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Human Chorionic Gonadotropin (HCG) is a novel medication that can be used in men, off label, to enhance testosterone levels while maintaining fertility.
According to the American Urology Association (AUA) a total testosterone level <300ng/dL should be utilized by clinicians as the threshold for diagnosing hypogonadism ( medical term for Low-T, Testosteron deficiency or Andropause ) and for the use of testosterone replacement. In men who have a testosterone level greater than 300, but are still symptomatic with signs such as decreased energy, libido, fatigue and weight gain the use of HCG can be an effective therapy.
HCG is an analogue (identical) of Luteinizing Hormone (LH). LH is the primary signaling hormone produced by the pituitary gland that tells the testicles to make more testosterone. In effect, using HCG stimulates a man’s body to naturally up-regulate testosterone production. The benefit of HCG therapy are improving testosterone levels without using exogenous testosterone injections, less adverse events related to erythrocytosis and an application of therapy that is more comfortable than an intramuscular injection of testosterone cypionate.
HCG is also used in hypogonadal men who are currently utilizing exogenous testosterone to maintain testicular size and reproductive potential. Younger men and mature fitness and bodybuilding athletes who use supra-physiological doses of testosterone often utilize HCG to combat the adverse effects of reduced testicular size and reduction in fertility.
A small study by Madhusoodanan et al. looked reviewed the clinical charts of 37 men with presented with low libido, low energy, erectile dysfunction and insomnia and had a serum testosterone level > 300ng/DL. Men were given HCG for their condition and symptoms. HCG monotherapy improved testosterone levels by as much as 263 ng/DL (42.8%). Duration of HCG therapy was approximately 29 weeks and no adverse events or effects were noted. While improvement in symptoms was not the primary outcome study of this investigation, the use of HCG to raise testosterone levels was evident.
A study by Sato Y. et al. reviewed the effects of androgen replacement therapy (HCG) and once a day tadalafil dosing to improve libido and energy in men. This is otherwise known as LOVE syndrome (Loss of Vigor and Energy). 78 patients with LOVE syndrome were recruited into the study and had normal testosterone and free testosterone values. Mean male age was 57.8. Patients were given tadalafil (Cialis ®) daily and 5000IU of HCG every 2 weeks. At 8 weeks symptoms were assessed. Results found improvement in sexual symptoms, especially spontaneous morning erections. Patients who had morning erections were found to have more pronounced vigor and libido during daily activity and more self-confidence.
The use combination therapy of HCG with Clomid (clomiphene citrate) has been well studied as an option to improve testosterone levels. A prospective study by Habous M. et al, Clomiphene Citrate and Human Chorionic Gonadotropins are Good Alternative Therapy for Hypogonadal Men in Restoring Serum Testosterone and Improving Patient Symptoms, looked at 324 patients with Low-T. Patients were randomized into the following four groups:
1) Testosterone undecanoate 1000mg (Nebido)
2) Clomiphene Citrate 50mg tablets daily
3) HCG 5000IU twice weekly
4) Combination therapy Clomiphene Citrate and HCG 5000IU.
All patients had physical examination, BMI calculated and lab tests performed at 1 month and 3 months. Mean patient age was 43. The largest testosterone increase was in Group 1 during the initial first month of therapy and the smallest rise in testosterone was in patients enlisted in group 3. Interestingly between 1-3 months the largest rise in testosterone was revealed in Group 3 (combination therapy of Clomid and HCG). HbgA1c (a marker of diabetic and glucose control) and body mass index (BMI) decreased in all groups during therapy. This small study supports prior studies and guidelines that HCG and Clomid, in combination, can be utilized as an alternative to testosterones supplementation and be as effective as testosterone therapy alone in some cases.
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