Let’s Talk About the Use Gonadorelin for Men on Testosterone Replacement Therapy (TRT)



What is Gonadorelin?


Gonadorelin is also known as “gonadotropin releasing hormone,” or “GnRH.” It is bioidentical to (exactly the same as) the natural neuropeptide produced by the hypothalamus, a part of the brain. In a normal and healthy young male, gonadorelin is always being produced, but is only released in a pulsatile manner from the hypothalamus about every two hours. The neuropeptide is delivered directly to the anterior pituitary gland, which responds to the stimulation by releasing in its own pulsatile fashion a bolus of luteinizing hormone (LH), follicle stimulating hormone (FSH), and even small amounts of human chorionic gonadotropin (HCG). These hormones travel from the anterior pituitary to the testicles to stimulate them to produce testosterone, estrogen, and sperm.

When Do We Prescribe Gonadorelin?


We generally prescribe gonadorelin for men who are on testosterone replacement therapy (TRT) who don’t want to experience further gradual testicular shrinkage and decreased testicular functional capacity while they’re on TRT than they’re already experiencing. We have determined how to prescribe gonadorelin for our male patients who are on TRT in such a way that they are able to at least maintain their testicular size and functional capacity.

It’s important to point out that men who suffer from severe testosterone deficiency (low T) already have decreased fertility and ability to produce their own testosterone. Depending on the cause of their testosterone deficiency they may have larger or smaller than typical testicular size. Most of the time though our patients with testosterone deficiency already have much smaller than ideal testicular size.

Therefore, for most men, especially for older men, it’s just a matter of preventing further testicular shrinkage. However, for many men, especially for younger men, it’s also a matter of at least maintaining their fertility and their own ability to produce their own testosterone.

What is the Difference Between Prescribing Gonadorelin to Prevent Testicular Shrinkage Versus to Maintain Testicular Functional Capacity?


We prescribe HCG primarily to prevent or delay the testicular shrinkage that older men experience naturally as they get older and experience testosterone deficiency due to andropause, which would otherwise be exacerbated while they were on TRT. Most men over 40 years old and almost all men 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 prescribe HCG for them specifically to address their physical symptoms due to testicular shrinkage.

We prescribe HCG secondarily for younger men who want to maintain their fertility and ability to produce their own testosterone while they are 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 they may be planning to have children in the future or want to keep that as an option for them in the future. Sometimes, they’re also not sure if they want to stay on TRT. For these men, we prescribe HCG 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 Well Does Gonadorelin Work to Accomplish These Objectives?


The way that we prescribe it, gonadorelin is extremely effective at accomplishing these objectives. While almost all patients get comparable benefits from HCG and gonadorelin, there are some patients for whom HCG is more effective and there are some patients for whom gonadorelin is more effective. Also, in general, we have found that patients will tend to have a slightly greater potential for adverse effects while using HCG compared to gonadorelin. The adverse effects are due to HCG’s ability to directly stimulate more estrogen production from the testicles compared to gonadorelin, which tends to stimulate more sperm production compared to HCG.

It’s important to point out that there are some men who are not able to prevent testicular shrinkage while they’re on TRT, whether they’re using human chorionic gonadotropin (HCG), gonadorelin, or gonadorelin with enclomiphene citrate, or other medications. We cannot guarantee any male patient that they will not experience testicular shrinkage while they’re on TRT.

Are There Potential Adverse Effects From Using Gonadorelin?


It is not common for our male patients to experience significant adverse effects while using gonadorelin the way that we prescribe it. The most common adverse effect from gonadorelin is due to its ability to actually stimulate the testicles to produce testosterone and estrogen, in addition to sperm. In some cases it may be “too effective,” in that it will stimulate the production of enough testosterone and estrogen to cause testosterone and estrogen levels to become higher than ideal, which can cause a patient to feel less overall benefits, including some symptoms of estrogen dominance, until their dosing can be adjusted.

Sometimes men will experience more testicular stimulation than needed or desired. In these cases, a patient will experience a sensation of being more aware than they want to be of their testicles, that their testicles feel like they are growing too fast or too much, or that they have become larger than they want for them to be. Rarely, a patient will have a greater than expected testicular production of testosterone or estrogen due to increased testicular stimulation. If this is the case, and the response is significant enough, a patient will have higher than ideal testosterone or estrogen levels until they follow up with us and we can adjust their dose of HCG, testosterone and / or anastrozole.

Why Do We Prescribe Gonadorelin Instead of Human Chorionic Gonadotropin (HCG)?


  1. During the period of time during which we were not able to get prescriptions for HCG filled for our patients we began to prescribe gonadorelin instead and we found that our patients get comparable benefits from gonadorelin with slightly less potential for adverse effects due to direct production of estrogen in the testicles compared to HCG.
  2. It is extremely easy for us to find a pharmacy that can fill these prescriptions for our patients. Our patients don’t have to spend any time or energy to get their prescriptions filled. In fact, it shows up at their doorstep with their other TRT medications.
  3. There is no risk that a patient will get stable on a gonadorelin dose and then suddenly be out of the medication and unable to get a refill, causing changes in their testosterone and estrogen levels, which in turn can cause changes in how they’re benefiting from TRT.
  4. A therapeutic dose of gonadorelin costs our patients about $20 – 30 per month compared to $60 – $120 per month for HCG, depending on the pharmacy.

It is important to point out again that at this time we do prescribe HCG for our patients if that is their preference for any reason.


Click here to learn more about the use of human chorionic gonadotropin (HCG) for men on TRT.


We Have Helped Thousands of Men to Prevent Testicular Shrinkage While on TRT Using Gonadorelin


Are you suffering from symptoms and diseases we’ve all been told are just an inevitable part of getting older, when in fact they’re really caused by low testosterone and low levels of other hormones, which can be treated? Have you been told that if you do testosterone replacement therapy (TRT), then you must resign yourself to gradual testicular shrinkage and loss of fertility? If so, then regardless of your age, but especially if maintaining testicular size and fertility is important to you, it’s really important that you see a TRT or hormone replacement therapy (HRT) doctor with expertise and successful experience prescribing gonadorelin for men on TRT.

Our distinguished team of physicians and staff has more than 10 years of experience successfully treating many thousands of men near Portland, Oregon and Seattle, Washington with testosterone replacement therapy (TRT) for low testosterone, helping these men to live and perform to their full potential health and longevity.

Call 971-319-4636 for more information or help with scheduling an appointment.

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