The aim of Testosterone Replacement Therapy (TRT) is to restore and optimise your testosterone levels. Having an optimal testosterone is pivotal to men’s health and its benefits are far more wide reaching than just an improvement in sexual function and libido, it is essential to overall health.
If you are deficient in testosterone, it makes perfect sense that you replenish your levels with a testosterone that is bio-identical. Here at the Men’s Health Clinic, you have the option of a topical gel or an intramuscular slow acting depot injection. These bio-identical testosterones have the same chemical structure as the naturally occurring hormone which is produced within the body.
Unfortunately, it is impossible to perfectly simulate what would be a normal physiological testosterone level through medication, even if it is bioidentical. Due to this, TRT has been associated with side effects such as reduced fertility, testicular shrinkage and alteration of sex drive. However, there are well documented health benefits associated with having a normal testosterone. Bearing this in mind, in my opinion, the benefits far outweigh the risks, especially as we can minimise these symptoms with modern medicine.
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.
How does it work? Human Chorionic Gonadotropin is a hormone that essentially mimics Luteinising Hormone. It stimulates the Leydig cells within the testes to produce testosterone and sperm production.
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.
HCG is used as a fertility treatment in both men and women. In men its use has been associated with increased sperm production.
Men diagnosed with Testosterone Deficiency Syndrome (TDS) are not producing enough testosterone. TDS can be classified as primary, where the testes have failed; secondary, where the hormone signalling from the brain has faltered, or a mixed condition, which is a combination of both. Since HCG mimics Luteinising Hormone, its maximum benefit is in men who have secondary and mixed TDS. This is why it is important to have a full work up so that your clinician can best advise you whether HCG is appropriate for you.
We know that TRT alters the brain’s signalling of the hypothalamic–pituitary–gonadal axis. This is a complex system that keeps hormonal balance through a feedback mechanism regulating production of hormones from the hypothalamus, pituitary gland and testes. When your body recognises that you have enough testosterone, it signals the brain to stop producing both Luteinising Hormone (LH) and Follicle Stimulating Hormone (FSH). This negative feedback mechanism prevents excess testosterone from being produced. Your body functions best when it is balanced, any alteration in a wide number of factors causes a reaction within the body to try and re-establish balance. In TDS, those feedback mechanisms have been disrupted and so testosterone may be necessary to optimise your levels to restore health.
HCG has a place in the management of men on testosterone replacement therapy with TDS. Whilst administration of testosterone will obviously restore your testosterone levels, it will supress testicular function by essentially making your Leydig cells dormant. This is because they no longer receive the normal signalling from the brain to stimulate your testes to produce testosterone.
TRT can therefore affect fertility through suppression of LH & 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. Concomitant use of HCG can help preserve and improve fertility in men receiving TRT(2).
Testicular shrinkage is a known side effect of TRT for the reasons discussed above. HCG can help maintain testicular size in patients receiving TRT as it has a direct stimulatory effect on the testes. As previously mentioned, suppression of LH by TRT makes the Leydig cells in the testes dormant due to lack of hormonal stimulation by the brain. HCG will help maintain both size and function by mimicking LH. Its use therefore, may be simply seen as more of a cosmetic one in men who do not want to conceive and where fertility is not a consideration. However, maintaining testicular size and function helps preserve libido and sexual function. Testosterone is not the only androgen responsible for a healthy sex life.
Benefits of HCG:-
Restores testicular size
Improves libido and penis sensitivity
Dr Robert Stevens MBChB MRCGP Dip.FIPT
(1) Empirical medical therapy for idiopathic male infertility: a survey of the American Urological Association. Ko EY, Siddiqi K, Brannigan RE, et al. J Urol 2012;187:973-8
(2)Testosterone+ HCG Preserves Healthy Sperm in Men on Testosterone Replacement Therapy (Injections and gels) – Tung-Chin Hsieh, Alexander W. Pastuszak, Kathleen Hwang and Larry I. Lipshultz*,† From the Division of Urology, University of California-San Diego (TCH), San Diego, California, Scott Department of Urology, Baylor College of Medicine (AWP, LIL), Houston, Texas, and Department of Urology (KH), Brown University School of Medicine, Providence, Rhode Island