hCG (Human Chorionic Gonadotropin)
HRT MEMBERS ONLY
INDICATIONS FOR USE
Human Chorionic Gonadotropin (hCG) is used off-label in male hormone replacement therapy to preserve testicular function and fertility. It is commonly used in men receiving exogenous testosterone to prevent or reverse testicular atrophy, maintain intratesticular testosterone production, and stimulate spermatogenesis. hCG may also be used as a primary treatment in men with secondary hypogonadism who wish to avoid testosterone therapy.
ROUTE OF ADMINISTRATION
Subcutaneous or intramuscular injection
FORMULATIONS AND PRICING
| Vial Size | Price |
|---|---|
| 10,000 IU vial | $215 |
COMMON INITIAL DOSING REGIMENS
A typical starting dose is 250-500iU (subcutaneously or intramuscular) 2-3 times weekly.
hCG can also be dosed daily for more even effects.
MECHANISM OF ACTION
hCG is a glycoprotein hormone structurally similar to luteinizing hormone (LH). When administered, it acts as an LH analog, directly stimulating the Leydig cells in the testes to produce testosterone. In men on exogenous testosterone therapy, hCG helps maintain intratesticular testosterone concentrations, which are critical for preserving sperm production and testicular volume.
Unlike GnRH analogs, hCG bypasses the hypothalamus and pituitary, acting directly on the testes. This makes it useful in situations where upstream hypothalamic or pituitary function is impaired or suppressed.
COMMON SIDE EFFECTS
General: Fatigue, mood fluctuations, and mild bloating.
Endocrine: Elevated estradiol levels due to increased aromatization of testosterone may lead to gynecomastia, fluid retention, or increased emotional sensitivity.
Injection Site: Local irritation, redness, or swelling.
Rare: Ovarian hyperstimulation syndrome (in women), thromboembolic events, or allergic reactions. In men, rare complications may include acne, increased libido, or headaches.
CONTRAINDICATIONS
Absolute: Known hypersensitivity to hCG or any excipients in the formulation; known or suspected hormone-sensitive tumors (e.g., prostate cancer, breast cancer).
Relative: Use with caution in individuals with cardiovascular disease, uncontrolled hypertension, or a history of clotting disorders, due to potential fluid retention and estradiol elevation.
COMPARISON WITH OTHER AGENTS
Gonadorelin: Unlike hCG, which directly mimics LH, gonadorelin stimulates the entire HPG axis by prompting endogenous LH and FSH secretion. Gonadorelin may offer more physiological regulation but requires an intact hypothalamic-pituitary function.
Clomiphene Citrate or Enclomiphene: These SERMs indirectly stimulate testosterone production by blocking estrogen’s feedback inhibition on the hypothalamus, increasing endogenous GnRH and downstream LH and FSH. hCG is more direct and often used when a faster or more potent effect on testosterone or spermatogenesis is desired.
MORE INFORMATION
Lee J. Indications for the use of human chorionic gonadotropic hormone for the management of infertility in hypogonadal men. Transl Androl Urol. 2018 [PubMed Link]
La Vignera S et al. Late-onset hypogonadism: the advantages of treatment with human chorionic gonadotropin rather than testosterone. Aging Male. 2016. [PubMed Link]
Corona G. The pharmacotherapy of male hypogonadism besides androgens. Expert Opin Pharmacother. 2015 [PubMed Link]
Zitzmann M. Hormone substitution in male hypogonadism. Mol Cell Endocrinol. 2000 [PubMed Link]
Lee J. Indications for the use of human chorionic gonadotropic hormone for the management of infertility in hypogonadal men. Transl Androl Urol. 2018 [PubMed Link]