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Testosterone Replacement, Low T, HCG, & Beyond
When Testosterone Is Not Enough
Treatments for Low Sex Drive in Men
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<blockquote data-quote="Nelson Vergel" data-source="post: 274638" data-attributes="member: 3"><p>Cureus. 2022 May; 14(5): e25543.</p><p>Published online 2022 May 31</p><p></p><h3><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9246432/" target="_blank">Efficacy and Safety of Human Chorionic Gonadotropin Monotherapy for Men With Hypogonadal Symptoms and Normal Testosterone</a></h3><p></p><p>Background</p><p></p><p>Male hypogonadism has a prevalence of about 6% and is defined by two-morning testosterone levels below 300 ng/dl associated with symptoms. This definition presents a challenging problem for patients without other medical problems but with symptoms of low testosterone (T) who do not meet the biochemical criteria for therapy.</p><p></p><p>Objectives</p><p></p><p>Our objective was to evaluate changes in symptoms and side effects in men with T levels >300ng/dL using human chorionic gonadotropin (hCG) monotherapy for the treatment of hypogonadal symptoms.</p><p></p><p>Methods</p><p></p><p>After IRB approval, 31 male patients treated with hCG monotherapy for low T symptoms were retrospectively reviewed. We evaluated changes in hormones, hypogonadal symptoms, and the incidence of thromboembolic events before and after starting hCG.</p><p></p><p>Results</p><p></p><p><strong>We found subjective improvement in erectile dysfunction, 86% (19/22), and libido, 80% (20/25)</strong>, with no patient experiencing a thromboembolic event. In addition, no change was observed in the follicle-stimulating hormone, luteinizing hormone, estradiol, hematocrit, hemoglobin A1c, and prostate-specific antigen.</p><p></p><p>Conclusion</p><p></p><p>Weekly treatment with hCG appears safe and can improve hypogonadal symptoms in patients with T >300 ng/dl without changes to hematocrit, prostate-specific antigen, and hemoglobin A1c.</p><p></p><p>Keywords: eugonadism, testosterone deficiency, hypogonadism, testosterone therapy, human chorionic gonadotropin</p><p>******************</p><p></p><p>"...our study is the first to identify hCG as a possible therapy for patients with hypogonadal symptoms and normal T."</p><p></p><p></p><p><strong>Men with testosterone levels above 300 with symptoms of low testosterone represent a challenging patient population,</strong> as there is no clear guidance on treatment, and physicians often encounter patients with testosterone levels that are "low for their age".</p><p></p><p>Human chorionic gonadotropin (hCG) is homologous to luteinizing hormone (LH) and stimulates endogenous testosterone production from the testes. The American Urological Association (AUA) recommends using hCG for men with TD and fertility concerns, as it can maintain sperm production, while exogenous testosterone can act as a contraceptive. There is limited research on the efficacy and safety of hCG monotherapy, particularly in men who fail to meet the biochemical criteria for conventional TRT [<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9246432/#REF5" target="_blank">5</a>]. As a result, we sought to evaluate the response of patients to hCG monotherapy. We hypothesize that hCG is a safe and effective therapy for treating hypogonadal symptoms in men with T levels >300ng/dL who do not meet the criteria for TRT.</p><p></p><p>The study was conducted after the institutional review board from the University of Miami (IRB) approved for retrospective chart review. We retrospectively assessed the charts of 31 men (age 25-79) who began hCG monotherapy between October 2017 and August 2020, treated by one andrologist at the University of Miami for hypogonadal symptoms with a T average >300 ng/dL, who had laboratory investigations and clinical appointments at least one month after the initiation of hCG therapy. Patients were treated with varying doses of hCG as determined by an andrologist (<strong>range: 1000-3000 international units (IU) twice a week</strong>). All patients had two initial T tests, and the median was used to establish a baseline. All men were screened for other causes of symptoms, including pituitary adenomas, obstructive sleep apnea, depression, and thyroid disorders. We evaluated changes in hormones: T, LH, follicle-stimulating hormone (FSH), estradiol (E), hematocrit (HCT), glycated hemoglobin (A1c), and prostate-specific antigen (PSA).</p><p></p><p>On the initial visit, all patients were screened for symptoms of hypogonadism, including low libido and erectile dysfunction (ED). At each follow-up appointment, we asked patients to report subjective changes in hypogonadal symptoms to assess for symptom improvement. Follow-up times were variable depending on doctor recommendation and hCG dosage. As there are no recommended validated questionaries to screen or monitor symptom improvement [<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9246432/#REF1" target="_blank">1</a>], subjective improvement of specific hypogonadal symptoms as identified when initially prescribed hCG was recorded and documented. In subsequent follow-up visits, all patients were asked for specific improvements in symptomatology previously expressed. Finally, the patient's treatment start date was recorded, and the latest follow-up visits were made to evaluate the duration of treatment and patient side effects, including stroke, deep vein thrombosis, myocardial infarction, and change in hCG dose.</p><p></p><p></p><p>The median age of patients was 52 (21.5) years old, with a BMI of 28.1 (6.6) kg/m2 (Table <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9246432/table/TAB1/" target="_blank">(Table1).1</a>). The average follow-up after starting hCG therapy was 41.7 weeks, ranging from 11 to 122 weeks. The average hCG dosage was 1529.03 IU. There was no significant change in serum T (413 (143.1) ng/dL to 433 (174) ng/dL), FSH (3.1 (2.65) to 3.05(2.0) mIU/mL), PSA (1.35 (1.18) to 1.53 (2.0) ng/mL), HCT (42.85 (2.85) to 44.85 (2.7) %), Estradiol (27.5 (4.35) to 32 (8.9) pg/mL), A1c (5.85 (0.9) to 5.95 (0.6) %) or LH (4.8 (3.4) to 4.0 (2.2) mIU/mL) (Table <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9246432/table/TAB2/" target="_blank">(Table2).2</a>). When evaluated for improvement of ED and low libido, 86% (19/22), and 80% (20/25) of patients reported improvement of each symptom, respectively (Table <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9246432/table/TAB3/" target="_blank">(Table3).3</a>). All patients with ED were noted to be on another medication or therapy specifically for ED. No thromboembolic events or hCG side effects, including headache, gynecomastia, and gastrointestinal issues, were observed (Table <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9246432/table/TAB3/" target="_blank">(Table33</a>).</p><p></p><p></p><p>[ATTACH=full]40917[/ATTACH]</p></blockquote><p></p>
[QUOTE="Nelson Vergel, post: 274638, member: 3"] Cureus. 2022 May; 14(5): e25543. Published online 2022 May 31 [HEADING=2][URL='https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9246432/']Efficacy and Safety of Human Chorionic Gonadotropin Monotherapy for Men With Hypogonadal Symptoms and Normal Testosterone[/URL][/HEADING] Background Male hypogonadism has a prevalence of about 6% and is defined by two-morning testosterone levels below 300 ng/dl associated with symptoms. This definition presents a challenging problem for patients without other medical problems but with symptoms of low testosterone (T) who do not meet the biochemical criteria for therapy. Objectives Our objective was to evaluate changes in symptoms and side effects in men with T levels >300ng/dL using human chorionic gonadotropin (hCG) monotherapy for the treatment of hypogonadal symptoms. Methods After IRB approval, 31 male patients treated with hCG monotherapy for low T symptoms were retrospectively reviewed. We evaluated changes in hormones, hypogonadal symptoms, and the incidence of thromboembolic events before and after starting hCG. Results [B]We found subjective improvement in erectile dysfunction, 86% (19/22), and libido, 80% (20/25)[/B], with no patient experiencing a thromboembolic event. In addition, no change was observed in the follicle-stimulating hormone, luteinizing hormone, estradiol, hematocrit, hemoglobin A1c, and prostate-specific antigen. Conclusion Weekly treatment with hCG appears safe and can improve hypogonadal symptoms in patients with T >300 ng/dl without changes to hematocrit, prostate-specific antigen, and hemoglobin A1c. Keywords: eugonadism, testosterone deficiency, hypogonadism, testosterone therapy, human chorionic gonadotropin ****************** "...our study is the first to identify hCG as a possible therapy for patients with hypogonadal symptoms and normal T." [B]Men with testosterone levels above 300 with symptoms of low testosterone represent a challenging patient population,[/B] as there is no clear guidance on treatment, and physicians often encounter patients with testosterone levels that are "low for their age". Human chorionic gonadotropin (hCG) is homologous to luteinizing hormone (LH) and stimulates endogenous testosterone production from the testes. The American Urological Association (AUA) recommends using hCG for men with TD and fertility concerns, as it can maintain sperm production, while exogenous testosterone can act as a contraceptive. There is limited research on the efficacy and safety of hCG monotherapy, particularly in men who fail to meet the biochemical criteria for conventional TRT [[URL='https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9246432/#REF5']5[/URL]]. As a result, we sought to evaluate the response of patients to hCG monotherapy. We hypothesize that hCG is a safe and effective therapy for treating hypogonadal symptoms in men with T levels >300ng/dL who do not meet the criteria for TRT. The study was conducted after the institutional review board from the University of Miami (IRB) approved for retrospective chart review. We retrospectively assessed the charts of 31 men (age 25-79) who began hCG monotherapy between October 2017 and August 2020, treated by one andrologist at the University of Miami for hypogonadal symptoms with a T average >300 ng/dL, who had laboratory investigations and clinical appointments at least one month after the initiation of hCG therapy. Patients were treated with varying doses of hCG as determined by an andrologist ([B]range: 1000-3000 international units (IU) twice a week[/B]). All patients had two initial T tests, and the median was used to establish a baseline. All men were screened for other causes of symptoms, including pituitary adenomas, obstructive sleep apnea, depression, and thyroid disorders. We evaluated changes in hormones: T, LH, follicle-stimulating hormone (FSH), estradiol (E), hematocrit (HCT), glycated hemoglobin (A1c), and prostate-specific antigen (PSA). On the initial visit, all patients were screened for symptoms of hypogonadism, including low libido and erectile dysfunction (ED). At each follow-up appointment, we asked patients to report subjective changes in hypogonadal symptoms to assess for symptom improvement. Follow-up times were variable depending on doctor recommendation and hCG dosage. As there are no recommended validated questionaries to screen or monitor symptom improvement [[URL='https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9246432/#REF1']1[/URL]], subjective improvement of specific hypogonadal symptoms as identified when initially prescribed hCG was recorded and documented. In subsequent follow-up visits, all patients were asked for specific improvements in symptomatology previously expressed. Finally, the patient's treatment start date was recorded, and the latest follow-up visits were made to evaluate the duration of treatment and patient side effects, including stroke, deep vein thrombosis, myocardial infarction, and change in hCG dose. The median age of patients was 52 (21.5) years old, with a BMI of 28.1 (6.6) kg/m2 (Table [URL='https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9246432/table/TAB1/'](Table1).1[/URL]). The average follow-up after starting hCG therapy was 41.7 weeks, ranging from 11 to 122 weeks. The average hCG dosage was 1529.03 IU. There was no significant change in serum T (413 (143.1) ng/dL to 433 (174) ng/dL), FSH (3.1 (2.65) to 3.05(2.0) mIU/mL), PSA (1.35 (1.18) to 1.53 (2.0) ng/mL), HCT (42.85 (2.85) to 44.85 (2.7) %), Estradiol (27.5 (4.35) to 32 (8.9) pg/mL), A1c (5.85 (0.9) to 5.95 (0.6) %) or LH (4.8 (3.4) to 4.0 (2.2) mIU/mL) (Table [URL='https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9246432/table/TAB2/'](Table2).2[/URL]). When evaluated for improvement of ED and low libido, 86% (19/22), and 80% (20/25) of patients reported improvement of each symptom, respectively (Table [URL='https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9246432/table/TAB3/'](Table3).3[/URL]). All patients with ED were noted to be on another medication or therapy specifically for ED. No thromboembolic events or hCG side effects, including headache, gynecomastia, and gastrointestinal issues, were observed (Table [URL='https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9246432/table/TAB3/'](Table33[/URL]). [ATTACH type="full"]40917[/ATTACH] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
When Testosterone Is Not Enough
Treatments for Low Sex Drive in Men
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