Using Human Chorionic Gonadotropin (HCG) alone for the treatment of men with low testosterone.

[madman]

Human Chorionic Gonadotropin monotherapy for the treatment of hypogonadal symptoms in men with total testosterone > 300 ng/dL.

Madhusoodanan V, Patel P, Lima TFN, Gondokusumo J, Lo E, Thirumavalavan N, Lipshultz LI, Ramasamy R

Human Chorionic Gonadotropin monotherapy for the treatment of hypogonadal symptoms in men with total testosterone > 300 ng/dL. - PubMed - NCBI


Abstract

PURPOSE:

The 2018 American Urological Association guidelines on the Evaluation and Management of Testosterone Deficiency recommended that 300 ng/dL be used as the threshold for prescribing testosterone replacement therapy (TRT). However, it is not uncommon for men to present with signs and symptoms of testosterone deficiency, despite having testosterone levels greater than 300 ng/dL. There exists scant literature regarding the use of hCG monotherapy for the treatment of hypogonadism in men not interested in fertility. We sought to evaluate serum testosterone response and duration of therapy of hCG monotherapy for men with symptoms of hypogonadism, but total testosterone levels > 300 ng/dL.


MATERIALS AND METHODS

We performed a multi-institutional retrospective case series of men receiving hCG monotherapy for symptomatic hypogonadism. We evaluated the patient's age, treatment indication, hCG dosage, past medical history, physical exam findings, and serum testosterone and gonadotropins before and after therapy. Descriptive analysis was performed and Mann Whitney U Test was utilized for statistical analysis.


RESULTS

Of the 20 men included in the study, treatment indications included low libido (45%), lack of energy (50%), and erectile dysfunction (45%). Mean testosterone improved by 49.9% from a baseline of 362 ng/dL (SD 158) to 519.8 ng/dL (SD 265.6), (p=0.006). The median duration of therapy was 8 months (SD 5 months). Fifty percent of patients reported symptom improvement.


CONCLUSIONS

Treatment of hypogonadal symptoms with hCG for men who have a baseline testosterone level > 300 ng/dL appears to be safe and efficacious with no adverse events.

 

[Rain27]

Loco no logro ver que dosis utilizaron?

 

[madman]

Loco no logro ver que dosis utilizaron?

"They were prescribed an average of 2000 IU hCG weekly, which is based on the bi/tri-weekly regimen of 1500 IU hCG generally prescribed to men with hypogonadotropic hypogonadism (HH) and infertility, educated on administering it subcutaneously and followed up consistently with proper documentation of follow-up testosterone (T) levels (1). Patients were asked to schedule follow-up clinic visits every 3 months, with labs taken at these times"




RESULTS

The study included 20 men. The average age was 50.3 (SD 15.6) years and ranged from 26 to 77. On past medical history, 2 of the patients had a history of anabolic steroid use, and two had a history of prostate cancer, one of whom was post- -radical prostatectomy. These patients had an average testicular volume of 14.2cc (SD 4.3), and 3 presented with varicoceles, 2 of which were grade II and 1 of which was grade I (Table-1). Indications for treatment were largely attributed to persistent complaints of one or multiple of either low libido, low energy, or erectile dysfunction, but also included infertility and insomnia. Patients received an average dose of 2000 IU weekly.


These men presented with an average initial T of 361.8 ng/dL (SD 158.2) and improved to an average follow-up T of 519.8 ng/dL (SD 265.6). The duration of therapy for these men averaged 6 months, with an average weekly hCG dose of 2000 IU. Over this period, they experienced an average change in T of 60%. One-tail Mann Whitney U test demonstrated this improvement was significant, as the sample of T at baseline was significantly less (p<0.005) than that of follow-up T. This corresponded with 50% of men subjectively reporting symptom improvement. Of the 10 men who reported symptom improvement, only 2 had negative changes in testosterone levels, both by less than 15%.


CONCLUSION

Our study indicated that hCG monotherapy is a safe and efficacious treatment option for patients with symptoms of hypogonadism who do not desire fertility or may not have initial testosterone levels greater than 300 ng/dL, significantly improving testosterone levels with no associated reports of complications or side effects. The role of hCG monotherapy in treating these men is promising. Future studies should evaluate changes in hematocrit levels in these patients, as well as the effect that baseline luteinizing hormone may play on response to hCG monotherapy.

 

[madman]

Table 1. Summary of baseline characteristics of men included in study.

 

[Rain27]

Gracias loco,!!!!!

 

[madman]

el placer es mío

 

[Mr S]

"They were prescribed an average of 2000 IU hCG weekly, which is based on the bi/tri-weekly regimen of 1500 IU hCG generally prescribed to men with hypogonadotropic hypogonadism (HH) and infertility, educated on administering it subcutaneously and followed up consistently with proper documentation of follow-up testosterone (T) levels (1). Patients were asked to schedule follow-up clinic visits every 3 months, with labs taken at these times"




RESULTS
The study included 20 men. Average age was 50.3 (SD 15.6) years and ranged from 26 to 77. On past medical history, 2 of the patients had a history of anabolic steroid use, and two had a history of prostate cancer, one of whom was post- -radical prostatectomy. These patients had an average testicular volume of 14.2cc (SD 4.3), and 3 presented with varicoceles, 2 of which were grade II and 1 of which was grade I (Table-1). Indications for treatment were largely attributed to persistent complaints of one or multiple of either low libido, low energy or erectile dysfunction, but also included infertility and insomnia. Patients received an average dose of 2000 IU weekly.


These men presented with an average initial T of 361.8 ng/dL (SD 158.2), and improved to an average follow-up T of 519.8 ng/dL (SD 265.6). Duration of therapy for these men averaged 6 months, with an average weekly hCG dose of 2000 IU. Over this period, they experienced an average change in T of 60%. One-tail Mann Whitney U test demonstrated this improvement was significant, as the sample of T at baseline was significantly less (p<0.005) than that of follow-up T. This corresponded with 50% of men subjectively reporting symptom improvement. Of the 10 men who reported symptom improvement, only 2 had negative changes in testosterone levels, both by less than 15%.








CONCLUSION
Our study indicated that hCG monotherapy is a safe and efficacious treatment option for patients with symptoms of hypogonadism who do not desire fertility or may not have initial testosterone levels greater than 300 ng/dL, significantly improving testosterone levels with no associated reports of complications or side effects. The role of hCG monotherapy in treating these men is promising. Future studies should evaluate changes in hematocrit levels in these patients, as well as the effect that baseline luteinizing hormone may play on response to hCG monotherapy.

This is really good information concerning hCG. However, I keep hearing that hCG will shutdown one’s HTPA anyway. That part I find confusing since stopping hCG monotherapy will be pretty much like the administration of exogenous testosterone and its effect on the HTPA. Am I understanding this correctly?

 

[Nelson Vergel]

Many posts on HCG used alone (monotherapy) here:
hcg monotherapy excelmale.com site:www.excelmale.com - Google Search

 

[Mr S]

“Personally, I never saw the point of hCG mono, as it's still suppressive but not usually as effective as TRT. Not really sure of what the goal is with hCG monotherapy, it's not going to "restart" you like clomid is, and isn't successful for many”.
The above quote basically summarizes what I think HCG mono vs TRT comes down to be concerning the HTPA. I get the intersticular testosterone by mimicking and hence the avoidance of the atrophy of the gonads, but once the patient stops he will be shutdown. If he stops cold turkey or uses Clomid to restart the HTPA , will it all depend on how suppressed his HTPA might be to recover? Unless the fact of not having used exogenous testosterone makes a difference in the way in which the HTPA was suppressed? Will recovery depend on this factor?

 

[Nelson Vergel]

We have little to no data on HPTA recovery using hCG, clomiphene, and other agents. Some limited data suggests that younger men, men with shorter exposure to anabolic steroids or testosterone, and men with higher testosterone before they started androgens tend to have faster recovery. Also, a case study on a bodybuilder on anabolic steroids showed that his using hCG while cycling preserved his fertility. hpta recovery excelmale.com site:www.excelmale.com - Google Search

 

[Mr S]

We have little to no data on HPTA recovery using hCG, clomiphene, and other agents. Some limited data suggests that younger men, men with shorter exposure to anabolic steroids or testosterone, and men with higher testosterone before they started androgens tend to have faster recovery. Also, a case study on a bodybuilder on anabolic steroids showed that his using hCG while cycling preserved his fertility. hpta recovery excelmale.com site:www.excelmale.com - Google Search

So basically it’s trial and error. Nobody can really tell. BTW, my doctor suggested Cabergoline to enhance my libido. I’m already on TRT and HCG and Cialis Daily 5mg. He told me to look into that and just give it a try if I choose to do so. He explained that there weren’t any guarantees either. If I were to try Cabergoline (.50mg X a week) how long does it usually take to notice if it’s working? I have read a lot about this drug but the studies show 6 months... I have also read threads on this forum but nothing was clear. Thank you for your guidance.

 

[Nelson Vergel]

Cabergoline only improves libido in men with high prolactin or low dopamine. I think it's a waste of time for most. Lowering prolactin too much can affect your heart. We have discussed this a lot. cabergoline did not work excelmale.com site:www.excelmale.com - Google Search