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 historically recommended 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, and which usually is exacerbated while they’re 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 recommended HCG for them specifically to address their physical symptoms due to testicular shrinkage.

We historically recommended gonadorelin secondarily for younger men who wanted 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 recommended 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 of our male patients were satisfied with the efficacy of human chorionic gonadotropin (HCG) at accomplishing these objectives, we have noticed that gonadorelin, at least the way that we prescribe it, is even more effective, and also has less potential for adverse effects. It is really obvious that this medication works for our male patients on TRT.

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 extremely rare that our male patients experience adverse effects while using gonadorelin the way that we prescribe it. Sometimes men will experience more testicular stimulation than is needed or desired. In this case, a patient may experience a sensation of being more aware than they want to be of their testicles, that their testicles feel like they’re growing too fast or too much, or that they’ve become larger than they want for them to be. Rarely, a patient may 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 may have higher than ideal testosterone or estrogen levels until they follow up with us and we adjust their dose of gonadorelin, testosterone and / or anastrozole.

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


Primarily, it’s because for all intents and purposes, HCG is simply not available at any price right now in the United States.

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. One of the three major manufacturers of HCG actually stopped manufacturing it because they didn’t think it was worth it to come into compliance with this unnecessary and expensive regulation. 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. 

Secondarily, gonadorelin seems to be more effective than HCG with less potential for adverse effects.

Would We Prescribe HCG for Men on TRT if it Were to Become Available Again?


W‘re no longer optimistic that the national shortage of manufactured HCG will resolve any time soon. Unfortunately, the additional, unnecessary and expensive regulations have created a monopoly on manufactured HCG, which means that it may be cost-prohibitive for many men if it does become readily available again. 

However, if it does become readily available again we would definitely prescribe it for men on testosterone replacement therapy who would prefer to use it rather than gonadorelin to prevent testicular shrinkage and / or to maintain their testicular functional capacity while on TRT.

At this point, from what we’ve observed, gonadorelin is more effective than HCG and is less likely to cause adverse effects. We believe that many if not most of our patients would choose to continue to use gonadorelin if HCG were to become readily available again.

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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