Best HCG Dose for Men on TRT: Two Studies That Used HCG with Testosterone

Note:HCG mimics LH but it is not LH and it's not picked up by the LH blood test. In fact, it suppresses LH like endogeneous testosterone does. But the amazing thing that the study below found is that HCG can increase sperm production and quality even in the absence of LH AND FSH. Most researchers believed that without FSH there was no possible sperm production.

The second study shows that testosterone inside the testicles (instratesticular testosterone or ITT) has to reach a certain amount for Sertoli cells to "wake up" to produce sperm. TRT actually decreases testosterone inside the cells by an unknown mechanism. HCG doses under 300 IU along with TRT may not normalize intratesticular testosterone since 250 IU produced an ITT 7% below baseline. 500 IU produced ITT 25% above normal. The Baylor study below used the 500 IU dose.

Conclusion: Do not use anything below 500 IU if you want to normalize your ITT while on TRT. No studies have been done on twice per week injection frequency, but that dose may work to prevent testicular atrophy (anecdotally). Three times per week or more may be needed to preserve fertility while on TRT. However, 33% of men (mostly older and who have been on TRT the longest prior to introducing hCG) do not respond as well to TRT+hCG when it comes to sperm quantity and quality. Those men may be better off on hCG+FSH.



Testosterone+ HCG Preserves Healthy Sperm in Men on Testosterone Replacement Therapy (Injections and gels)

Tung-Chin Hsieh, Alexander W. Pastuszak, Kathleen Hwang and Larry I. Lipshultz*,†

From the Division of Urology, University of California-San Diego (TCH), San Diego, California, Scott Department of Urology, Baylor College of Medicine (AWP, LIL), Houston, Texas, and Department of Urology (KH), Brown University School of Medicine, Providence, Rhode Island


Purpose: Testosterone replacement therapy results in decreased serum gonadotropins (hormones produced by the pituitary gland- LH and FSH- that jump start testicular function) and intratesticular testosterone (inside the testicles), and impairs spermatogenesis (sperm production), leading to azoospermia (no viable sperm) in 40% of patients. However, intratesticular testosterone can be maintained during testosterone replacement therapy with co-administration of low dose human chorionic gonadotropin, which may support continued spermatogenesis in patients on testosterone replacement therapy.

Materials and Methods: We retrospectively reviewed the records of hypogonadal men treated with testosterone replacement therapy and concomitant low dose human chorionic gonadotropin(HCG). Testosterone replacement consisted of daily topical gel or weekly intramuscular injection with intramuscular human chorionic gonadotropin (500 IU) every other day. Serum and free testosterone,estradiol, semen parameters and pregnancy rates were evaluated before and during therapy.

Results: A total of 26 men with a mean age of 35.9 years were included in the study. Mean followup was 6.2 months. Of the men 19 were treated with injectable testosterone and 7 were treated with transdermal gel. Mean serum hormone levels before vs during treatment were testosterone 207.2 vs 1,055.5 ng/dl (p<0.0001), free testosterone 8.1 vs 20.4 pg/ml (p = 0.02) and estradiol 2.2 vs 3.7 pg/ml (p = 0.11). Pretreatment semen parameters were volume 2.9 ml, density 35.2 million per ml, motility 49.0% and forward progression 2.3. No differences in semen parameters were observed during greater than 1 year of followup. No impact on semen parameters was observed as a function of testosterone formulation. No patient became azoospermic during concomitant testosterone replacement and human chorionic gonadotropin therapy. Nine of 26 men contributed to pregnancy with the partner during followup.

Conclusions: Low dose human chorionic gonadotropin appears to maintain semen parameters in hypogonadal men on testosterone replacement therapy. Concurrent testosterone replacement and human chorionic gonadotropin use may preserve fertility in hypogonadal males who desire fertility preservation while on testosterone replacement therapy.

**************************

Low-Dose Human Chorionic Gonadotropin Maintains Intratesticular Testosterone in Normal Men with Testosterone-Induced Gonadotropin Suppression





Coviello AD, et al. J Clin Endocrinol Metab. 2005.

Abstract

In previous studies of testicular biopsy tissue from healthy men, intratesticular testosterone (ITT) has been shown to be much higher than serum testosterone (T), suggesting that high ITT is needed relative to serum T for normal spermatogenesis in men. However, the quantitative relationship between ITT and spermatogenesis is not known. To begin to address this issue experimentally, we determined the dose-response relationship between human chorionic gonadotropin (hCG) and ITT to ascertain the minimum dose needed to maintain ITT in the normal range. Twenty-nine men with normal reproductive physiology were randomized to receive 200 mg T enanthate weekly in combination with either saline placebo or 125, 250, or 500 IU hCG every other day for 3 wk. ITT was assessed in testicular fluid obtained by percutaneous fine needle aspiration at baseline and at the end of treatment. Baseline serum T (14.1 nmol/liter) was 1.2% of ITT (1174 nmol/liter). LH and FSH were profoundly suppressed to 5% and 3% of baseline, respectively, and ITT was suppressed by 94% (1234 to 72 nmol/liter) in the T enanthate/placebo group. ITT increased linearly with increasing hCG dose (P < 0.001). Posttreatment ITT was 25% less than baseline in the 125 IU hCG group, 7% less than baseline in the 250 IU hCG group, and 26% greater than baseline in the 500 IU hCG group. These results demonstrate that relatively low dose hCG maintains ITT within the normal range in healthy men with gonadotropin suppression. Extensions of this study will allow determination of the ITT concentration threshold required to maintain spermatogenesis in man.

MORE ON HCG:

The Use of HCG to Prevent / Reverse Testicular Shrinkage and Preserve Fertility

The use of human chorionic gonadotropin (hCG) in combination with testosterone replacement therapy (TRT) is a strategic approach to preserve fertility in men undergoing TRT, particularly those with hypogonadism. The effectiveness of hCG in this context is primarily due to its ability to mimic luteinizing hormone (LH), thereby stimulating intratesticular testosterone production, which is crucial for spermatogenesis.

### Effective Dosing of hCG

The most effective dose of hCG to preserve fertility while on TRT varies, but several studies provide guidance on dosing strategies that balance efficacy with minimizing potential side effects:

1. **Low-Dose hCG**: A common approach involves the administration of low-dose hCG to maintain intratesticular testosterone levels. Studies suggest that doses as low as 250 to 500 IU of hCG administered every other day can be effective. For instance, a study by Coviello et al. demonstrated that 500 IU hCG every other day maintained intratesticular testosterone within the normal range in healthy men with testosterone-induced gonadotropin suppression[19].

2. **Dose-Response Relationship**: Research indicates a dose-dependent response in intratesticular testosterone levels with varying doses of hCG. For example, a study found that increasing doses of hCG from 250 IU to 500 IU every other day resulted in higher intratesticular testosterone levels, suggesting that adjusting the dose based on individual response might be necessary[19].

3. **Combination with Clomiphene Citrate**: Some protocols recommend combining hCG with clomiphene citrate, another agent that stimulates endogenous testosterone production through a different mechanism. This combination can be particularly useful when trying to optimize fertility preservation[15].

4. **Monitoring and Adjustment**: It is crucial to monitor serum testosterone and intratesticular testosterone levels as well as sperm parameters to adjust hCG dosing appropriately. This ensures that the dose is sufficient to maintain spermatogenesis without causing supra-physiological testosterone levels that could have adverse effects[19].

### Clinical Recommendations

- **Starting Dose**: A typical starting dose can be around 500 IU every other day, with adjustments based on individual response and laboratory values[19].
- **Follow-Up**: Regular follow-up with semen analysis and hormone levels is recommended to ensure that the hCG dose is effectively maintaining fertility while on TRT[20].
- **Higher Doses**: In some cases, higher doses of hCG, ranging from 1500 IU to 3000 IU administered two to three times per week, might be used, especially in men with more severe hypogonadotropic hypogonadism[14].

### Conclusion

The effective dose of hCG for fertility preservation in men on TRT needs to be individualized based on the patient's response and hormonal levels. Low-dose hCG (250-500 IU every other day) is commonly effective, but doses may need to be adjusted based on the specific needs and responses of the individual. Regular monitoring of fertility parameters and hormone levels is essential to optimize treatment outcomes.

Sources
[1] TRT and Fertility - The Truth | Optimale https://www.optimale.co.uk/trt-uk/trt-and-fertility/
[2] a hypothesis on fertility optimization in men with hypergonadotrophic ... New frontiers in fertility preservation: a hypothesis on fertility optimization in men with hypergonadotrophic hypogonadism - Herati - Translational Andrology and Urology
[3] Preserving fertility in the hypogonadal patient: an update - PubMed Preserving fertility in the hypogonadal patient: an update - PubMed
[4] The Benefits of Using HCG with TRT - The Men's Health Clinic The Benefits of Using HCG with TRT - The Men’s Health Clinic
[5] Recovery of spermatogenesis following testosterone replacement ... Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use
[6] Reasons to Use hCG with TRT - Balance My Hormones Reasons to Use hCG with TRT - Balance My Hormones
[7] Low-dose hCG can prevent sterility in men prescribed testosterone Low-dose hCG can prevent sterility in men prescribed testosterone
[8] Testicular responses to hCG stimulation at varying doses in men ... Testicular responses to hCG stimulation at varying doses in men with spinal cord injury - Spinal Cord
[9] How to Decrease Infertility Risk While On TRT - Alpha Hormones How To Decrease Infertility Risk While On Testosterone Replacement Therapy Alpha Hormones
[10] Efficacy and Safety of Human Chorionic Gonadotropin Monotherapy ... Efficacy and Safety of Human Chorionic Gonadotropin Monotherapy for Men With Hypogonadal Symptoms and Normal Testosterone
[11] New frontiers in fertility preservation: a hypothesis on fertility ... - NCBI New frontiers in fertility preservation: a hypothesis on fertility optimization in men with hypergonadotrophic hypogonadism
[12] Indications for the use of human chorionic gonadotropic hormone for ... Indications for the use of human chorionic gonadotropic hormone for the management of infertility in hypogonadal men - Lee - Translational Andrology and Urology
[13] [PDF] Concomitant Intramuscular Human Chorionic Gonadotropin ... https://citeseerx.ist.psu.edu/docum...009beaa84f17e1fb171a603f3&repid=rep1&type=pdf
[14] Management of Male Fertility in Hypogonadal Patients on ... - MDPI Management of Male Fertility in Hypogonadal Patients on Testosterone Replacement Therapy
[15] Evaluating the Combination of Human Chorionic Gonadotropin and ... Evaluating the Combination of Human Chorionic Gonadotropin and Clomiphene Citrate in Treatment of Male Hypogonadotropic Hypogonadism: A Prospective Study
[16] Human Chorionic Gonadotropin (hCG) Injections for Men - Healthline Your Guide to Human Chorionic Gonadotropin (hCG) Injections for Men
[17] Dose-Dependent Increase in Intratesticular Testosterone by Very ... Dose-Dependent Increase in Intratesticular Testosterone by Very Low-Dose Human Chorionic Gonadotropin in Normal Men with Experimental Gonadotropin Deficiency
[18] HCG / Human Chorionic Gonadotropin for Male Infertility HCG / Human Chorionic Gonadotropin for Male Infertility — Male Infertility Guide
[19] Low-Dose Human Chorionic Gonadotropin Maintains Intratesticular ... Low-Dose Human Chorionic Gonadotropin Maintains Intratesticular Testosterone in Normal Men with Testosterone-Induced Gonadotropin Suppression
[20] Low dose human chorionic gonadotropin prevents azoospermia and ... https://www.fertstert.org/article/S0015-0282(10)01624-9/fulltext

 

HCG and TRT: A Detailed Briefing​

Introduction​

Testosterone Replacement Therapy (TRT) is a common treatment for men with hypogonadism (low testosterone). While TRT effectively raises serum testosterone levels and alleviates symptoms, it often suppresses the body's natural production of testosterone, leading to potential side effects such as testicular atrophy and impaired fertility. Human Chorionic Gonadotropin (HCG) is frequently used in conjunction with TRT to mitigate these side effects. This briefing reviews the main themes, most important ideas, and key facts regarding the use of HCG with TRT, drawing from various medical sources and patient discussions.

Key Themes​

1. HCG's Role in Counteracting TRT-Induced Suppression​

TRT works by introducing exogenous testosterone, which signals the brain that the body has sufficient testosterone. This, in turn, suppresses the pituitary gland's release of Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH), essential for natural testosterone production and spermatogenesis.

• Mimics LH: HCG is a glycoprotein hormone that "mimics LH" and "stimulates the Leydig cells of the testes to produce testosterone," thereby maintaining some testicular function.
• Preserves Intratesticular Testosterone (ITT): TRT decreases intratesticular testosterone (ITT), which is "key for proper sperm production" and typically "ten times higher than regular blood levels." HCG helps "normalize ITT and sperm production."
• Suppresses LH: Interestingly, HCG, while mimicking LH, "suppresses LH like endogeneous testosterone does," yet still promotes sperm production, challenging previous beliefs that "without FSH there was no possible sperm production."

2. Fertility Preservation​

One of the primary reasons for incorporating HCG into a TRT regimen is to preserve fertility.

• Impaired Spermatogenesis: TRT alone "impairs spermatogenesis (sperm production), leading to azoospermia (no viable sperm) in 40% of patients."
• Maintenance of Semen Parameters: Studies show that "low dose human chorionic gonadotropin appears to maintain semen parameters in hypogonadal men on testosterone replacement therapy."
• Pregnancy Rates: The Baylor study noted that "nine of 26 men contributed to pregnancy with the partner during followup" while on concomitant TRT and HCG.
• Individual Variability: It's important to note that "33% of men (mostly older and who have been on TRT the longest prior to introducing hCG) do not respond as well to TRT+hCG when it comes to sperm quantity and quality. Those men may be better off on hCG+FSH." Also, "as men get older and as they are exposed to longer periods on TRT, their response to HCG may decrease."

3. Testicular Size Preservation​

TRT can lead to testicular atrophy due to the suppression of LH and FSH. HCG helps prevent this cosmetic and potentially uncomfortable side effect.

• Prevention of Atrophy: By stimulating the testes, HCG can "help prevent testicular atrophy, a common side effect of TRT." This is not merely an "aesthetic consideration," as "testicular atrophy can cause significant discomfort and distress."

4. Optimal Dosing and Frequency​

The optimal HCG dose varies, but research and clinical experience provide guidance.

• Recommended Doses: Studies suggest "doses as low as 250 to 500 IU of hCG administered every other day can be effective." The Baylor study used "intramuscular human chorionic gonadotropin (500 IU) every other day."
• Dose-Response Relationship: Research shows a "dose-dependent response in intratesticular testosterone levels with varying doses of hCG." For example, 500 IU HCG every other day resulted in ITT "26% greater than baseline" compared to lower doses.
• Frequency: While "no studies have been done on twice per week injection frequency" for testicular atrophy, anecdotal evidence suggests it "may work." For fertility preservation, "three times per week or more may be needed." One Reddit user noted a positive change when switching from 2x/week to 3x/week HCG injections.
• Higher Doses in Severe Cases: In some cases, "higher doses of hCG, ranging from 1500 IU to 3000 IU administered two to three times per week, might be used, especially in men with more severe hypogonadotropic hypogonadism."
• Post-Cycle Therapy (PCT): In PCT protocols (e.g., after anabolic steroid use), HCG doses of "250 iu/day SQ" are seen, often in combination with Clomid and Nolvadex.

5. Monitoring and Individualization​

HCG treatment requires careful monitoring and individualized adjustment.

• Monitoring Parameters: It is "crucial to monitor serum testosterone and intratesticular testosterone levels as well as sperm parameters to adjust hCG dosing appropriately."
• 17-Hydroxyprogesterone (17OH-P): This hormone is "correlated to intratesticular testosterone (ITT)" and can serve as a "quick way to determine if your hCG dose and frequency is adequate" within two weeks of starting HCG, as opposed to the 3-month wait for sperm count tests. A 17OH-P level "greater than 6.5 nmol/L (or 215 ng/dL) was found to normalize ITT while using HCG doses of 500 IU every other day plus testosterone enanthate injections given at 200 mg/week."
• Sperm Count/Quality Test: Despite the utility of 17OH-P, "only testing sperm count/quality after 3 months of hCG initiation makes it possible to know for sure if HCG is effective in improving fertility in men."

6. Additional Benefits and Side Effects​

Beyond fertility and testicular size, HCG offers other potential benefits and has its own set of side effects.

• Improved Libido and Sexual Function: Some men report "enhanced libido and sexual performance when hCG is added to their TRT regimen." HCG may also "maximise penis size" (though not defy genetics) and improve "penis sensitivity."
• Cognitive Function: HCG's mimicry of LH, with LH receptors found in the brain, suggests "an improvement in cognition."
• Potential Side Effect Mitigation: HCG "may help mitigate some of the side effects associated with TRT, such as testicular shrinkage and reduced sperm count," and potentially polycythemia.
• Potential Side Effects of HCG: While generally well-tolerated at typical TRT doses, higher doses or individual sensitivity can lead to side effects such as "gynecomastia (male breast enlargement), acne, mood swings, and water retention." One Reddit user reported becoming "irritable" on HCG.

7. Administration and Contraindications​

HCG is administered via injection, and certain medical conditions may contraindicate its use.

• Injection Methods: HCG is typically injected "subcutaneously (into the layer of fat just under the skin)" or "intramuscularly (directly into the body’s muscles)." Subcutaneous injections are generally less painful.
• Preparation: HCG is received as a liquid (store in fridge) or powder (mix with sterile water).
• Injection Sites: Common subcutaneous sites include the "lower abdomen," "front or outer thigh," and "upper arm." Intramuscular sites include the "outer arm" (deltoid) and "upper outer buttocks."
• Contraindications: HCG is not for everyone. Avoid taking it if you have "asthma, cancer (especially of the breast, ovaries, uterus, prostate, hypothalamus, or pituitary gland), epilepsy, hCG allergy, heart disease, hormone-related conditions, kidney disease, migraines, precocious (early) puberty, or uterine bleeding."

8. HCG Monotherapy and Combination Therapies​

HCG can be used alone or in combination with other treatments.

• HCG Monotherapy: HCG can be used alone to boost testosterone in men with hypogonadism.
• HCG + Clomiphene Citrate (CC): This combination can be "particularly useful when trying to optimize fertility preservation." A study showed that "Clomiphene citrate and human chorionic gonadotropin are both effective in restoring testosterone in hypogonadism," with the combination group showing a "significant difference in intergroup analysis" for symptom improvement (qADAM scores).
• HCG + FSH: For men who don't respond well to TRT+HCG for sperm quality/quantity, "hCG+FSH" may be a better option.

Conclusion​

The consensus among experts and in medical literature is that HCG is a valuable adjunct to TRT, primarily for "preserving fertility and testicular function." While TRT effectively addresses low testosterone symptoms, HCG helps maintain the integrity of the hypothalamic-pituitary-gonadal (HPG) axis by stimulating endogenous testosterone production, mitigating the suppressive effects of exogenous testosterone. Optimal dosing requires individualization, with 500 IU every other day being a common effective starting point, and monitoring of 17OH-P and sperm parameters is crucial. Collaboration with a knowledgeable healthcare provider is essential to tailor HCG dosage and frequency to achieve optimal patient outcomes.

Dose-dependent increase in intratesticular testosterone by very low-dose human chorionic gonadotropin in normal men with experimental gonadotropin deficiency. Randomized controlled trial
Roth MY, et al. J Clin Endocrinol Metab. 2010.


Serum 17-hydroxyprogesterone strongly correlates with intratesticular testosterone in gonadotropin-suppressed normal men receiving various dosages of human chorionic gonadotropin. Randomized controlled trial
Amory JK, et al. Fertil Steril. 2008.


Intratesticular testosterone concentrations comparable with serum levels are not sufficient to maintain normal sperm production in men receiving a hormonal contraceptive regimen. Randomized controlled trial
Coviello AD, et al. J Androl. 2004.

Human Chorionic Gonadotropin monotherapy for the treatment of hypogonadal symptoms in men with total testosterone > 300 ng/dL.

Fertility induction in hypogonadotropic hypogonadal men.

Indications for the use of human chorionic gonadotropic hormone for the management of infertility in hypogonadal men.

Clomiphene citrate and human chorionic gonadotropin are both effective in restoring testosterone in hypogonadism: a short-course randomized study.

The Effect of Human Chorionic Gonadotropin Therapy on Semen Parameters and Pregnancy Rate after Varicocelectomy.

[Anabolic steroid induced hypogonadism in men: overview and case report].

Testicular responses to hCG stimulation at varying doses in men with spinal cord injury.

Age and duration of testosterone therapy predict time to return of sperm count after human chorionic gonadotropin therapy.

Serum estradiol after single dose hCG administration correlates with Leydig cell reserve in hypogonadal men: reassessment of the hCG stimulation test.

 

HCG Efficacy: Should We Measure 17-OH-progesterone to Titrate HCG Dose?

 

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Briefing Document: The Role of HCG in Men's Health and Testosterone Replacement Therapy (TRT)​

Date: October 26, 2023

Source: Excerpts from "Men's Guide to HCG" by Nelson Vergel (x.com)

Purpose: This briefing document summarizes the key information regarding the use of Human Chorionic Gonadotropin (HCG) in conjunction with Testosterone Replacement Therapy (TRT) in men, drawing from the provided source. It highlights HCG's benefits in mitigating TRT side effects, preserving fertility, and reactivating crucial upstream hormone pathways.

Executive Summary​

Nelson Vergel's "Men's Guide to HCG" elucidates the significant benefits of incorporating HCG into a TRT regimen for men. While TRT effectively boosts testosterone levels, it often leads to a shutdown of natural hormone production, causing testicular atrophy, infertility, and a deficiency in "upstream" hormones like pregnenolone and progesterone. HCG, by mimicking Luteinizing Hormone (LH), counteracts these negative effects, maintaining testicular function, preserving fertility, and, crucially, reactivating the production of these foundational hormones, which may offer additional neurocognitive and overall health benefits. The document emphasizes the need for more clinical data to support anecdotal observations and encourage wider medical acceptance of HCG alongside TRT.

Key Themes and Most Important Ideas/Facts​

1. Understanding the Hormonal Cascade and TRT's Impact:

• Normal Pathway: The pituitary gland produces LH, which stimulates Leydig cells in the testicles to produce testosterone. Testosterone then converts into Estradiol (estrogen) and DHT (dihydrotestosterone). These hormones, in turn, regulate the pituitary gland's output (a negative feedback loop).
• TRT's Shutdown Effect: When exogenous testosterone is introduced via TRT (injections, gels, pellets), the body perceives sufficient testosterone, leading the pituitary gland to "shut down completely" LH and FSH (follicle-stimulating hormone) production. This "shuts down completely shuts down the L production."
• Consequences of Shutdown: Leydig Cell Dormancy: Without LH stimulation, Leydig cells "tend to not die off but shrink... they go dormant." This can lead to testicular atrophy (shrinkage).
• Infertility: The shutdown of FSH production, along with LH, significantly reduces "sperm production in men using testosterone replacement therapy [and] can decrease almost to zero in many cases." This is a major concern for men desiring children.
• Upstream Hormone Depletion: A critical, often overlooked consequence is the cessation of upstream hormone production. LH is involved in the "uptake of cholesterol into cells to produce hormones" and the conversion of cholesterol to pregnenolone and subsequently to progesterone. Without LH, "our prar loone goes to zero or very low levels" and "progesterone... also goes down to basically zero." These hormones, while their full role in men is still being studied, are believed to have "neurocognitive effects."

1. HCG's Role as an LH Mimetic:

• Mechanism: HCG "mimics acts like LH which we shut down." While it acts like LH, it is "not LH" and will not register as LH in blood tests.
• Reactivation of Leydig Cells and Testicular Size: HCG "reverses the activity of atic cells" and "keeps the testicular leg itself plumped, activated, and awake." This prevents or reverses "testicular atrophy."
• Fertility Preservation: Baylor College of Medicine studies (Dr. Lipshultz's group) have shown that combining HCG with testosterone "actually found the sperm production improved, increasing fertility obviously increases and improves." This is a significant benefit for men on TRT who wish to maintain fertility.
• Reactivation of Upstream Hormones (Crucial Benefit): "The most important thing that nobody talks about about the use of HCG with testosterone is the fact that HCG reactivates Upstream hormones." By mimicking LH, HCG "wakes up this process again," leading to the production of pregnenolone and progesterone, which had been shut down by TRT. Vergel believes these hormones have independent beneficial functions beyond being testosterone precursors, potentially offering "neurocognitive" advantages.

1. HCG Dosing and Protocols:

• Baylor Protocol (Fertility Focus): For fertility, the Baylor group protocol involved "HCG at 500 I use three times a week" alongside once- or twice-weekly testosterone injections.
• General Use/Preventative Protocol: For men not actively seeking fertility but wanting to maintain testicular health and upstream hormones, common doses among the Excel Male community are "anywhere from 350 to 500 IU of HCG two to three times a week."
• Combined Injections (Personal Practice): Vergel personally injects "50 milligrams of testosterone and 500 IU of HCG in the same syringe" twice a week to reduce injection frequency.

1. Anecdotal Evidence and Call for More Data:

• Mood and Sex Drive: While "there's not a single study that has proven whether or not combining exogenous testosterone boosts sex drive and mood," many users and Vergel himself "do believe that HCG can enhance even more so the sex drive and mood enhancement effects of testosterone replacement."
• Doctor Education: Vergel stresses the need for "more data on HG so that doctors feel more comfortable prescribing it with test replacement," as many doctors are "afraid of HCG" due to a lack of understanding and clinical evidence.

Conclusion​

HCG offers multifaceted benefits for men on TRT, addressing critical side effects and optimizing overall hormonal health. Its ability to maintain testicular size, preserve fertility, and reactivate the production of essential upstream hormones like pregnenolone and progesterone makes it a valuable adjunct. While anecdotal evidence strongly supports additional benefits like enhanced mood and sex drive, more robust clinical studies are needed to solidify its place in standard TRT protocols and educate the medical community on its importance.

 

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The Use of HCG with Testosterone Replacement Therapy​

This briefing summarizes key information regarding the use of Human Chorionic Gonadotropin (HCG) in conjunction with Testosterone Replacement Therapy (TRT), drawing primarily from Nelson Vergel's video "How to Use HCG with Testosterone To Preserve Fertility, Libido, and Testicle Size." The main themes revolve around addressing common side effects of TRT and simplifying the administration protocol.

Main Themes and Key Ideas:​

1. Disadvantages of Testosterone Replacement Therapy (TRT): While TRT offers numerous benefits for men with low testosterone, it comes with several notable drawbacks that HCG aims to mitigate. These include:

• Suppression of Natural Testosterone Production: "You're basically shutting down your own body's production of testosterone." Your testicles basically stop producing testosterone..." This occurs because Leydig cells in the testicles, responsible for testosterone production, go dormant.
• Testicular Atrophy: A direct consequence of suppressed natural production, "your testicles can shrink with time."
• Impaired Fertility: "Your fertility, your sperm count, can go down so it may impair your ability to get your wife or girlfriend pregnant."
• Decreased Libido and Penis Sensitivity: Some men experience a decline in sex drive and "feel that their penis is not as sensitive" after long-term TRT use, indicating the therapy may not be working as well in these areas.

2. The Role and Benefits of HCG: HCG is presented as a crucial adjunct to TRT, counteracting its negative effects. It is a legally prescribed peptide in the United States, despite "a lot of bad publicity due to its use for what they call the HCG diet, which is really not supported by the FDA." Its proven benefits when used with testosterone include:

• Improved Fertility: HCG is "effective at improving not only fertility in men using testosterone."
• Restoration of Testicular Size: It has been "proven by studies also improving testicular size in basically getting your testicles to look a lot like before you used the testosterone."
• Enhanced Sex Drive and Penis Sensitivity: HCG helps to "improve your sex drive and your penis sensitivity."

3. Common HCG/TRT Protocols and Their Challenges: Traditional protocols often involve a high frequency of injections:

• "Most protocols used by different clinics... use two injections a week or three injections a week of HCG... and also along with that, they prescribe testosterone either once a week for a once-a-week injection or twice a week."
• This adds up to a considerable number of injections: "When you add it up, five injections a week." I don't know who likes to inject that much, not me." The speaker emphasizes the desire to simplify life due to busy schedules.

4. Simplified Protocol Designed by Nelson Virgil: Virgil advocates for a more convenient protocol to improve adherence and compliance:

• Combined Injections: "Injecting only twice a week of both products combined in the same syringe." This significantly reduces injection frequency from potentially five to two per week.
• Specific Syringe Type: A "very tiny syringe, 27 gauge half-inch syringe... insulin syringe" is recommended for minimal discomfort.
• Dosing Recommendations (Example Protocol): Testosterone: The speaker uses "100 milligrams per week divided by two, that's 50 milligrams twice a week" of testosterone cypionate or enanthate (typically 200 mg/mL concentration). For 50mg, this translates to 0.25 mL per injection.
• HCG: HCG comes in an 11,000 IU powder vial, mixed with 5.5 mL of bacteriostatic water, resulting in 2,000 IU per mL. The speaker uses "500 IU twice a week," which equates to 0.25 mL per injection. Some men might be okay with 250 IU twice a week.
• Combining Oil- and Water-Based Products: While testosterone is oil-based and HCG is water-based and they "never really combine in the syringe," they can be drawn into the same syringe for immediate injection.

5. Administration Technique: The injection technique is described as simple and minimally painful.

• Injections are performed "on my shoulder at 90 degrees."
• The small size of the needle means it "doesn't hurt; it's really a tiny syringe half an inch long."

6. Determining the Right Dose: The effectiveness of HCG can be assessed through subjective markers within a few weeks:

• "You'll know it within two or three weeks if your testicles are not feeling fuller and you're not feeling more sex drive."
• Fertility improvement, however, "takes a while to find out if it's working or not."

In conclusion, Nelson Vergel highlights HCG as a vital component of TRT to counteract adverse effects like testicular atrophy, fertility issues, and decreased libido. His proposed simplified protocol aims to improve patient adherence by combining testosterone and HCG into two weekly injections, making TRT a more manageable and sustainable long-term therapy.

 

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HCG plus TRT to Prevent / Reverse Testicular Shrinkage and Decreased Fertility - Excel Male TRT Forum

Human Chorionic Gonadotropin (From the book Testosterone: A Mans Guide, amazon.com) Short podcast: hCG: What Every Man Should Know Human chorionic gonadotropin (HCG) (not to be confused with human growth hormone, or HGH) is a glycoprotein hormone that mimics LH (luteinizing hormone), produced...

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HCG Use in Men on TRT or as Monotherapy: Over 200 Questions and Answers - Excel Male TRT Forum

I collected questions and answers posted on ExcelMale.com in the last 10 years about the use of human chorionic gonadotropin in men who want to prevent loss of testicular size and fertility while on testosterone replacement therapy or that want to use hCG alone as a way to boost their...

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To find out if sperm count is normalized in men using hCG plus TRT, several studies have found that 17OH-P blood level is correlated to intratesticular testosterone (ITT) required for the testicles to make sperm, so testing for this hormone could not only save time while optimizing HCG dose/frequency but also eliminate the need to perform testicular aspirations, a very difficult procedure to do. Sperm count does not stabilize until 6-8 weeks after starting hCG plus TRT, so knowing your 17OH-progesterone blood level can give you a quick way to determine if your hCG dose and frequency is adequate.

This test uses liquid chromatography/mass spectrometry (LC/MS) the most accurate method for hormone testing.

The use of testosterone replacement therapy (TRT) increases blood levels of testosterone but, surprisingly, it decreases the level of testosterone inside the testicles (Intratesticular testosterone or ITT). ITT is key for proper sperm production. This ITT decrease is due to the LH and FSH shut down that occurs with TRT. This shut down decreases ITT and sperm production in men on TRT. These two gonadotropins are required to maintain healthy levels of ITT and, thus, sperm production. Some men on TRT become infertile because of this issue. ITT levels are usually ten times higher than regular blood levels. Having high testosterone blood levels on TRT have no positive effect on ITT. Only increasing LH or FSH can increase ITT. That is where hCG comes in...

Several studies have found that using human chorionic gonadotropin (hCG) while on TRT can normalize ITT and sperm production in some men (older age and longer pre-exposure to testosterone predicted poorer response). However, the optimum dose and frequency of hCG vary in every man. Fortunately, there are several ways to determine if the dose/frequency of hCG while on TRT is effective: Performing a sperm count/quality test (which requires a 3 month wait period) and/or measuring an upstream hormone to testosterone called 17-hydroxyprogesterone (17OH-P) (which can be measured within 2 weeks of starting hCG). TRT decreases 17OH-P and other upstream hormones due to the shut down of LH. Since hCG mimics LH, using hCG plus TRT may normalize upstream hormones like 17OH-P.

Several studies have found that 17OH-P blood level is correlated to ITT, so testing for this hormone could save time in optimizing HCG dose while waiting for a required 3-month sperm test. The 17OH-P test can also eliminate the need to perform testicular aspirations to measure ITT, which is a very difficult procedure to do and which is reserved to research settings. A study found that a 17OH-P level greater than 6.5 nmol/L (or 215 ng/dL) was found to normalize ITT while using HCG doses of 500 IU every other day plus testosterone enanthate injections given at 200 mg/week. However, only testing sperm count/quality after 3 months of hCG initiation makes it possible to know for sure if HCG is effective in improving fertility in men. As men get older and as they are exposed to longer periods on TRT, their response to HCG may decrease. These men may need combination approaches using clomiphene and/or FSH (follicle stimulating hormone).

References:

Amory et al. Serum 17-hydroxyprogesterone strongly correlates with intratesticular testosterone in gonadotropin suppressed normal men receiving various dosages of human chorionic gonadotropin. Fertility and Sterility. Vol. 89, No. 2, February 2008

17 Hydroxyprogesterone Test | Discounted Labs

Explore the 17 hydroxyprogesterone test at DiscountedLabs.com, and take a proactive step towards understanding and managing fertility. Our state-of-the-art testing methods offer accurate insights, providing a clear path to optimize reproductive well-being

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I collected questions and answers posted on ExcelMale.com in the last 10 years about the use of human chorionic gonadotropin in men who want to prevent loss of testicular size and fertility while on testosterone replacement therapy or that want to use hCG alone as a way to boost their...

www.excelmale.com

 

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TRT + hCG Lab Test Panel

TRT + hCG Lab Test Panel used to determine the right dose of hCG plus testosterone to normalize sperm production in men on TRT who want to father a child.

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