When it comes to testosterone optimisation therapy (TOT), Human Chorionic Gonadotropin (HCG) is not an adjuvant, it is integral to hormonal health. 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 and 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 its effects and is chosen over LH 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. The only brand of u-hCG currently available in the UK is ‘Gonasi HP’.
- Recombinant HCG(rhCG) – Produced by DNA based biotechnology. The brand name available in the UK is ‘Ovitrelle’, however it is impractical for TRT due to the prefilled syringe delivery method(1).
Half-life – HCG has a mean half-life of 2.32 days(2), so stability is achieved in approximately 10 days.
Potency of HCG
It may be possible to check to see if your HCG is still potent with the modern highly sensitive pregnancy tests. However, the dose of HCG is as important as the dose of testosterone in establishing stable levels.
Why Can’t you Measure HCG Levels with the LH Blood Test?
HCG mimics LH as they bind to a common receptor. However, there are differences in their structure(3).
How is HCG Administered?
Subcutaneously – Under the skin.
HCG is measured in international units which is a unit of measurement based on the particular chemical.
- 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
Storage & Viability
It is not necessary to store the unmixed / unconstituted HCG in the refrigerator, however it should be kept out of light and below a temperature of 25° C.
Once mixed / constituted it should be stored in the refrigerator and used within six weeks.
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:
- Your name
- What countries you are visiting
- Details of strength, amount and doses of the medication
- Your doctor’s signature
Storage Whilst Travelling
When travelling with your HCG, we recommend storing it in an insulin carry case – eg. Medicool Insulin Protector Carry Case.
As HCG is a controlled drug, your prescription is ONLY valid for 28 days from date of issue. It MUST be dispensed within this time period or it will be invalid.
- Gonasi HP 5000iu
- BBD Micro Fine+ 0.5ml Insulin Syringe & Needle 29g x 12.7mm x 100
- Bacteriostatic Saline (Torbac) 5ml ampoules (Can be purchased in clinic if required)
- 10ml Sterile Vials (Can ONLY be purchased in clinic)
- 5ml syringes and 21g needles for reconstituting the bacteriostatic saline with the HCG dry powder
- Sharps bin
Here is a link to a blog detailing what supplies and equipment are necessary for the administration of HCG – TRT Equipment & Supplies.
I have prepared a YouTube video with full instructions – How to prepare Gonasi HP (HCG) with Bacteriostatic Saline for use in TRT.
Here is a link to a blog with full injecting instructions – TRT Injection Instructions.
Dr Robert Stevens MBChB MRCGP Dip.FIPT