When it comes to hormone replacement therapy, Human Chorionic Gonadotropin (HCG) is not an adjuvant, it is integral to hormonal health. In my professional opinion, HCG should be part of EVERY good TRT protocol if the aim is to mimic the natural physiological processes that occur within the body. This is discussed in more detail in one of my previous blogs – The Benefits of using HCG with TRT.
What is HCG & How is it Made?
Human Chorionic Gonadotropin is a glycoprotein produced by the placenta to support the corpus luteum during pregnancy. It replaces the Lutenising Hormone (LH) that is suppressed with effective testosterone therapy. It mimics the effects of LH in the body and is chosen over LH replacement as it is more stable and has a longer half-life.
There are two types of HCG available:
- Human Chorionic Gonadotrophin (uhCG) – Derived from the urine of pregnant females.
- Recombinant HCG(rhCG) – Produced by DNA based biotechnology. The only brand of this type currently available in the UK is ‘Ovitrelle’. Unfortunately it is impractical for use in TRT due to it being a single-use, pre-filled syringe delivery method.
Pharmocokinetics of HCG
HCG has a mean half-life of 2.32 days(1) and so stability is achieved in approximately ten days.
Why Isn’t HCG Detected as LH in a Blood Test?
HCG mimics LH as they bind to a common receptor. However, there are some differences in their molecular structure(2) and so HCG will not be detected as LH in a blood test.
How is HCG Administered?
HCG is administered subcutaneously, under the skin.
Unit Measurement of HCG
HCG is measured in international units (IU) which is a unit of measurement based on the particular chemical.
Storage, Preparation & Viability
Unmixed / unconstituted Pregnyl HCG powder must be stored in the refrigerator, whereas Gonasi HCG can be stored at room temperature while still in powder form.
HCG usually comes with a saline solvent, which is only suitable for use when the HCG is being administered as a single, one-off dose (usually in fertility treatment). If you are multi-dosing your HCG for use in TRT, the saline solvent that it comes with MUST be discarded and substituted for bacteriostatic saline. This is also a prescription-only product which should be supplied by your prescribing clinician as it is not usually available to individuals in the UK, even with a private prescription. Bacteriostatic saline contains a preservative which inhibits the growth of bacteria, thereby prolonging your HCG’s shelf-life.
Once mixed / constituted, all HCG should be stored in the refrigerator and used within 30 days. HCG is an extremely fragile substance and exposure to light and heat will cause it to degrade.
Depending on the volume of bacteriostatic saline you are supplied with, you can using the following as a guide:
- 5ml Bacteriostatic Saline + 5000iu HCG = 100iu / 0.1ml
- 2.5ml Bacteriostatic Saline + 5000iu HCG = 200iu / 0.1ml
- 1.0ml Bacteriostatic Saline + 5000iu HCG = 500iu / 0.1ml
Is HCG Safe?
Whilst there is a theoretical concern with prion disease, transmission through urine has not been demonstrated. An international consensus statement from 2005 concluded that urinary-derived HCG appears to be safe(3)
Travelling with HCG
HCG is a Class C / Schedule 4 controlled medication. When travelling with medicine containing a controlled drug, the GOV.UK guidelines state that you need a letter from the person who prescribed your medicine as you may be required to show this at the border. The letter must include the following details:
- Your name
- What countries you are visiting
- Details of strength, amount and doses of the medication
- Your doctor’s signature
When travelling with your HCG, we recommend keeping it cool by storing in an insulin travel case.
As HCG is a controlled drug, a private prescription for this medication is only valid for 28 days from date of issue. It MUST be dispensed by a pharmacy within this time period or it will be invalid.
What Injecting Equipment is Required?
Further details on the equipment and supplies that are required for administration of your HCG can be found here.
All of our patients are given access to an instruction video which demonstrates how to safely and effectively prepare your HCG for injection.