What is the best dose of HCG? Dr Saya presents two case studies.

[BJE]

It depends on why someone’s using it. If you’re just trying to maintain testicular function for the purposes of fertility and to prevent atrophy if you ever decided to quit TRT, you don’t seem to need that much. 250-500iu’s a week split up into at least 2 injections seems fine for that. You can always do more later if you’re trying to have kids and want to make it easier.

If you’re using HCG for the upstream hormonal benefits or to potentially deal with other issues like PFS, I’d recommend titrating up to the 1000-2500 iu’s a week range slowly over time, getting by with as little as you can until the benefits taper off. Minimum injections should probably be around 250-350iu’s each at 3-4x a week for that based on Dr Saya’s chart and my own personal experience, or 500iu’s EOD. I may even get more benefits from going a little higher but I don’t think I will because that’s really getting up there.

Most guys either feel way better from HCG, nothing, or way worse. I’d titrate HCG accordingly based on which you find yourself to be. Even if you don’t ever want kids, I wouldn’t necessarily recommend no HCG to somebody on TRT because keeping your testes functioning seems vital for a number of reasons far beyond fertility. Plenty of guys do it and say they’re fine, but I personally wouldn’t.

If you’re not on TRT and are using HCG for PFS or other reasons, you seem to be able to get by with less since test raises your usage and requirements of a lot of things, as do thyroid hormones.

I’ve used HCG since I started TRT eight years ago. Last year I stopped using it because I couldn’t get it. I was off of it for about a year before I was able to get it again. My testicles shrunk to about half size. Back on it my testicles are back. However, I’d like to use the lowest effective dose. The only effect I’ve had for sure is testicle size but I’d like to know what other effects I might look for and attribute to HCG. I’m currently using 200IU every other day.

 

[Anonymon]

I’ve used HCG since I started TRT eight years ago. Last year I stopped using it because I couldn’t get it. I was off of it for about a year before I was able to get it again. My testicles shrunk to about half size. Back on it my testicles are back. However, I’d like to use the lowest effective dose. The only effect I’ve had for sure is testicle size but I’d like to know what other effects I might look for and attribute to HCG. I’m currently using 200IU every other day.

It has the potential to increase a lot of your upstream hormones like pregnenolone, as well as a lot of things up, down, and across the cascade. It also seemingly upregulates 5AR according to studies.

For some more concrete things outside of fertility itself that all those hormones can impact, it can affect your mood, energy, ability to handle stress, erections, erection quality, sleep, dopamine levels, appetite, muscle pump and cortisol levels, and most likely it’ll stimulate your thyroid a little. Depending on the person, those effects could either be a good or a bad thing. For me it’s all positive it would seem.

If you were curious, I’d experiment with doubling your dose and seeing how you feel. If it’s better and that persists over a long period of time, you’re most likely getting the additional benefits of HCG. If things get worse for you, I’d stick with the minimum effect dose to keep your testicles full.

 

[BJE]

It has the potential to increase a lot of your upstream hormones like pregnenolone, as well as a lot of things up, down, and across the cascade. It also seemingly upregulates 5AR according to studies.

For some more concrete things outside of fertility itself that all those hormones can impact, it can affect your mood, energy, ability to handle stress, erections, erection quality, sleep, dopamine levels, appetite, muscle pump and cortisol levels, and most likely it’ll stimulate your thyroid a little. Depending on the person, those effects could either be a good or a bad thing. For me it’s all positive it would seem.

If you were curious, I’d experiment with doubling your dose and seeing how you feel. If it’s better and that persists over a long period of time, you’re most likely getting the additional benefits of HCG. If things get worse for you, I’d stick with the minimum effect dose to keep your testicles full.

What would you say that minimum effective dose would be? Given the same weekly dose, are less frequent higher doses better rather than every other day? I’ll add that I’m 56 and I have no need to enhance fertility.

 

[Gman86]

Has anyone used 500-1000iu’s of HCG per week and not had their testicles increase in size at all, but then increased their dose above 1000iu’s/ week and then seen an increase in testicular size, using the sam exact HCG?

Empower’s HCG doesn’t increase my testicle size even a little bit in doses between 500-1000iu’s/ week, jc if increasing the dose further would do anything

 

[captain]

Dr. Crisler told me that HCG only has effect on 20% of the testicle so adjust your expectations. If 20% of the testicle increases in size by whatever % are you going to notice it all that much?

 

[Cataceous]

Dr. Crisler told me that HCG only has effect on 20% of the testicle so adjust your expectations. If 20% of the testicle increases in size by whatever % are you going to notice it all that much?

This isn't quite accurate, as explained by @madman here.

The use of hCG will mimic LH and result in stimulating the Leydig cells in the testes to produce ITT which will have a big impact on stimulating the Sertoli/germ cells located inside the seminiferous tubule lobes to produce sperm and this will cause an increase in testicular volume.​

Thus hCG affects both cell types. From anecdotes we might guess that some guys get more of this indirect Sertoli cell stimulation than others.

 

[madman]

Dr. Crisler told me that HCG only has effect on 20% of the testicle so adjust your expectations. If 20% of the testicle increases in size by whatever % are you going to notice it all that much?

He would have stated such seeing as the Leydig cells only make up 10-20% of testicular volume.

Much more to the story.

hCG mimics LH which stimulates the Leydig cells to produce ITT (intra-testicular testosterone).

Although the Leydig cells become dormant/atrophy without stimulation from LH/LH analog you would think that testicular shrinkage would be minimal.

Unfortunately when using exogenous T not only is their lack of LH but also FSH which is needed to stimulate Sertoli/germ cells to produce sperm.

Seminiferous tubules are made up of Sertoli cells and germ cells and the reduction of these cells results in testicular atrophy which reflects the loss of both spermatogenesis and Leydig cell function.

Hope you understand that when using/abusing testosterone let alone AAS testicular atrophy can be significant and extreme in some cases since 80% of the testicular volume is made up of germ cells/seminiferous tubules.

Even though the use of hCG will stimulate Leydig cells to produce ITT you need to keep in mind that ITT will also have an impact on Sertoli/germ cells and can still contribute to preventing/minimizing overall testicular atrophy let alone improve sperm production.

The addition of FSH would have a greater impact on preventing/minimizing the degree of testicular atrophy let enhancing sperm production.

Use of hCG whether solo (monotherapy) or with exogenous T will still have a big impact on preventing/minimizing testicular atrophy let alone sperm production.

Would not put too much weight behind the.....HCG only has effect on 20% of the testicle so adjust your expectations

When testicle size increases, what happens?

We know that HCG or Clomid can increase testicle size. But exactly how does a testicle increase in size once extra LH or HCG enter the cells? Does it stop apoptosis, or more cells uptake glucose or water, etc?

www.excelmale.com

Fig. 9 Testicular atrophy in a 30-year old AAS abuser (right) compared to normal size (left)

 

[madman]

What would you say that minimum effective dose would be? Given the same weekly dose, are less frequent higher doses better rather than every other day? I’ll add that I’m 56 and I have no need to enhance fertility.

Keep in mind that when it comes to preventing/minimizing testicular atrophy let alone preserving/maintaining fertility (sperm production) many are not even using what would be considered the minimum effective dose.

Some of the take-home points:

*The main goal when using hCG is to restore physiological ITT levels and in order to achieve such a minimum effective dose would be needed (125-500IU) and 250-500IU would seem to be the sweet spot

*Previous studies indicate that HCG can significantly increase ITT in a dose-dependent manner and that dosages between 250 and 500 IU might be optimal to restore physiological ITT levels

*It can be suggested that low dose HCG (~500IU) injected 3 times per week can restore healthy serum and intratesticular testosterone levels in HH patients. The higher dosages used in infertility treatment to trigger sperm production might not be necessary if the goal is to increase serum testosterone levels. That is, combined treatment with HCG followed by rFSH might also be potent in order to induce fertility

*Indeed, HCG dosages used in the treatment of infertility can range from 3,000 to 10,000 IU 2-3 times per week [30]. One study showed that 3-6 months (1000 IU 3 times/week or 2000IU 2 times/week) of HCG treatment in 100 males with hypogonadotropic hypogonadism leads to normal serum testosterone concentrations despite the fact that 81 patients remained azoospermic [31]. These data show that low dose HCG treatment is very effective in restoring normal serum testosterone levels, however, spermatogenesis might require higher dosages of HCG. The exact mechanism by which HCG affects sperm production besides testosterone increase is not completely understood yet and needs further investigation. We summarized studies involving HCG treatment on testosterone and/or fertility parameters in Table 1.




My reply from a previous thread:

post #37

Playing with HCG gave me libido

I am thinking more like maybe 500 hcg and 250 is too much and increases something very high where you don’t get this libido maybe low than 250 is a key ? I am checking this now I will see how long it will last M.J., what you're finding is also being discussed on this thread as well...

www.excelmale.com

The main purpose of adding hCG to trt is to preserve/maintain fertility and prevent/minimize testicular atrophy.

The use of exogenous testosterone results in the suppression of ITT (intra-testicular testosterone) which is critical for sperm production.

The main goal when using hCG is to restore physiological ITT levels and in order to achieve such a minimum effective dose would be needed (125-500IU) and 250-500IU would seem to be the sweet spot.

Anything less will have a minimal impact on increasing ITT!

Other than one experiencing possible side effects from such doses (250-500IU) using anything <125IU will have a minimal impact on increasing ITT.




My reply from a previous thread where the poster asked if hCG was needed:


Depends on the individual.....Is hCG needed?

*To preserve/maintain fertility then yes.

*To prevent/minimize testicular atrophy then yes.

*To enhance mood/libido than it is not a given as some may experience such effects whereas others may feel worse-off.

*To maintain upstream hormones and possibly prevent long-term consequences for health/well-being.....you be the judge!


Effect of TRT vs hCG/FSH on upstream hormone pathways.

*Take-home point:

A replacement regimen with combined hCG/rFSH mimics physiologic steroid hormone profiles better than a substitution with exogenous testosterone. The documented differences in steroid profiles on testosterone replacement in hypogonadal males with absent or severely reduced endogenous LH and FSH secretion may have long-term consequences for health and wellbeing. Specifically, body composition, bone health, glucose, and lipid metabolism, salt and water balance, cognition, mood, sleep, and sexual function could be affected. The steroidogenic differences could also be relevant for gonadotropin-suppressive treatments with long-acting testosterone preparations in males with primary hypogonadism. To what extent this hypothesis is true, should be addressed in future clinical studies.




This is the most recent paper on the use of hCG!

Pros and cons of using TRT vs HCG for treatment low-t symptoms


5.1 Effects on intratesticular testosterone

Exogenous testosterone administration suppresses intratesticular testosterone (ITT), which is crucial for the production of sperm [24]. In such patients, ITT has been shown to be suppressed by 94%. However, with every other day injections of HCG at dosages of 125IU, ITT was only 25% less than baseline, with 250IU 7% less and with 500IU 26% greater than the baseline [25].

In another study, 37 normal men were treated with GnRH antagonist acyline and attributed to one of the following low dose HCG groups: 0, 15, 60, or 125 IU sc every other day or 7.5 g daily testosterone gel for 10 days. In order to measure ITT, testicular fluid was retrieved via percutaneous aspiration at baseline and after 10 days of treatment. The median baseline ITT was 2508 nmol/liter.

ITT improved in a dose-dependent manner: 15 IU HCG group reached an ITT of 136 nmol, 60 IU HCG group reached an ITT of 319 nmol, 125 IU HCG group reached an ITT of 987 nmol/liter. Serum HCG significantly correlated with both ITT and serum testosterone [24,26].

*These studies indicate that HCG can significantly increase ITT in a dose-dependent manner and that dosages between 250 and 500 IU might be optimal to restore physiological ITT levels.




5.2 Effects on serum testosterone

A weekly dosage of 4500IU spread over 3 weekly injections has shown to lead to normal testosterone levels in isolated HH men [27]. Another study showed that single injections of 400IU, 2000IU, and 4000IU of HCG led to significant serum testosterone concentrations in hypogonadal as well as eugonadal males without differences among the groups after administration [28]. In hypogonadal men, 400IU, 2000IU, and 4000IU of HCG increased testosterone from about 200 to 400 ng/dl. In eugonadal men, 400IU, 2000IU, and 4000IU of HCG led to an increase from about 450 to 700 ng/dl in testosterone [28]. Interestingly, higher doses of HCG did not lead to greater testosterone level increases [28]. Another study showed similar results, with no differences in serum testosterone after single injections of 1500, 3000, or 4500IU of HCG, with testosterone increasing 24 hours post-injection and peaking 3-4 days later [29]. Serum testosterone peaked 3 days after injection [28].

From the above information, it can be suggested that low dose HCG (~500IU) injected 3 times per week can restore healthy serum and intratesticular testosterone levels in HH patients. The higher dosages used in infertility treatment to trigger sperm production might not be necessary if the goal is to increase serum testosterone levels. That is, combined treatment with HCG followed by rFSH might also be potent in order to induce fertility [21].

Indeed, HCG dosages used in the treatment of infertility can range from 3,000 to 10,000 IU 2-3 times per week [30]. One study showed that 3-6 months (1000 IU 3 times/week or 2000IU 2 times/week) of HCG treatment in 100 males with hypogonadotropic hypogonadism leads to normal serum testosterone concentrations despite the fact that 81 patients remained azoospermic [31]. These data show that low dose HCG treatment is very effective in restoring normal serum testosterone levels, however, spermatogenesis might require higher dosages of HCG. The exact mechanism by which HCG affects sperm production besides testosterone increase is not completely understood yet and needs further investigation. We summarized studies involving HCG treatment on testosterone and/or fertility parameters in Table 1.


* It is currently unknown if long-term administration of HCG can lead to side effects such as gonadotropin resistance. (Table 2)

 

[Anonymon]

What would you say that minimum effective dose would be? Given the same weekly dose, are less frequent higher doses better rather than every other day? I’ll add that I’m 56 and I have no need to enhance fertility.

I’d agree with Madman’s 250-500iu’s a week if you’re talking about things like ITT and sperm, but as far as the other hormonal benefits that are more removed from that, it’s really anyone’s guess. Personally, if you’re doing 500iu’s EOD, I imagine you’re maxing out the safe potential benefits with that, with 250iu’s 2-3x a week being the lower end minimum of that. It would again depend on what you’re looking to do with it, which in your case doesn’t appear to be related to fertility. For mood and other benefits if you’re the kind that responds to that, 1000-1400iu’s a week would probably be closer to the minimum for that.

 

[Charliebizz]

I've been on trt without HCG for around a year and a half. Can Any permanent damage occur to the testicles from being shut down that long? Going to be starting HCG next week to see if I can get a boost In well being.

 

[Anonymon]

I've been on trt without HCG for around a year and a half. Can Any permanent damage occur to the testicles from being shut down that long? Going to be starting HCG next week to see if I can get a boost In well being.

Potentially, but some guys have been on TRT without HCG for longer and bounced back fine, either coming off of test or by adding HCG. Everybody’s different, but there’s precedent for you potentially being fine if you ever wanted to take action. I’d say better safe than sorry though and have at least a minimal dose of HCG a week to keep your testicles working.

 

[SkyWarn]

I was running low on HCG so I cut my dose in half the last 2 months. Im doing 250 units once a week. Testicles have started to shrink again and I am getting a dull ache on the left side for some reason. Next week I will go back up hopefully if I can get more.
When I use HCG my orgasms are much better. Without it the orgasms seem blunted. Not sure why

 

[Gianluca]

since I have found in the forum many anecdotes on the difference in potency between Empower HCG and Pregnyl, it would be interesting to see what the difference would be on this graph using Pregnyl HCG. Based on the anecdotes, it may be quite different.

 

[DorianGray]

since I have found in the forum many anecdotes on the difference in potency between Empower HCG and Pregnyl, it would be interesting to see what the difference would be on this graph using Pregnyl HCG. Based on the anecdotes, it may be quite different.

Has anyone noticed a difference clinically between the two?

 

[Kenp]

since I have found in the forum many anecdotes on the difference in potency between Empower HCG and Pregnyl, it would be interesting to see what the difference would be on this graph using Pregnyl HCG. Based on the anecdotes, it may be quite different.

Based on this graph, could one take a high dose of HCG once/week? (let's say 2500IU)

 

[madman]

Based on this graph, could one take a high dose of HCG once/week? (let's say 2500IU)

HCG one week per month?

I've had problems with ED and anorgasmia since I began TRT 5 years ago. It took me almost four years to figure it out, but HCG gives me anorgasmia in doses above 250iu/2x week. Once I decreased from 2x 500iu to 2x 250iu, and then to 2x 200iu, the situation resolved. I just spent the past two...

www.excelmale.com

 

[Gianluca]

Has anyone noticed a difference clinically between the two?

search the forum "difference between empower HCG and pregnyl"

 

[Gianluca]

@Vince @Nelson Vergel I'm assuming you guys also are using Pregnyl now or another brand of HCG, have you noticed a difference or had to decrease the dose of it when switching?

 

[Nelson Vergel]

No difference whatsoever.

 

[Forty2]

No difference whatsoever.

Have you tried Ovitrelle, Nelson?