Nelson Vergel
Founder, ExcelMale.com
Nelson Vergel, co-founder of ClinicOptimizers.com, founder of ExcelMale.com and DiscountedLabs.com, and author of the book "Testosterone: A Man's Guide", reviews current data on the use of human chorionic gonadotropin (hCG) in men to preserve/regain fertility, testicular size, libido and higher testosterone blood levels. For more information, click here: HCG plus TRT to Prevent / Reverse Testicular Shrinkage and Decreased Fertility
•Essentials of Human Chorionic Gonadotropin (hCG) Therapy in Men
•Agenda
• General Review of Current Practices
• Beyond Fertility: Are There Other Non-fertility/TST-Related Benefits of hCG
• HPTA Normalization After AAS: Post- Cycle Therapy Approaches with hCG
• Opportunities for Further Research
•Human Chorionic Gonadotropin
• Commercially available by urine collected from pregnant women.
• Also available from cell cultures using recombinant DNA technology.
• Originally used in women to induce ovulation.
• Use in men based on its ability to mimic the action of LH and FSH.
•Human Chorionic Gonadotropin (hCG)
•Naturally produced in the human placenta to maintain progesterone production during the first trimester.
• Glycoprotein composed of 237 amino acids
• Alpha subunit IDENTICAL to LH, FSH, and TSH.
• Beta subunit unique to hCG
Human Chorionic Gonadotropin
•Produced by human placenta, a sterile product derived from the urine of pregnant females.
•Used by fertility specialists to induce ovulation to harvest eggs, etc.
•In men, hCG mimics LH from the pituitary to stimulate testicular Leydig cells to produce testosterone. However, it shuts down LH production just like testosterone therapy.
•When used in combination with testosterone supplementation therapy (TST), It can potentiate increases in estradiol, hematocrit, edema and/or acne (DHT)
•Normal lyophilized vials containing 5,000 or 11,000 units hCG are made by compounding pharmacies (commercial products cost 3X compounding)
•Latest data show that some men on TST + hCG were able to remain fertile.
•Anecdotal effect on raising sex drive.
•Use of hCG as Testosterone Therapy Adjunct
•Continuous exposure to exogenous testosterone may reduce fertility in vast majority of users
• TST may also cause testicular atrophy in 10-30% of users
• Smaller testicular size at baseline may make atrophy more obvious
• Possible effects of TST on fertility and testicular size need to be explained to patients
• If these potential side effects are important to the patient, discuss the possible use of hCG with T with emphasis on adherence to 2-3 times per week injection compliance.
•hCG- Typical Clinical Doses
• For boosting testosterone and maintaining sperm production in hypogonadal men (monotherapy): 1000-2500 IU 3 times per week
• To maintain fertility in men on TST: 500 IU every other day.
• To prevent/reverse testicular atrophy and boost libido (anecdotal) in men on TST: 250-500 IU twice per week (non-validated dose)
•Timing of hCG dose in men on TST varies among clinics. There is some anecdotal efficacy of combining hCG + T in the same syringe.
•Monitoring increases in hematocrit, estradiol and DHT may be needed.
•Use of hCG in Males
•Treatment of cryptorchidism (undescended testicles)
• Hypogonadism
• Infertility
• Testosterone Therapy Adjunct
• Anabolic Steroid Adjunct
• Anabolic Steroid Post Cycle Therapy (PCT)
• Possible improvement of libido beyond effect of testosterone alone (Unproven hypothesis)
•Are there any benefits to reactivation of upstream hormones (pregnenolone & progesterone) with testosterone with hCG? (Unproven hypothesis)
•TST and Upstream Hormones
•TSH decreases or shuts down the following hormones:
–LH & FSH (shuts down)
–Pregnenolone (decreases)*
–Progesterone (decreases)*
–Intratesticular T (decreases)*
–DHEA (decreases at higher doses)
–SHBG (decreases)
* May be restored by hCG
•
Journal of Steroid Biochemistry.
Volume 23, Issue 1, July 1985, Pages 33-38
•Response of testosterone’s precursor hormones to anabolic steroid and testosterone self-administration. J. Steroid Biochem. Vol. 23, No. I, pp. 33-38, 1985
•hCG and Libido: Beyond Anecdotes
• A study shows that hCG increases not only serum and intratesticular testosterone (responsible for sperm production) but also increases upstream hormones:
–17-Hydroxyprogesterone,
–Androstenedione, and
–DHEA
•hCG decreases SHBG, so it increases
Free T
•Could these be some of the reasons why libido
may increase in men on TRT + hCG?
Fertil Steril. 2008 Feb; 89(2): 380–382.
•Testosterone Therapy + hCG: Effect on Intratesticular Testosterone
Coviello et al.performed a study in young healthy men where they observed that men placed on exogenous testosterone and hCG were able to maintain normal levels of intratesticular testosterone
o24 men
oT enanthate 200 mg/week
ohCG or placebo, 125, 250 & 500 IU every other day for 3 weeks
•TST + hCG: The Baylor Study
·In a retrospective review of 4 years of hypogonadal men presenting to the Baylor andrology clinic, Hsieh reported on 26 men, concerned about their fertility, who were treated simultaneously with hCG treatment (500 IU qod) and exogenous T (19 IM T 200mg per week and 7 with transdermal gel- 5 Grams/day) for an average of 6.2 months.
·Despite a mean post-treatment level T level of 1055 ng/dl seminal parameters (count, motility and morphology) did not significantly change during the periods of observation.
·The Baylor study demonstrated the ability of low dose hCG to maintain spermatogenesis despite the administration of exogenous T.
The Journal of Urology
Volume 189, Issue 2, February 2013, Pages 647–650
•hCG + FSH Spermatogenesis Recovery Studies in Men
•Beta hCG Serum Levels- Two Doses
•Mood, Libido and ED:
AAS Current vs Former Users
•Anabolic Steroid-Induced Hypogonadism/Infertility
Anabolic steroid-induced male infertility is a frequently observed problem in some bodybuilders and young men seeking to enhance muscle bulk. Turek et al. first reported on the use of hCG as a successful treatment modality in an azoospermia anabolic steroid abuser
The reversibility of anabolic steroid-induced azoospermia.Turek PJ, Williams RH, Gilbaugh JH 3rd, Lipshultz LI. J Urol. 1995 May; 153(5):1628-30.
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