Nelson:
Hi everybody, Nelson Vergel here, founder of ExcelMale.com and DiscountedLabs.com. We're very excited today. We're going to be covering a very hot topic, the use of HCG in men. We have a really good expert on the subject, Allison Woodworth. She is the clinical director of PrimeBody.com. It's a national network of clinics around the United States.
Thank you so much, Allison, for joining us today.
Allison:
You're welcome. Thank you for having me Nelson.
Nelson:
We're going to go right into it. Many of the guys here have many questions on HCG, but let's start with the most basic one. What is HCG?
Allison:
HCG stands for human chorionic gonadotropin, not to be confused with human growth hormone, or HGH. This is a glycoprotein hormone that mimics luteinizing hormone in the body, or LH. In women LH triggers ovulation, and in men it stimulates the testes to produce testosterone. So this hormone can be prescribed for various reasons including for women or men with infertility. It can be used for weight loss in combination with a special diet. I'm sure most of us have heard of the HCG diet by now. It can also be used in young boys when their testes have failed to descend normally into the scrotum. Today we'll specifically be discussing HCG's use in men on testosterone replacement therapy in order to stimulate the body's natural production of both testosterone and sperm.
Nelson:
So why is it important to use HCG along with testosterone replacement therapy?
Allison:
That's a great question. When testosterone is replaced in the body in any form, whether it be topical or injectable, the body actually senses that no additional testosterone is needed. What happens is the body shuts down the hormone cascade via what we call a negative feedback loop, so the gonadotropins LH and FSH become suppressed. In the body, LH and FSH stimulate the body's natural production of both testosterone and sperm, so when they become suppressed the testicles' production of testosterone and sperm decreases. This is actually what leads to testicular atrophy or a decrease or a shrinkage of the testicles when men are on testosterone replacement.
In addition, the suppression of FSH in particular and also LH will decrease the body's production of sperm. In fact, up to 40% of men on testosterone replacement therapy will have impaired spermatogenesis, which is just the production of sperm, leading to no viable sperm. That's in 40% of men on therapy, so that's significant. Almost half.
HCG actually mimics luteinizing hormone in the body so it will stimulate the testicles to produce testosterone so we want to give it in combination with testosterone therapy so we don't inhibit or decrease the body's production. If anything we want to maintain it and stimulate it to produce a little bit more naturally. In giving HCG it will also maintain the body's production of sperm which preserves fertility in men. It's very important for patients to be aware of that fact that if they're on testosterone up to 40% of them will have no viable sperm, so they really should be thinking about HCG use.
Nelson:
It is amazing that many patients don't know about this, and doctors actually, about HCG. The ones that do hear about it think it's just a treatment without any research data. Do we have actually studies on the use of HCG to prevent and reverse testicular atrophy and improve fertility in men using testosterone?
Allison:
That's a great question. What you said is absolutely true. A lot of providers really aren't aware of using HCG in combination with testosterone replacement therapy and they're not even really, oftentimes aware of the research that supports it. There are several studies that support its use.
The first one that I want to mention was done in 2005, so that's over 10 years ago now. This study was published in the Journal of Clinical Endocrinology and Metabolism so this is a very reputable journal. The study looked at the use of a low-dose HCG every other day in combination with testosterone replacement therapy. What they found was that giving HCG actually increased intratesticular testosterone, which is the testosterone that is present inside of the testicles, to levels higher even then baseline, which is pretty significant. It was amazing to see that.
A more recent study done by Lipshultz in 2013 also looked at HCG in low doses every other day in combination with testosterone, either in the form of a topical gel or an injectable. They found that giving HCG actually was able to preserve normal semen and sperm parameters. This study was very interesting because we traditionally think of FSH as the gonadotropin that's solely responsible for stimulating sperm production but using this protocol with just HCG in combination with testosterone men actually were able to preserve their normal semen and sperm parameters. That was really a interesting study to see. That was done pretty recently, just a few years ago now.
Nelson:
It's a very good study. It's actually kind of sad that some men that want to have kids are told that they cannot use testosterone or that they have to get off testosterone if they want to have their wives pregnant. So it's really a sad thing that most men out there and doctors don't know about it. It is a prescription product right? So how is it made?
Allison:
Good question. Like you mention, HCG is only available by prescription, and it can be supplied by traditional pharmacies such as Walgreens or CVS under brand names like Novarel. Also compounding pharmacies are able to manufacture the product in different vial sizes based on a specific physician order. HCG is actually made through either genetic modification, or it can be extracted through pregnant women's urine. That's how it's actually made and then supplied by the pharmacy that the provider and the patient choose to use.
One important thing to mention is that prescriptions for HCG are not typically covered by insurance. They usually don't want to reimburse for it, because they consider its use in men who are on testosterone and want to preserve their testicular functioning and size and preserve their fertility, they consider its use off-label still. So off-label basically means that a medication is being prescribed for something other than its official FDA-approved indication. So even though, as I mentioned, there are numerous studies supporting its use in men and it's gaining acceptance by a growing body of medical professionals and providers, it's still not usually reimbursed by insurance companies. So purchasing the vial through a compounding pharmacy is usually about half the cost of getting a name brand at a traditional pharmacy. So that's the route that most patients go considering that it's not typically going to be reimbursed by insurance.
Nelson:
Thanks for that. How is it administered? Is it injected? Do you have to -
Allison:
Yep. So it is given in injectable form and it can either be given subcutaneously which is into the layer of fat between the skin and the muscle or actually intramuscularly into the muscle. There is a little bit of debate on which method is actually the best but the typical protocol is to inject the HCG subcutaneously with a very fine insulin syringe. The needle is very tiny. We instruct patients to give it in their abdominal area, so it's usually about two inches away from the belly button. We teach them to pinch a little bit of the skin and then inject right into that area with this tiny needle. So most patients, even those who are a little bit afraid of needles or the sound of an injection makes them nervous, they're able to successfully take these injections with very little, if any, pain.
The compounding pharmacies once the order is called in they typically will provide the patient with everything needed to self-inject. So that would be the vial of HCG. It typically comes in dry powder form so the patient actually has to mix with bacteriostatic water. It usually contains a mixing kit, alcohol wipes, insulin syringes. You do need a little bit more than just the vial of HCG to successfully inject it, so I would recommend that patients just call their compounding pharmacy or check with their physician or provider to make sure that all the supplies they need are sent with their shipment or when they pick it up it's ready for them to use.
Nelson:
What are the doses most commonly used?
Allison:
At the moment, there's no official dosage recommendation for men on testosterone replacement therapy but just reviewing the literature and looking at what most physicians and providers are prescribing their patients, I would say anywhere from 200 to 500 international units, two to three times a week is the standard protocol. I have seen and read of providers using up to 1,000 to 5,000 international units of HCG twice a week. With such high doses, there is concern that potentially the Leydig cells in the testes would become desensitized or less responsive to HCG over time, if we're using such high doses. Also there can be increased conversion or spikes in estrodiol and DHT. So when you give testosterone the body can convert a portion over to estrogen or to DHT, so with high doses of HCG you can see high levels of those byproducts of testosterone and if they go too high it can cause some side effects.
Nelson:
So it can be used by itself but it's not a very smart thing to do, right? That's what you're saying?
Allison:
Yeah. Well, it can be used by itself and I actually get that question by a lot of men. They say, "Hey, my testosterone level's low but can we just use HCG to just stimulate my body to produce testosterone naturally on its own?" That's a really good question. But typically I don't recommend that to my patients and most providers in this field really don't recommend that approach for several reasons.
The first would be using such high dosages of HCG to stimulate the body's production of testosterone would cost quite a lot. You would need really high doses to do that without testosterone.
Second would be, this is just based on mostly my personal experience working with patients and other providers in the field, we've found if we just give HCG alone patients oftentimes don't see as many of the subjective benefits of therapy compared to testosterone delivery systems in term of sex drive, well-being, response to therapy. They just don't seem to have as many of those subjective benefits.
Another reason, like I mentioned previously, is with high dosages of HCG the testes could be desensitized to it over time. It may not be as responsive. So maybe temporarily it would work pretty well but over time the levels would really probably drop back down a little bit if the body became less responsive.
The last point, which I also mentioned previously, with higher doses of HCG could cause higher levels of estradiol and DHT. So most providers, including myself, would recommend to patients if you're clinically deficient, you're low in testosterone and we really want to give you the full benefit of therapy I would recommend HCG in order to maintain and stimulate the body's natural production of testosterone a little bit and then give testosterone on top of that to get the patient to an optimal level of testosterone so they can see all the benefits. Why withhold that from them and also just try to give HCG almost fighting this losing battle over time. So that's what I personally recommend and most providers in this field would most likely agree with that.
Nelson:
Good. There's a lot of frustration in my site, on Excel Male, there are over 12,000 guys there. A lot of them, the new ones that come in every day and I have many coming, they're very frustrated because they cannot get their doctors to prescribe HCG. How does somebody find a doctor, a provider that is educated on the use of HCG in men?
Allison:
That's another great question. I hear that from new patients all the time. I would say patients in general are more educated nowadays with sites like Excel Male, like you mentioned, watching webinars like this. They've really come to the point where they're educating themselves, coming in telling their physician or provider, "I've read about HCG. I really don't want to experience testicular atrophy on my testosterone. I might want to have children at some point in the future. What about prescribing it for me?" Oftentimes the physician's answer will flat-out be "No, I don't prescribe it." Often because they're just not familiar with it. They haven't read the studies to support it. Also, it still is considered off-label so it's understandable some of them may be just don't have the experience with it yet. That can be frustrating for a patient.
I would recommend if someone's looking for a provider they can always call their local compounding pharmacy and just say "I'm on testosterone. I'm wondering which providers in the area locally are you seeing write prescriptions for testosterone in combination with HCG?" So that could be a really good way to find someone.
Nelson:
Or on websites like mine.
Allison:
Or on Excel Male, yes. That's a great site. I've personally learned a lot from that site. It's great. There's so much literature on there. The discussion boards and the forums just have very engaging and interesting conversations so I would definitely recommend checking it out.
Nelson:
Thank you. We also have a ******** group with 5,800 guys. It's called Testosterone Replacement Discussion. So we get frustrated guys from all over the world posting daily about their lack of access for HCG. Many help them because obviously there's a network of people already obtaining it through their doctors.
This was really great information. I really appreciate the time that you took to explain this very hot topic. Hopefully we'll have a few more of these in the future.
Thank you so much for all of you out there that are watching this video. As I said, ExcelMale.com, you can come visit and register with us, or check PrimeBody.com. It's a network of national clinics that may provide some of these products by prescription to you. Thank you so much.
Allison:
Thank you.
Nelson:
Thank you Allison.
