtain over sight — seek urgent care.
- Severe upper-abdominal pain spreading to the back, with vomiting (urgent amylase/lipase test); pain under the right ribs with fever or yellow eyes; vomiting with no stool or wind; blood in stool after a long race — seek urgent care.
- Fever with chills, fast breathing, confusion, or redness that spreads quickly — seek urgent care.
- A hot, red, swollen or pus-filled injection site with fever — signs of an abscess; see a doctor.
In an emergency, call your local emergency number.
For women
The label warns it may harm the fetus in pregnancy (growth restriction, adrenal suppression in the newborn). Use while breastfeeding needs a doctor's decision.
Myth & fact
“ACTH boosts endurance because it raises your own cortisol.”
In a placebo-controlled study synthetic ACTH did not change time-trial performance or perceived exertion in trained cyclists, while prolonged use brings the harms of cortisol excess.
Combinations
No specific combination notes for this substance yet. The stack check still adds up side effects that several substances share.
Sources
Possible side effects by body system, combinations, how to lower the risks and which tests to do — free.
Open the stack check