Let’s Talk About the Use of Human Chorionic Gonadotropin (HCG) for Men on Testosterone Replacement Therapy (TRT)
What is HCG?
Human chorionic gonadotropin is also known as “HCG” and is a hormone that is naturally produced on an ongoing basis in only very small amounts, except in the case of pregnancy. Prescription HCG is bioidentical (exactly the same as) the natural HCG produced in humans. Because of its similarity to luteinizing hormone (LH) and follicle-stimulating hormone (FSH), HCG directly stimulates the testicles to produce testosterone, estrogen, and sperm.
Do We Still Prescribe HCG?
Yes, we do sometimes prescribe HCG. For patients of ours who want to use HCG instead of gonadorelin we will ask them to find a local retail pharmacy who has confirmed that they can and will fill a prescription for HCG. Once the patient notifies us of the pharmacy, we will send a prescription to that pharmacy for them. Throughout the year 2023 we have seen that patients have been able to find retail pharmacies who are willing and able to fill prescriptions for HCG. However, it does sometimes take them time and energy and does sometimes cause them frustration. There have also been numerous occasions when a patient of ours will be stable on TRT while using HCG and then be unable to fill their HCG prescription. This is concerning because a gap in their use of HCG would cause testosterone and estrogen levels to change in addition to allowing some temporary testicular shrinkage to happen. It is logistically challenging to prescribe gonadorelin in these cases as a bridge to last them until they are able to get a prescription for HCG filled again, because HCG and gonadorelin work differently for different people.
We historically prescribed HCG for all of our male patients who were on testosterone replacement therapy who didn’t want to experience further testicular shrinkage and decreased testicular functional capacity to make testosterone, estradiol, and sperm while on TRT. Unfortunately, starting in early 2021 it became difficult to find pharmacies who could fill prescriptions for HCG, and it only became increasingly difficult until around August of 2022, when it began to start to become less difficult. During this time although we prescribed HCG for many patients from many pharmacies almost none of them were able to fill their prescriptions. Starting in November of 2022 our patients began to find that they were able to get their prescriptions filled, although it would sometimes take them a lot of time and energy. Since then, it’s continued to gradually become a little easier; however, it continues to be the case that even as we are about to enter 2024 that some patients will be unable to consistently get their prescriptions filled, and will have to shop around for retail pharmacies in order to get their prescriptions filled, or they will have to temporarily discontinue HCG. Sometimes these shortages cause the price of HCG to temporarily rise significantly.
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 volume. Most of the time though our patients with low testosterone already have much smaller testicular volume.
Therefore, for most men, especially for older men, HCG is prescribed to prevent further testicular shrinkage. However, for many men, especially for younger men, it is also prescribed to at least maintain their fertility and their own ability to produce their own testosterone while they were on TRT.
What is the Difference Between Prescribing HCG 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 HCG Work to Accomplish These Objectives?
The way that we prescribed it, HCG 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 HCG?
It is not common for our male patients to experience significant adverse effects while using HCG the way that we prescribe it. The most common adverse effect from HCG is due to its ability to directly stimulate estrogen production from the testicles, which in some cases can make it so that a male’s estrogen levels are higher than ideal or cause 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 Generally Prescribe Gonadorelin Instead of Human Chorionic Gonadotropin (HCG)?
We now generally prescribe gonadorelin rather than HCG for four reasons:
- 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.
- 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.
- 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.
- Patients for whom we prescribe a therapeutic dose of gonadorelin will typically spend $20-30 per month for a therapeutic dose of gonadorelin. Patients for whom we prescribe HCG will typically spend $70 – 100 per month for a therapeutic dose of HCG. Patients who elect for prescription of HCG must be aware that we do not have control over the price or supply of this medication and there are times when there is no supply or the price temporarily goes up.
- Patients who elect for prescription of HCG must be aware that we do not have control over the price or supply of this medication and there are times when there is no supply or the price temporarily goes up.
- 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.
We Have Helped Thousands of Men to Prevent Testicular Shrinkage While on TRT Using Either HCG or 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 or HCG 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.