hCG on TRT: How Adjunct Therapy May Improve Strength, Endurance, and Energy in Active Men

[madman]

Abstract​

INTRODUCTION AND OBJECTIVES:​

Human chorionic gonadotropin (HCG) is commonly added to testosterone therapy (TTh) to preserve testicular function. In clinical experience, many men with testosterone deficiency express a preference for adjunctive HCG with TTh. We performed a propensity-matched analysis comparing symptom improvement in men receiving testosterone cypionate with adjunctive HC therapy versus without.

METHODS:​

Retrospective analysis of 7,906 men initiating TTh with testosterone cypionate. Patients receiving topical testosterone, clomiphene, mesterolone, or sustanon were excluded. Treatment groups comprised HCG+cypionate (n=3,875) versus cypionate alone (n=641). Propensity score matching (1:1) based on baseline age, body mass index (BMI), and total testosterone yielded 640 matched pairs. The primary outcome was change in the quantitative Androgen Deficiency in the Aging Male (qADAM) questionnaire scores from baseline to 3 and 6 months across 10 symptom domains: libido, energy, strength/endurance, enjoyment of life, happiness, erectile function, work performance, fatigue, sports ability, and height loss.

RESULTS:​

Matched cohorts were well-balanced (HCG+cypionate: age 43.4±9.4y, BMI 28.6±4.2, baseline testosterone 11.4±5.0nmol/L; cypionate alone: 45.2±9.0y, 28.9±4.5, 11.4±6.7nmol/L). At 3 months, total qADAM score improvement was similar between groups (HCG+cypionate: +9.81±6.03 vs cypionate alone: +8.64±6.13, p=0.17). Individual domain analysis revealed that HCG+cypionate showed significantly greater improvement only in strength/endurance (mean difference +0.37, p=0.007) at 3 months. HCG+Cypionate patients neared significance in changes to their enjoyment of life (mean difference +0.27, p=0.05). At 6 months, no significant differences emerged between groups in total score change (+10.1 vs +9.96, p=0.95) or any individual domain (all p>0.05). Work performance trended toward greater improvement with HCG at both timepoints but did not reach significance at 6 months (p=0.19).

CONCLUSIONS:​

Adjunctive HCG therapy demonstrates selective benefit for strength/endurance and vitality outcomes in the near term. While overall symptomatic improvement is comparable between groups, HCG may provide targeted benefits for physically active patients prioritizing strength and endurance performance on testosterone replacement therapy.