The Use of HCG to Prevent / Reverse Testicular Shrinkage and Preserve Fertility
• HCG (human chorionic gonadotropin) is produced by human placenta, sterile product derived from urine of pregnant females. Recombinant DNA formulas are produced by pharmaceutical companies and compounding pharmacies.
• In men HCG mimics LH from pituitary to stimulate Leydig cells of testes to produce testosterone.
• It can have an additive effect to testosterone replacement therapy's ( TRT) increases in estradiol, hematocrit and/or acne
• Normal lyophilized vial contains 5,000 or 11,000 units HCG by compounding pharmacies (commercial products cost 3X compounding). The vial is sent with bacteriostatic water for reconstitution.
• Used by fertility specialists to induce ovulation to harvest eggs, and sperm production.
• Latest data show that men on TRT + HCG were able to remain fertile. (TRT + 500 IU HCG every other day)
• Usual dose of 350-500 IU two times a week for prevention/reversal of testicular atrophy. No data have been published on this use.
• Anecdotal effect on raising sex drive in men. No data.
• HCG acts as a Leydig cell stimulator and cell volumizer. Testicles regain size but do not grow beyond baseline size.
• Continuous testosterone can reduce fertility in over 50% of TRT users and testicular size by 10-30 % . HCG may reverse those two issues.
• Noticeable testicular size reduction can be a more common complaints in men with smaller testicular size at baseline. May not be important to some older men or men not worried about fertility.
• HCG may be used in patients who have abused steroids for 6-8 weeks before clomiphene to attempt to accelerate natural production of testosterone.
• May be used in younger males as sole method of testosterone treatment with secondary hypogonadism. All men respond differently to HCG in ability to boost T production by testes. Expensive as monotherapy and frequently used with testosterone replacement since that combination may be more cost effective in normalizing testosterone and fertility.
. HCG may reactivate upstream hormones like pregnenolone and progesterone that are shut down by testosterone replacement therapy.
• HCG may not work well in some men who have primary hypogonadism, i.e. dysfunction of the Leydig cells in the testes.