Once-Weekly hCG Helps Preserve Fertility in Men on Testosterone Therapy (Largest Study Yet)

Abstract​

INTRODUCTION AND OBJECTIVES:​

Testosterone therapy (TTh) is known to suppress spermatogenesis, but combination TTh with human chorionic gonadotropin (hCG) has been shown to maintain spermatogenesis in a small 26-patient case series. That study did not account for prior fertility (or infertility). The objective of this study is to assess total motile count (TMC) in men on combination TTh and hCG versus men on monotherapy TTh, while accounting for prior fertility.

METHODS:​

We reviewed patient charts from a single academic institution from 2015 to present to identify men with 1) proven fertility, 2) actively taking injectable TTh, and 3) who provided a semen sample for analysis. Men were included if they were taking 200-300 mg of testosterone weekly, either as monotherapy TTh or TTh combined with 1500 IU of hCG injected once weekly. Proven fertility was defined by previously fathering a child or a normal semen analysis prior to starting TTh. Men were excluded if not actively on TTh (TTh discontinued prior to semen analysis) or if they were taking or had previously taken oral anabolic steroids. Standard parametric and non-parametric statistical tests, as well as linear multivariate regression, were performed using R.

RESULTS:​

We included 62 men on monotherapy TTh and 44 men on combination TTh + hCG. Median total motile count was significantly higher in men on combination therapy compared with men on TTh monotherapy (median TMC 13.7 vs 0 million motile sperm, p<0.0001). 100% of patients on TTh monotherapy had TMC ≤5 million, while only 32% on combination therapy had TMC ≤5 million. 3 of 44 men (7%) became azoospermic on combination therapy, compared with 81% of men on TTh monotherapy. Compared with men on TTh monotherapy, men on TTh+hCG combination therapy were younger but had been on testosterone for longer and had higher total testosterone levels (p<0.05 for all). On multivariate regression, only the use of hCG was associated with higher total motile counts (p<0.0001); age, duration of testosterone use, and hormone levels were non-significant.

CONCLUSIONS:​

This is the largest study assessing the fertility potential of combination TTh and hCG. A high proportion of previously fertile men maintained spermatogenesis with once weekly hCG injections while on TTh.

 

No harm in trying as trial and error is the only way to know but even then I would not be recommending hMG or FSH if one were looking to improve libido, orgsms or sensitivity.

Adding in hCG is what I would be pushing here especially when you understand the functions of the gonadotropins LH and FSH.

Some members have serious issues with anxiety and libido. So they try to keep some LH and FSH levels. It seems to help some members. Maybe if you inject FSH or HMG it would give them what they are missing. This may be something @Cataceous could use.

T

Thread 'hmg/fsh along TRT/HCG for sex enhancement'

Jun 1, 2026

so after couple years on TRT+HCG, i got my hands on relatively cheap HMG/FSH from here:

https://cosmicpct.sx/shop/menodac-150-iu/

https://cosmicpct.sx/shop/lupi-fsh-150-iu/

I've been running those, at 3x week 150iu (entire vial 3x/week), rotating either FSH/HMG in no particular order.
the first 2-3 weeks i haven't noticed a whole lot, but by week 4 or so the effects got very noticeable. apologies if I get explicit here, but the orgasm length/quality improved like 300%. the difference is really big. i haven't really measured volume but I highly suspect and subjectively can say...

• t_spacemonkey
• fsh hmg
• Replies: 1
• Forum: When TRT Is Not Enough (ED, Libido, & More)

• 

 

did you see that he goes up to 300 mg/week TRT?

Yes, I was prescribed 1mg anastrozole a week with 200 mg/test and 1500 hcg a week. I did father a child so that was awesome but I had to dial back test and arimidex it had me messed up. well at least the ai did

 

I wonder if a 1x/week of low dose hcg would be enough too? What about 500IU or lower?

 

I wonder if a 1x/week of low dose hcg would be enough too? What about 500IU or lower?

imo unlikely. It may keep your balls larger in size but maybe not enough to have a kido.

 

imo unlikely. It may keep your balls larger in size but maybe not enough to have a kido.

Just enough to keep the balls working though? What about 250IU/week?

 

I wonder if a 1x/week of low dose hcg would be enough too? What about 500IU or lower?

No one knows if 500 IU once weekly is enough.

Trial and error would be the only way to know.

A higher once-weekly dose may be required to maintain intratesticular testosterone which supports the germ-cell mass that accounts for most of the seminiferous tubule volume/size.

If intra-testicular testosterone falls too low between injections then germ-cell mass, seminiferous tubule volume, and testicular size may decline.

Top it all off that most men are judging testicular size whether a natty baseline or on T therapy by feel as in palming the testes in the hand.

Maybe the wife or girlfriend fondling your family jewels too LOL!

Unfortunately the only way to truly know how much shrinkage occurred on solo exogenous T or growth when adding hCG or hCG + FSH would be using a prader orchidometer most commonly used by endocrinologists or the gold standard high frequency scrotal ultrasound or even an MRI.




Figure 2: Ontogeny of the evolution of testicular volume from birth to adulthood. Seminiferous cords (Sertoli cells + germ cells) are the main component of the testes. From birth and during the prepubertal period (i. e., until 9–14, Tanner stage 1), the volume of seminiferous cords is determined by Sertoli cells, whereas germ cell proliferation determines testicular volume during puberty (i. e., Tanner stages 2 to 5) (adult spermatogenesis). This Figure was modified using BioRender (Scientific Image and Illustration Software | BioRender) under the authorization of[1]. © 2019 Elsevier Ltd

Thread 'TESTICULAR SHRINKAGE AND TESTOSTERONE THERAPY'

Dec 30, 2023

If you're considering testosterone replacement therapy, understanding its effects on testicular size is crucial. Learn why shrinkage occurs, the treatments available to mitigate this side effect, and why testicle size usually has minimal impact on your overall health. Urologist John Smith, MD, delves into these aspects to provide a comprehensive view.


2:50-4:40

What Men Should Know About Testicular Shrinkage and Testosterone Therapy

Considering testosterone replacement therapy? Understand its impact on testicular size, treatment options for mitigating shrinkage, and why it's usually a minimal health concern.

healthcare.utah.edu

• madman
• trt; testosterone; testicular atrophy; hcg
• Replies: 7
• Forum: Testosterone Side Effect Management

• 

 

Again I would put more weight behind the use of hCG over FSH or hMG for boosting libido or improving orgasm.

But the poster had already been on HCG+test a couple of years before adding FSH/HMG as i'm sure you noticed.

 

But the poster had already been on HCG+test a couple of years before adding FSH/HMG as i'm sure you noticed.

What you mean that guy with low SHBG overmedicated on T, the same guy that was ranting and. raving about a sky-high libido on a T only protocol, the same guy that was ranting and raving about his libido on T + hCG yet still doing reruns here searching for that magic fix LOL!

The guy that was banging 210 mg TP (30 mg daily) calling it HRT.

Better yet the guy that was banging 40 mg TP daily a whopping 280 mg TP/week (minus ester = 232.4 mg active T), therapeutic LMFAO!

That would be equivalent to banging 332 mg TC/week (minus ester = 232.4 mg active T )!

The guy that has been chasing that libido since 2022!

Years later same old sob story here.

Could poke holes through this with ease.

Why do you think Lipshultz was the one who taught Dr. Rand that adding in hCG can improve libido in men on T?

Anyone in the know would recommend hCG not hMG or FSH!

Lipshultz has been at this for decades.

Again.

FSH has a well established clinical role in stimulating spermatogenesis and treating male infertility but there are no high quality clinical studies demonstrating it improves libido in men.

hCG has a clearer mechanistic basis and some clinical evidence from smaller studies and clinical practice suggesting improvement in libido via LH receptor–mediated testicular steroidogenesis.

I would put more weight behind the addition of hCG over FSH or hMG when it comes to libido.

Would not even waste my time or $$$ on FSH or hMG unless my goal was maximizing fertility.

When it comes to the quality/quantity of sperm let alone testicular volume the combination of hCG + FSH would be more effective as they work synergistically.

If anything adding in hMG/FSH will improve the quality/quantity of sperm which is made by the germ/Sertoli cells in the testes as FSH acts directly upon such.

It can also help with improving testicular volume when combined with hCG although hCG will be the main driver as it mimics LH which stimulates the Leydig cells in the testes to produce ITT (intratesticular testosterone) which is critical for the maintenance of germ cells/seminiferous tubules let alone fertility.


* Since 80% of testicular volume consists of germinal epithelium and seminiferous tubules, a reduction in these cells is usually manifested by testicular atrophy and this reflects the loss of both spermatogenesis and Leydig cell function

*Spermatogenesis is largely dependent on the action of FSH on Sertoli cells coupled with high intra-testicular testosterone concentrations. Within the seminiferous tubules, only Sertoli cells possess receptors for both FSH and testosterone. Numerous signaling pathways are activated when FSH binds to FSH receptors on these cells. It acts synergistically with testosterone to increase fertility and the efficiency of spermatogenesis