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. We should actually think about the term hormone replacement therapy not simply testosterone replacement therapy.
In order to understand why this is and what relevance it has, you need to have an understanding of the Hypo-Pituitary Gonadal (HPG) axis. It’s actually basic physiology. The HPG axis works through a negative feedback loop that is constantly responding to not only oestrogen levels through aromatisation of testosterone to oestradiol, but to other neurophysiological factors. HCG perfectly mimics Lutenising Hormone (LH) whose release from the pituitary is suppressed through a relative increase in oestrogen. LH / HCG stimulates the Leydig cells in the testes to produce testosterone. Simples!
Wait, there’s more! LH / HCG also has a role in fertility. Testosterone Replacement Therapy (TRT) essentially shuts down the HPG axis. TRT can therefore affect fertility through suppression of LH & Follicle Stimulating Hormone (FSH) production, causing azoospermia. A recent survey of American Urologists observed that approximately 25% of their patients treated with TRT due to low testosterone levels had associated male infertility(1). HCG has long been recognised as a treatment for male infertility.
Whilst HCG mimics LH, it doesn’t have the same chemical structure, hence it does not show up as LH in a blood test. Also, the delivery system is different, LH is released in a pulsatile manner, so you cannot perfectly replicate natural LH stimulation of the testes. Most men have an element of both primary and secondary, so HCG monotherapy is not a substitute for testosterone. We should think of TRT as optimising LH with HCG and supplementing with testosterone.
In TRT, shutting the HPG axis is quite deliberate and in fact, necessary. If your pituitary is still producing LH and FSH whilst on TRT, your brain is sensing your current circulating levels are inadequate. So, whilst it might seem counter-intuitive to deliberately shut down your pituitary, it’s actually a good sign. The downside is your brain is no longer producing LH and FSH.
As already discussed, one role of LH is to stimulate the Leydig cells to produce testosterone. If you have a primary hypogonadism (a problem with the testes) you could argue, why use HCG? When it comes to intratesticular production of testosterone, we know that HCG will not be as effective if you have a problem with the testes. However, assuming your testes are not completely shut down, there will still be some effect from its concomitant use.
So how do you weigh these benefits against the possibility of reduced fertility if you and your partner are considering a family? Fortunately, there is growing evidence and research that this risk can be minimised by using Human Chorionic Gonadotrophin (HCG) alongside TRT, so that you can reap the benefits of a healthy testosterone whilst remaining fertile. Use of HCG alongside TRT can help preserve and improve fertility in men receiving TRT(2). In fact, two of my guys on Testosterone Enanthate and HCG can testify to it’s effectiveness!
Use of HCG alongside TRT will help preserve testicular size, this may not be of significant concern to you or you might rationalise not using it because you don’t want children. I’m rather uncomfortable with the idea of allowing an organ to atrophy, surely that seems counter-intuitive to the philosophy behind balance. Homeostasis is a about maintaining physiological stability through feedback systems, remove a part of the jigsaw and you will never see the complete picture.
There are LH receptors in the brain, use of HCG alongside testosterone is often the difference between feeling good and feeling great. HCG is the hormone I tend to manipulate most when adjusting our protocols here at The Men’s Health Clinic. It’s partly because it’s the easiest way of manipulating oestrogen but it’s also in part due to the qualitative difference felt due to it’s action in the brain.
If you needed another reason to use HCG alongside TRT there is the up-regulation of steroid hormone synthesis in the cascade down from Pregnenolone. Pregnenolone is often referred to as the ‘father’ hormone, it’s made from cholesterol. Tank your cholesterol with a statin at your own risk! It’s important to recognise that there is inter-relationship between all hormones, whether it be direct or indirect, harmony comes from having everything in balance.
I don’t want to oversell HCG, but there is evidence to suggest that HCG can improve penis size if you have a micro-penis.(3) I appreciate, no one wants to admit their penis isn’t the size it once was, but HCG can maximise its natural size. It can’t increase its size per se due to the Suspensory ligament, but it can certainly help you achieve its intended size.
What is HCG ? HCG is actually a hormone produced by pregnant females. It is produced by the embryo once the sperm has fertilised the egg. Its production ensures that the corpus luteum continues to produce progesterone throughout the first trimester of pregnancy, thus preventing menstruation and allowing the placenta to develop. But don’t let that put you off, much like oestrogen is considered the female sex-hormone, it’s plays an essential part in men’s health as well. It’s time for some common sense medicine!
The Benefits of HCG:-
Restores Testicular Size
Improves Libido and Penis Sensitivity
Up-regulation of Steroid Hormones
So… Should HCG be part of your TRT protocol? Yes!!
Dr Robert Stevens MBChB MRCGP Dip.FIPT
(3) Penile Growth in Response to Human Chorionic Gonadotropin (hCG) Treatment in Patients with Idiopathic Hypogonadotrophic Hypogonadism – Sun-Ouck Kim, Kwang Ho Ryu, In Sang Hwang, Seung Il Jung, Kyung Jin Oh, and Kwangsung Park