Human chorionic gonadotrophin (hCG) is best known as the hormone picked up by pregnancy tests. But sometimes clinicians prescribe it to men to help boost testosterone production.
HCG can be used alongside testosterone replacement therapy (TRT) to help preserve testicular function and fertility. In selected men, it can also be used instead of testosterone. However, it’s not something that every man needs.
In this article, we explain how hCG works, who’s likely to benefit, how it’s given, and what side effects to look out for.
Contents
- What is hCG and how does it work?
- Should I take hCG with TRT?
- What are the benefits of hCG?
- Can you use hCG instead of TRT?
- How often is hCG taken?
- How quickly does hCG raise testosterone?
- What are the side effects of hCG?
- How much does hCG cost?
What is hCG and how does it work?
Testosterone production is normally controlled by signals from the brain. The pituitary gland releases LH, which travels to the testicles and stimulates the Leydig cells to produce testosterone.
TRT supplies testosterone directly. As testosterone levels rise, the brain reduces its production of LH and follicle-stimulating hormone (FSH). This can lower testosterone concentrations inside the testicles, reduce sperm production, and cause the testicles to shrink.
HCG binds to the same receptors as LH. It therefore provides the testicles with a signal to continue producing testosterone, even while the body’s own LH production is suppressed.
Importantly, hCG does not restart the brain’s natural hormone signalling while you are taking TRT. It temporarily replaces part of that signal.
Should I take hCG with TRT?
Most men don’t need to take hCG as part of their TRT. It’s usually considered when maintaining testicular function (and fertility) is particularly important.
You might discuss hCG with your doctor if:
- you want to preserve your fertility for the future
- you’re concerned about reduced testicular size
If you have completed your family and aren’t concerned by changes in testicular size, adding hCG offers little practical benefit. It also means additional injections, expense, and another medication whose effects need to be monitored.
If you are actively trying to conceive, tell your doctor before starting or continuing TRT. Testosterone therapy can significantly suppress sperm production and is generally avoided when treating male infertility. HCG may form part of an alternative fertility-focused treatment plan, sometimes alongside FSH.
You can read more in our guide to protecting fertility while on TRT.
What are the benefits of hCG?
Depending on why it is prescribed, hCG may help to:
- maintain the testicles’ own testosterone production
- reduce testicular shrinkage associated with TRT
- support continued sperm production
- raise blood testosterone in men using hCG without TRT
However, hCG does not guarantee that your sperm count will remain normal. If fertility is a priority, semen analysis provides much more useful information than testosterone levels alone.
Can you use hCG instead of TRT?
HCG can sometimes be used without testosterone, but the two treatments aren’t interchangeable.
TRT replaces testosterone directly. HCG stimulates the testicles (similar to LH) to produce more of their own testosterone. For hCG to work, the testicles must still be capable of responding to that signal.
This makes hCG most relevant to men with secondary hypogonadism, where the problem is arising from the pituitary gland or hypothalamus in the brain. It’s less likely to work well in primary hypogonadism, where the problem lies within the testicles themselves. Men with primary hypogonadism often already have raised LH levels because the body is trying, and failing, to stimulate the testicles.
HCG may be considered on its own when preserving fertility is important, but the evidence supporting it for routine treatment of low-testosterone symptoms is less extensive than the evidence for TRT [3]. It also requires several injections each week and can be more expensive.
Neither treatment is universally ‘more effective’. The right choice depends on the cause of your low testosterone, your symptoms, your fertility plans and how you respond to treatment.
How often is hCG taken?
HCG is usually given by injection several times a week because its effect gradually wears off between doses.
When hCG is prescribed alongside TRT, a common protocol is 250 or 500 international units (IU) three times a week. This is just an example. Your clinician will determine your dose and schedule based on why you’re taking it and how you respond.
Higher doses may be used when hCG is prescribed without TRT or as part of active fertility treatment.
What’s the minimum dose?
There’s no universal minimum effective dose of hCG and its effect varies between men. Usually, lower doses start around 250 IU three times a week.
How quickly does hCG raise testosterone?
The testicles can respond to hCG within days. Studies examining a single injection have generally found that the testosterone response peaks around 72 hours later.[4]
But this doesn’t mean you’ll feel different within a few days. Changes in energy, libido, erections, or mood may take several weeks and are affected by more than testosterone alone.
Fertility changes take considerably longer. Sperm cells take around three months to develop, and treatment intended to restore sperm production may be needed for several months or more before reaching its full effect. A semen analysis is usually required to determine whether treatment is working.
What are the side effects of hCG?
HCG is generally well tolerated when appropriately prescribed and monitored. Possible side effects include:
- pain, redness, bruising, or swelling at the injection site
- headache or tiredness
- acne or oily skin
- irritability, restlessness, or changes in mood
- fluid retention
- breast tenderness or gynaecomastia
Because hCG stimulates testosterone production in the testicles, it can also increase oestradiol. This may contribute to breast symptoms, fluid retention, or mood changes in some men.
Side effects don’t automatically mean hCG must be stopped. Your doctor may review your dose, blood results, injection schedule, and whether the treatment is still providing a worthwhile benefit.
How much does hCG cost?
The cost of hCG depends on the prescribed dose, the product available, and the dispensing pharmacy. A higher-dose fertility regimen will usually cost considerably more than low-dose hCG used alongside TRT.
Is hCG right for you?
HCG can be useful for men who want to maintain testicular function while taking TRT, particularly if future fertility or testicular shrinkage is a concern for you. It may also work as an alternative to TRT for some men whose testicles can still respond to hormonal stimulation.
It does, however, add cost and several injections each week, and it can't guarantee that fertility will be preserved. Your fertility plans, hormone results, and the underlying cause of your low testosterone should all be considered before hCG is added to your treatment.
If you are considering TRT or want to discuss whether hCG belongs in your treatment plan, get in touch with us.
References
- Coviello AD, Matsumoto AM, Bremner WJ, et al. Low-dose human chorionic gonadotropin maintains intratesticular testosterone in normal men with testosterone-induced gonadotropin suppression. J Clin Endocrinol Metab. 2005;90(5):2595–2602. doi:10.1210/jc.2004-0802
- Hsieh TC, Pastuszak AW, Hwang K, Lipshultz LI. Concomitant intramuscular human chorionic gonadotropin preserves spermatogenesis in men undergoing testosterone replacement therapy. J Urol. 2013;189(2):647–650. PubMed
- European Association of Urology. Male hypogonadism. EAU Guidelines on Sexual and Reproductive Health.EAU guidance
- Meier C, et al. Serum estradiol after single-dose hCG administration in men. Testosterone concentrations peaked after approximately 72 hours. PubMed
- Pregnyl prescribing information. Product information
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