Understanding Testosterone Deficiency (TD)Testosterone deficiency (TD) is a condition characterized by insufficient testosterone production by the gonads. Regular morning testosterone (T) readings below 300 ng/dl are indicative of TD. Symptoms of TD can include poor libido, erectile dysfunction, weight gain, fatigue, depression, and concentration difficulties. Approximately 6% of the population suffers from TD, and the prevalence increases with age. Typically, men with TD are treated with external testosterone replacement therapy (TRT), which is recommended only for those who meet specific biochemical and symptomatic criteria. However, the treatment approach for men with low testosterone levels that are still above 300 ng/dl remains less clear, necessitating regular evaluation by healthcare providers for age-appropriate testosterone levels [1, 2, 3, 4].
The Role of Human Chorionic Gonadotropin (hCG)Human chorionic gonadotropin (hCG) acts similarly to luteinizing hormone (LH), stimulating the testes to produce more testosterone naturally. The American Urological Association (AUA) suggests the use of hCG to maintain sperm production and as a supplementary testosterone form for birth control in men with TD who wish to remain fertile. However, the effectiveness and safety of hCG monotherapy in males who do not meet the criteria for conventional TRT, particularly those with T levels above 300 ng/dl, have not been well established .
The Study's AimThe main goal was to find out how hCG monotherapy affected symptoms and side effects in men who had hypogonadal symptoms and starting T levels above 300 ng/dl. This study was conducted following the approval of the University of Miami's Institutional Review Board (IRB). The research involved reviewing the medical records of 31 males, aged between 25 and 79, who commenced hCG monotherapy from October 2017 to August 2020. These individuals were treated for hypogonadal symptoms with an average T level greater than 300 ng/dl and underwent lab testing and clinical consultations at least a month after beginning hCG treatment. Patients received hCG doses ranging from 1000 to 3000 IU twice weekly. The study also involved comprehensive testing for various health conditions and monitoring several health parameters.
Statistical Analysis and FindingsThe study's statistical analysis presented medians with middle and higher quartiles, employing the Mann-Whitney U test for significance. It was observed that patients experienced significant improvements in erectile dysfunction and libido. Notably, no serious side effects like thromboembolic events or common hCG-related adverse effects such as headaches, gynecomastia, or stomach issues were reported.
Evaluating hCG Therapy for TDThe AUA's current recommendations for TRT are primarily for those with symptoms and T levels below 300 ng/dl. The present study focused on hypogonadal men treated exclusively with hCG, evaluating hormones, symptoms, and side effects. Despite the absence of a substantial increase in testosterone levels, hCG was found to alleviate hypogonadal symptoms without the side effects associated with hCG or synthetic testosterone. This suggests that even a small dosage of hCG may help elevate T levels in patients, albeit not significantly.
hCG for Fertility and SpermatogenesishCG is recommended for men with TD who wish to preserve fertility or boost sperm production after using synthetic testosterone. Various studies support hCG therapy to restore spermatogenesis following testosterone use. Also, hCG therapy caused big changes in the size of the testicles, the amount of testosterone in the body, and the production of sperm in people with isolated hypogonadotropic hypogonadism. Alternative treatments like clomid or anastrozole might be beneficial for men with hypogonadal symptoms and T levels below 300 ng/dl.
hCG's Impact on HypogonadismThere have been few studies exploring the effects of hCG on hypogonadism. Notably, research has shown that hCG therapy can improve symptoms (libido and erectile function) in men with psychogenic ED and low sexual drive without significantly increasing testosterone levels. The study under discussion is pioneering in suggesting that hCG might aid in alleviating hypogonadal symptoms in men with normal T levels.
Conclusions and Future ResearchDespite its small sample size and brief follow-up period, the study suggests that hCG monotherapy is a secure and effective treatment for hypogonadal symptoms in men with initial T levels above 300 ng/dl. Patients reported symptom improvement without serious adverse effects. However, a bigger, randomized, blinded study with validated questionnaires is needed to say for sure if hCG alone can treat hypogonadal symptoms in men whose T levels are normal.
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- sciencedirect.com - Safety of Human Chorionic Gonadotropin Monotherapy for ...
- tctmed.com - hCG: The Options for Treating Low Testosterone
- regenxhealth.com - Using HCG to Raise Testosterone Levels Naturally