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888.828.4300info@tctmed.com

hCG for Low Testosterone—Everything You Need to Know

someone's pulse being taken

If you’re afflicted with low testosterone, adding testosterone alone isn’t always the answer—we sometimes use hCG for low testosterone patients who experience specific side effects (or who are concerned about fertility).

Supplementary drugs like hCG can sometimes be necessary, and we may recommend hCG for low testosterone when the conditions are right, either alone or in combination with testosterone.

However, deciding on the right combination for you is a complicated process, and we may need to revise your individual therapy to ensure you’re getting precisely what you need.

The reason? Your body is an incredibly complex biological machine—and maintaining homeostasis is not a simple matter. Dozens of biological processes are occurring within your body at any given moment, and your hormones often play a crucial role within many of those processes.

Simply adding one hormone into the mix isn’t always the best way to alter a complex system (though it may indeed be).

And don’t forget—every person is different. What works for your coworker may not work for you. The differences between men and women are much more profound—and the proper hormone replacement therapy differs greatly between the sexes.

So, let’s talk a little about what hCG is (and why you might need it).

What is hCG and When Might It Be Used?

hCG stands for Human Chorionic Gonadotropin (which is very different from HGH, or Human Growth Hormone). While hCG does occur naturally in the human body, it is generally only produced by women during pregnancy. In fact, it is the hormone your standard urine pregnancy test is looking for.

Still, the pituitary gland does produce an analog of hCG, known as luteinizing hormone (LH), which can be found in both men and women, and at any age.

In short, hCG is a naturally occurring hormone—but it has a very specific use within the realm of testosterone replacement therapy.

While injection therapy for low testosterone is our preferred method of addressing low testosterone, not everyone is a candidate—we might recommend hCG for low testosterone patients who are very conscious of risk to fertility (especially if you plan to have children in the future).

hCG can also be indicated for patients for whom testicular atrophy is an issue.

Using hCG for Low Testosterone Patients Who Need to Maintain Testicular Function

This is probably our most common use of hCG for low testosterone patients. Combining hCG with testosterone replacement therapy can help to maintain testicular function, as testosterone replacement therapy can decrease the brain’s hormonal stimulation to the testes, causing testicular atrophy.

There are two side effects of testosterone replacement therapy that often concern men the most—testicular atrophy and loss of fertility. While fertility can be maintained through the exclusive use of hCG, your testosterone levels will likely not be raised optimally.

Another reason this is uncommon is that, generally, men who are suffering from low testosterone are at a place in their life where they no longer worry about their fertility (or may actually want to eliminate the possibility of having another child).

Still, using only hCG for low testosterone is a possibility if you feel strongly that you want to maintain your fertility (known as hCG monotherapy). Most patients on hCG monotherapy self-administer the injections three times a week. It’s a rigorous schedule and not easy to maintain.

Much more common is combination therapy—an injection of hCG combined with your normal testosterone injection, once a week. This can curtail testicular atrophy, and it may have a small protective effect on fertility.

If Testicular Atrophy is a Problem, Discuss Adding hCG to Your TRT Regimen

hCG is not for everyone, but it may help you deal with some of the side effects of testosterone replacement therapy.

To learn more about the side effects of testosterone replacement therapy and how they may affect you, click here.

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LOW T RESOURCES

(Augie) Juan Augustine Galindo Jr. MPAS, PA-C

(Augie) Juan Augustine Galindo Jr. MPAS, PA-C started his career in healthcare as a fireman/paramedic in West Texas where he served on the Midland Fire Department from 1998-2004.   He became interested in testosterone treatment after seeing how hormone replacement doctors helped those suffering from low testosterone.   After graduating from the Texas Tech Health Sciences Center Physician Assistant Program, he moved to DFW where he currently lives with his wife and three children.

18 Comments

  1. Kim on 12/13/2016 at 10:02 am

    I’m curious about hcg for my 14 year old son instead of giving him a low dose of testosterone.
    The endocrinologist says testosterone. The naturopathic dr. Says hcg. What do you think?
    Thank you for your input.

    • Augie Galindo on 12/16/2016 at 4:05 pm

      Kim,

      It depends on where the dysfunction lies, brain (hypothalamus/pituitary gland) or gonadal (testicular). If this represents testicular failure (primary hypogonadism), hCG will not work. However, if the issue is higher in the axis, hCG would be preferable as it would not negatively affect fertility. That being said, the likelihood of achieving normal, physiologic levels of testosterone with hCG monotherapy is somewhat low.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  2. Thomas dehaven on 03/27/2017 at 4:21 pm

    I am a 51 yr old male with diabetes and I started testosterone therapy replacement a month ago. My initial dose from a nurse practitioner was 400mg
    200 mg higher than the Dr recommended. I actually felt great a day or two later but it made my nipple crazy sensitive ! The sensitivity calmed down about 10 days later. I took another 400 mg shot 14 days later and felt great again but I didn’t affect my nipple quite as bad. The third shot was 300 mg 2 wks later and the bottle was empty . I had an a1c test and my total testosterone was 349 but I’m not sure if my free testosterone level was in normal range. I was never told what my estrogen level or hgc levels were at and everything I read tells me that testosterone alone is not recommended! Multiple sites recommend estrogen blockers and hgc injections are needed with testosterone. I’m concerned that the testosterone is reverting into estrogen due to the lack of sensitivity in my male organ if you know what I’m saying. The first 3-4 wks I noticed a major increase in sensitivity and overall sex drive ! I missed the next few weeks before I got back to see my doctor again and I realize that is a major no no! My blood test showed a total testosterone level in the 250 range. The bottom line is what dose of each is recommended, how often, and do they all need to be grouped together? Also how often should I have blood work done and what types should be done?

    • Augie Galindo on 03/30/2017 at 5:58 pm

      Thomas,

      I wish I had better news for you, but there isn’t a single thing about that course of care that is right in my opinion. Almost invariably, my male patients are on aromatase inhibitors from the beginning of therapy. The use of hCG is optional, but should be discussed. I rarely say this, but you may be better off not continuing therapy unless you find a provider with a different approach.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  3. Kelly Gilbert on 04/11/2017 at 6:56 pm

    I am 34 and have been on Testosterone replacement therapy for the last year to raise my levels. I have recently been switched to HCG for the same purpose. I have read multiple times now that using both in combination yields the best results. The reasoning behind switching to HCG from testosterone was to preserve the possibility of having another child. Will using the HCG and test together protect fertility?

    • Augie Galindo on 04/15/2017 at 12:23 pm

      Kelly,

      Well, the short answer is, yes. The real answer is, somewhat, but it’s complicated. There is no perfect study done in this area. What we know: testosterone suppresses fertility AND hCG promotes fertility. There is no evidence that supports a measured way to estimate the amount of influence of either drug as it relates to fertility. So, I can hazard a guess, but ultimately I can’t say whether the suppression or protection is an 8% or 88% proposition.

      On the flip side, I do have anecdotal evidence, the cumulative information on every TRT forum on the web, and clinical and personal experience. My gym partners from my early 20’s abused anabolics, with whopping doses of a multitude of drugs no less. I still know these guys, and now, in their late 30’s and early 40’s, they all have kids. There kids are just as ugly as they are, I KNOW they are their kids. You can read on forums about a multitude or patients on TRT with hCG who have successfully fathered children. I have seen the same in my practice. And, finally, I have been on TRT for years and I have a two year old who was conceived, without a hint of difficulty, while on TRT with hCG.

      The only definitive way to measure effect is to submit for semen analysis pre and post treatment. The use of hCG will NOT completely eliminate the risk of infertility, but I do think it mitigates it quite well.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  4. Rick on 05/09/2017 at 1:06 pm

    First….we know that everyone’s different. Generally speaking……. what’s the highest dose known of HCG? 65 yr old with long term lower back issues, on high amounts of all types of opiates. Total T has been as low as 48. With TRT, levels are back to normal. Have been on HCG 1ml every other day for a couple months, plus 250 cypionate every 2 weeks. Generally speaking….what’s the highest dose known? Take care.

    • Augie Galindo on 05/12/2017 at 5:16 pm

      Rick,

      The concentration of hCG varies widely, though the most common one is 1000 IU/ 1 mL. That being said, fertility specialists will use MUCH larger doses (1000’s of units per dose) than you are on. Understand that hCG relies on normally functioning testes to have any impact at all. The most important thing to change about your therapy would be to change to a once weekly dose.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  5. Paul on 08/21/2017 at 11:03 pm

    Hello, I am a 35 year old. Was diagnosed with low T (125 total). Free is in AVERAGE RANGE. Never had problems having kids. I have been put on clomid (levels went to 400 / felt a little better), t shot (horrible), last Pellet injections. They have run many tests and all ranges are good except Low T and Extermly high cortisol levels. Any advice to who I should see or what may help?

    • Augie Galindo on 08/31/2017 at 9:18 am

      Paul,

      It sounds like you’ve run the gamut. I can’t say that I’ve ever seen a free testosterone level in the “average range” in the setting of a low total T level. Recall, the (direct) analog free testosterone test is clinically useless. I strongly believe that injections given weekly, and properly managed, are the best way to treat hypogonadism. Cortisol issues can be often mitigated through dietary and stress management changes.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  6. Thomas on 08/24/2017 at 4:31 pm

    Im a 28 YO male with Low T. It sucks. Its putting a strain on my marriage due to sex life, tiredness and just overall well being. It doesn’t help that I work 24hours shifts away from home on top of the health problems. I went to the urolgist that specializes in Low T replacement. He wanted to start me on clomid 50mg every day. I have read some bad things about it and good things. I see where it may get your levels up but may not help with the libido and energy levels even though your T levels are up. I told the doctor I wanted to do testosterone which he was okay with except I lost him when I said I wanted to do HCG to try and keep my sperm count up and everything functioning. He will not do it. Said he doesn’t know about it and doesn’t even know how to dose it. Since this has been going on my levels have been steadily going down because the first time I had all this checked I went to my PCP. He would give me the testosterone due to my free T levels being low. My Total T was above 300 at the time so he said it was in range. Even though I felt like that was low for my age but I understand it doesn’t go off of age and there is a broad range. He sent me to the specialist to get the HCG and testosterone since it wasn’t his speciality and he knew nothing or the HCG. Thats why I went to the specialist he referred me to. This is a ongoing problem of 6 months or more and now since I started doing testing I am 2 more months in. Still no treatment and levels are dropping and the specialist wants to send me to a different doctor who he said may do HCG but he doubts it.

    Prolactin Levels were fine,
    Free T was 6.3 PG/ML
    SHBG was 29.4 NMOL/L
    LH was 2.0 MIU/ML
    FSH was 4.0 MIU/ML
    Estradiol was 20.5 PG/ML

    • Augie Galindo on 08/31/2017 at 9:26 am

      Thomas,

      It is a difficult situation to be in. I am sorry things have been so frustrating. I believe you are right to demand hCG be given concurrently with TRT since you want to maintain fertility. Perhaps you could have one provider prescribe the testosterone and estrogen blocker, and see a fertility specialist for the hCG, they are more familiar with its use for the promotion of reproductive health.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  7. Vikram on 10/24/2017 at 5:21 pm

    Hi does hcg work on failed testicles? I’m suffering with zero sperm count after 3 months on hcg results are the same? Doctor will recommended another dose of injections? Does hcg jumpstart failed testicles?

    • Vikram,

      Use of hCG only works with functional testes. It essentially “replaces” pituitary stimulation for the production of testosterone to the testes, but working Leydig cells are necessary to achieve natural testosterone production.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  8. Usman Sarwar on 11/01/2017 at 6:14 pm

    Hello there

    I have high LH and high FSH, low Test levels. Is it not the case that i should administer HCG to increase the LH and FSH even more resulting in the Leydig Cells being forced to get working. Basically I have primary Hypo.

    Many thanks

    • Usman,

      It’s been a long time since I have been able to respond. Please forgive the delay. You do have classic primary hypogonadism. You are on the right track with your suggestion, but the use of hCG does not increase LH or FSH, it is an LH analog and acts on the testes. It needs normally functioning testes in order to work well, and given that your brain (hypothalamus/pituitary axis) is already revving up the engine without appropriate effect, you may not have normal testicular function. Your most reliable bet will likely be traditional TRT.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  9. Steve on 06/28/2018 at 10:44 am

    Hello
    I’m 53 year old male with lot T. I have been on testosterone therapy for about 5 years. I get a shot once a week of 190 MG. My T levels and free T are doing well. I am receiving the Cypionate type of testosterone. Here is the problem I’m having that I think may be helped with the HCG. Hopefully you can tell me if I’m wrong or not or what I can do about the current problem. My testacies seem shrunken and my penis is cold most of the time. This has never been the case my entire life. It’s also uncomfortable. I had a vasectomy 10 years ago so I’m not worried about sperm count. Would the HCG help to resolve my uncomfortable situation?

    Thank you

    • Steve,

      The addition of hCG is almost certain to help with your testicular atrophy. As far as the cold sensation you have been experiencing is concerned, I’ve never come across that as a symptom of TRT so I am unable to offer any meaningful advice there. Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

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