This FAQ page is divided into two sections. The first section is titled, FREQUENTLY ASKED QUESTIONS ABOUT GONADORELIN, and the second section is titled, FREQUENTLY ASKED QUESTIONS ABOUT HOW AND WHY GONADORELIN IS REPLACING HUMAN CHORIONIC GONADOTROPIN (HCG) AS THE MEDICATION WE PRIMARILY PRESCRIBE AS PART OF THE TRT TRIFECTA

 

FREQUENTLY ASKED QUESTIONS ABOUT GONADORELIN:

 

When does Full Potential HRT Clinic recommend gonadorelin for men while they’re on testosterone replacement therapy (TRT)?

We recommend gonadorelin primarily for men who don’t want to experience testicular shrinkage while they’re on TRT. 

We recommend gonadorelin secondarily for men who want to maintain their fertility and ability to produce their own testosterone while they’re on TRT.

 

What is the difference between recommending gonadorelin for testicular shrinkage versus for maintaining fertility and the ability of men to produce their own testosterone while they’re on testosterone replacement therapy (TRT) at Full Potential HRT Clinic?

We recommend gonadorelin primarily to prevent or delay the testicular shrinkage that older men experience naturally as they get older and experience testosterone deficiency due to andropause, and which usually is exacerbated while they’re on TRT.

Most men over 40 years old and almost every man over 50 years old have already lost their fertility and ability to produce significant amounts of their own testosterone. For them, it’s not about restoring or maintaining their testicular function. Instead, it’s specifically about at least delaying – if not reversing to at least some extent – the continued testicular shrinkage that they’re already experiencing. Living with smaller testicles and a less full scrotum, and with reduced ejaculate makes them feel less masculine and potent. We recommend gonadorelin for them specifically to address their physical symptoms due to testicular shrinkage.

We recommend gonadorelin secondarily for younger men who want to maintain their fertility and ability to produce their own testosterone while they’re on TRT.

Younger men are usually also very concerned about the size of their testicles and the amount of their ejaculate, but moreover they’re mostly concerned about maintaining their fertility, because most of the time they’re planning to have children in the future. Sometimes, they’re also not sure if they want to stay on TRT. For these men, we recommend gonadorelin not just to prevent or delay testicular shrinkage, but to specifically maintain their fertility or their own albeit deficient ability to make their own testosterone.

 

How does gonadorelin prescribed by Full Potential HRT Clinic work for men to prevent testicular shrinkage, and maintain fertility and ability to produce testosterone? What is its mechanism of action? 

Gonadorelin is bioidentical to gonadotropin releasing hormone (GnRH). They are one in the same. In a normal and healthy young male: 1) gonadorelin is released from the hypothalamus in a pulsatile manner about every two hours; 2) then the anterior pituitary responds to these pulses by releasing luteinizing hormone (LH) and follicle stimulating hormone (FSH); 3) and lastly the testicles respond to these pulses by producing testosterone, estrogen, and sperm. Of course, this pathway is not working by the time a male patient comes to our clinic for testosterone replacement therapy.

The way that testosterone and anastrozole are prescribed significantly impacts the efficacy of the gonadorelin. Our goal for our male patients is to help them to experience their full potential health. Part of this is making sure that their testosterone levels are in their target range. Well, having testosterone levels in their target range all of the time will completely suppress their hypothalamus’ natural release of GnRH. This is okay though because gonadorelin completely bypasses the hypothalamus and acts directly to stimulate the anterior pituitary. Having testosterone levels in their target range all of the time does not prevent the anterior pituitary from responding to gonadorelin and releasing significant quantities of LH and FSH. It is also important that their estradiol levels are kept within their target range as well, because if estradiol levels are too high this will reduce the amplitude of LH and FSH released by the anterior pituitary in response to the gonadorelin. We maintain estradiol levels at a lower level with the proper prescription of the anastrozole to prevent the aromatization of testosterone to estradiol. With estradiol levels at these lower levels, the anterior pituitary is not prevented by high estradiol levels from responding to gonadorelin by releasing significant quantities of LH and FSH. 

We have found that when gonadorelin injections are prescribed once nightly before bed in this manner that a significant amount of LH and FSH is released, and that the testicles respond very well. 

 

What is the dose of gonadorelin that Full Potential HRT Clinic prescribes for their male patients while they’re on testosterone replacement therapy (TRT)?

The dose amount and dose frequency prescribed varies considerably from one male patient to the next. It depends on many factors. It depends on the responsiveness of their pituitary to the gonadorelin. It depends on the responsiveness of their testicles to their own luteinizing hormone (LH) and follicle stimulating hormone (FSH). It depends on whether they’re new to TRT or they’ve been on TRT for many years. It depends on how much they naturally aromatize testosterone to estradiol. It depends on how much fat tissue they have. It depends on whether they have sleep apnea, and whether it’s treated or not. It depends on how well they sleep and how much sleep they get. It depends on their diet and lifestyle. It depends on how otherwise normal and healthy they are. It depends on their age. It depends on their goals. It depends on whether they’ve previously been on TRT with or without human chorionic gonadotropin (HCG). If they’ve been on TRT without HCG, then it really depends on how long they’ve been on TRT without HCG. 

It also depends on where they’re at in the course of using gonadorelin. We recommend much higher doses and much greater dose frequency when our male patient is initiating their use of gonadorelin. We then work with our male patients to gradually reduce their dose amount and dose frequency over time to determine the minimum dose amount and dose frequency that is required in order for them to maintain their goals of treatment.

 

How quickly does gonadorelin work when prescribed by doctors at Full Potential HRT Clinic?

This depends on many factors (see above). Most younger patients who are new to testosterone replacement therapy (TRT) and who are otherwise normal and healthy will notice that it works right away. Most patients who have been on TRT with human chorionic gonadotropin (HCG) and were happy with the benefits they experienced from HCG, and who initiate gonadorelin right away without any gap between their use of HCG and their use of gonadorelin will initially experience some testicular shrinkage over about a month, after which it will then stabilize and reverse back to where it was when they were on HCG over about another month. Most patients who have been on TRT with another clinic for many years without HCG will notice that it may take one or two months or longer for gonadorelin to start to obviously work, and it may take a few more or several months for them to be obviously happy with the results.

It’s important to note that HCG doesn’t work for all men, and neither does gonadorelin. The information we’re sharing here should not be misconstrued as a guarantee of efficacy.

 

How do the doctors at Full Potential HRT Clinic know if gonadorelin is working for their male patients?

It’s really obvious. Most of the time it’s a simple matter of communicating with our male patients. For example, we’ll ask them during their regular follow-up office visits whether they’re experiencing any testicular shrinkage or reduced volume of ejaculate. For patients who are taking gonadorelin to maintain their fertility we also recommend that they have a semen analysis at baseline, and then periodically to make sure they’re maintaining their fertility. We also offer our male patients who are using gonadorelin the option of receiving an additional injection of gonadorelin during their office, followed by adding luteinizing hormone (LH) and follicle stimulating hormone (FSH) lab tests to their blood test panels in order to see how well their pituitary is responding to gonadorelin. 

 

What if gonadorelin doesn’t work for me while I’m on testosterone replacement therapy (TRT)? 

When I added this webpage I scanned the internet to see if I could find one instance in which a physician with experience prescribing this medication stated that the medication doesn’t work. I was not able to find a single instance. Instead, what I found was people on the internet who made statements that it doesn’t work were not even doctors; instead they were diet, fitness, or health enthusiasts, or simply salesmen, without a medical degree, who are not professionals, and don’t know enough to know they have no idea what they’re talking about.

Usually, when a male patient is saying that it’s not working, the reality is that it’s working very well, but it’s not completely working. In other words, a male patient may end up maintained on TRT with 75% of the testicular volume they had prior to initiating TRT, whereas if they don’t use gonadorelin they will have 0 – 20% of the testicular volume they had prior to initiating TRT. In these cases, it’s often a matter of increasing the dose, increasing the frequency of dosing, or adding oral enclomiphene citrate to the protocol to increase the anterior pituitary’s responsiveness to gonadorelin. Whether a male patient wants to increase their dose frequency or add enclomiphene citrate is a matter of personal preference. If they don’t mind giving themselves injections then they may decide to increase their dose frequency. If they don’t like giving themselves injections, and they’re able to afford the addition of enclomiphene citrate, then they may decide to do that instead.

It’s important to note that there are some men who are unfortunately not able to prevent significant testicular shrinkage while they’re on TRT, whether they’re using human chorionic gonadotropin (HCG), gonadorelin, or gonadorelin with enclomiphene citrate. We cannot state that any male can initiate TRT at our clinic and that we guarantee that they will not experience significant testicular shrinkage or significantly reduced fertility. The information we’re sharing here should not be misconstrued as a guarantee of efficacy.

 

What are the potential side effects of gonadorelin?

The primary adverse effect men will experience when using gonadorelin properly as prescribed is due to a hypersensitivity reaction to benzyl alcohol, which is an ingredient in the bacteriostatic water used to reconstitute lyophilized medications. Usually, when men have been able to tolerate the long-term use of other lyophilized medications, including compounded HCG, they’re not going to experience this adverse effect while using gonadorelin long-term. Other than that, sometimes men will experience adverse effects from higher than expected stimulation of the testicles to make testosterone and estradiol. Lastly, some men will experience a dull aching sensation from higher than expected stimulation of the testes in general. If a male patient is having a hypersensitivity reaction to the benzyl alcohol, then they’re usually not going to be able to continue to use the medication. If a male patient is experiencing higher than expected stimulation of their testes, then all it takes a dose reduction or an increased anastrozole dose to resolve that adverse effect. Otherwise, it seems that our patients never experience any adverse effects due to gonadorelin. 

 

FREQUENTLY ASKED QUESTIONS ABOUT HOW AND WHY GONADORELIN IS REPLACING HUMAN CHORIONIC GONADOTROPIN (HCG) AS THE MEDICATION WE PRIMARILY PRESCRIBE AS PART OF THE TRT TRIFECTA

 

Why doesn’t Full Potential HRT Clinic prescribe HCG instead of gonadorelin?

Unfortunately, the FDA began in March of 2020 to enforce The Biologics Price Competition and Innovation Act, which was ironically included in the Patient Protection and Affordable Care Act.

This law required the FDA to force all compounding pharmacies and manufacturers who didn’t have a biologics license to manufacture HCG to immediately discontinue their production of HCG. Because of this law,  compounded HCG is no longer available for men in the United States. Consequently, there’s been an ongoing supply crisis and national shortage of manufactured HCG in the United States ever since. For all intents and purposes, manufactured HCG is simply not available at any price right now. This is the only reason we don’t prescribe HCG instead of gonadorelin.

Consequently, Dr. Robert Strait, N.D. researched and developed alternative protocols for our male patients to use at least while HCG is no longer available. The primary HCG alternative right now is gonadorelin.

 

Why did you prescribe human chorionic gonadotropin (HCG) instead of gonadorelin before HCG was no longer available?

HCG does work very well for most men, but so does gonadorelin. Up until November of 2019, we did prescribe HCG for all of our male patients to use while they’re on TRT. The primary reason we historically prescribed HCG rather than gonadorelin is because it usually only requires two subcutaneous injections per week for HCG to be effective for most male patients on TRT, whereas gonadorelin usually requires one subcutaneous injection each night before bed. 

 

Does gonadorelin work as well as human chorionic gonadotropin (HCG) does for men who are on testosterone replacement therapy (TRT) at Full Potential HRT Clinic?

We’ve prescribed HCG for most of our male patients ever since we opened our doors on January 1st 2015. HCG works extremely well to prevent or delay the testicular shrinkage that older men experience naturally as they get older, or while they’re on TRT. HCG also works extremely well in younger men to prevent testicular shrinkage, and to furthermore maintain their fertility and ability to produce testosterone while they’re on TRT. Numerous studies over the last 50+ years explain why this is the case.

HCG is really easy to prescribe compared to gonadorelin. It’s not difficult for a medical provider to prescribe an ideal dose amount and dose frequency for HCG. Therefore, most patients who’ve been on HCG historically will have noticed that they obviously were able to prevent testicular shrinkage or decreased testicular function capacity while taking HCG.

Gonadorelin can work just as well as HCG, but unfortunately it’s not very easy to prescribe gonadorelin compared to HCG. The dose amount and dose frequency and the overall manner in which the course of gonadorelin is prescribed is extremely important. Gonadorelin’s efficacy completely depends on the expertise of the prescribing physician to prescribe the medication and work with the patient in an individualized manner with their goals in mind. For this reason, many patients who’ve tried gonadorelin prescribed by other doctors at other clinics will say online that they didn’t experience their desired benefits from using gonadorelin.

It’s important to note that HCG doesn’t work for all men, and neither does gonadorelin. The information we’re sharing here should not be misconstrued as a guarantee of efficacy.

 

If human chorionic gonadotropin (HCG) were available again, would Full Potential HRT Clinic prescribe it, instead of gonadorelin?

We’re optimistic that the national shortage of manufactured HCG will eventually resolve, as manufacturers will eventually increase their production of HCG in order to meet extraordinary nationwide demand. Unfortunately, they may effectively have a monopoly on manufactured HCG, and therefore it may be cost-prohibitive for many men. However, if or when our male patients are again able to fill prescriptions for manufactured HCG, we will definitely prescribe HCG for them, if that’s their preference. We believe that some patients will actually prefer gonadorelin, and would choose to continue to use gonadorelin.

 

I currently have a stockpile of human chorionic gonadotropin (HCG), or I’m currently able to get refills for prescriptions for manufactured HCG. Would the doctors at Full Potential HRT Clinic prescribe for me how to use my supply while I’m on testosterone replacement therapy (TRT) at Full Potential HRT Clinic?

If you’re lucky enough to have been able to stockpile your own personal supply of HCG, then yes we’re more than happy to prescribe an ideal HCG regimen for while you’re on TRT. For many of our male patients who are in this unique position, we are working with them to develop a protocol whereby they’re able to make their stockpile last as long as possible, before we transition them to the use of gonadorelin to replace HCG while they’re on TRT.

 

If I’m a current patient and I’ve been using human chorionic gonadotropin (HCG) prescribed by your clinic to prevent testicular shrinkage or maintain my own albeit deficient ability to produce my own testosterone, then should I continue to request that your clinic prescribe HCG for me to use right now while it’s still available, or should I switch to gonadorelin right now?

For patients who’ve historically used HCG while on testosterone replacement therapy (TRT), and who’ve been satisfied with their results, we recommend that you continue to use HCG for as long as possible, while it’s still available. We primarily recommend this because it requires only two injections per week, whereas patients usually have to inject gonadorelin each night before bed in order for it to work comparably to HCG to prevent testicular shrinkage.

 

If I’ve been using human chorionic gonadotropin (HCG) while on testosterone replacement therapy (TRT) in order to prevent testicular shrinkage or maintain my own albeit deficient ability to produce my own testosterone, then how do I transition off of HCG to gonadorelin prescribed by Full Potential HRT Clinic?

The best way to transition from HCG to gonadorelin is to make sure you have gonadorelin before you run out of HCG and to initiate gonadorelin as soon as you run out of HCG. The longer you’re on TRT without HCG the more testicular shrinkage and decreased testicular functional capacity you’ll experience, and the longer it will take to reverse that by initiating a course of gonadorelin.

 

If I’ve been using human chorionic gonadotropin (HCG) while on testosterone replacement therapy (TRT) in order to prevent testicular shrinkage or maintain my own albeit deficient ability to produce my own testosterone, then should I try to make my remaining HCG last as long as I can?

This is totally a matter of patient preference and goals. If you decrease your dose of HCG in order to make it last longer, then you will get reduced benefits along the way. This means that you may experience testicular shrinkage or reduced fertility or ability to make your own testosterone as you’re doing this. If this is acceptable to you, then we can discuss with you how to decrease your dose to try to strike a balance between the loss of benefits from the HCG versus making the HCG you have remaining last longer. However, for men who value their fertility or ability to make their own testosterone, we do not recommend that you do this. Instead, we recommend that you continue to use the HCG as prescribed, and that you make sure to immediately transition to the use of gonadorelin once you run out of your remaining HCG.

 

Should I use human chorionic gonadotropin (HCG) and gonadorelin at the same time?

No, you shouldn’t use both of these medications at the same time. 

HCG is an analog of luteinizing hormone (LH) and a partial analog of follicle stimulating hormone (FSH). This means that it looks just like LH and sort of like FSH to the cells of your body, including the cells of your hypothalamus, anterior pituitary, and testicles. What this means is that yes it will stimulate the testicles to produce testosterone (although in older men almost none of this testosterone ends up in circulation outside of the testicles), and to a much lesser extent it will stimulate the testicles to produce sperm. However, it also means that it tells the hypothalamus and anterior pituitary that there’s already a lot of LH and FSH in the body. This causes significant suppression of the hypothalamus’ ability to produce and release gonadotropin releasing hormone (GnRH) and significant suppression of the anterior pituitary’s ability to produce and release LH and FSH. Furthermore, because the half-life of HCG is about two days, meaning that half of it is still in your body after two days, and one fourth of it is still in your body after four days, if you’re dosing this medication about twice weekly then you’re consistently significantly suppressing this pathway, and therefore you’re consistently significantly suppressing your production and release of LH and FSH. This means that if you use HCG and gonadorelin at the same time, then you’re going to get much less results from the additional use of gonadorelin. It makes the most sense to use one or the other, but it doesn’t make sense to use both.