Should i take hcg with testosterone

HCG comes in injectable form and is usually administered 2 to 3 times a week. Previous studies have demonstrated that hCG increased testosterone levels compared to placebo. In another study, men taking testosterone along with hCG were able to maintain adequate sperm production and testicle volume. Given it helps to maintain fertility, hCG is a good option for men with low testosterone wanting to preserve their fertility.

Moreover, men who are concerned about the size of their testicles while being on testosterone replacement therapy, benefit from taking hCG as it may prevent testicular atrophy. In men, it serves as alternative to testosterone therapy to help boost testosterone levels while maintaining fertility. On certain occasions, your doctor can prescribe it in conjunction with testosterone products. Book Your Appointment Online.

Or Call This article was authored by Dr. Jonathan Clavell. Small studies suggest that men treated with testosterone who subsequently developed azoospermia experienced a recovery of spermatogenesis in about 4 months after discontinuing exogenous testosterone, regardless of the testosterone preparation, and initiating intramuscular hCG every other day, Lipshultz said.

However, the studies were single-arm, observational and retrospective in nature, he added. The findings, Lipshultz said, led researchers to question whether it was possible to prevent sterility in a man with hypogonadism who must use testosterone.

Coviello, MD, a reproductive endocrinologist and practicing clinician and researcher at Boston University School of Medicine, and colleagues analyzed data from 29 men with normal reproductive physiology randomly assigned to mg testosterone enanthate weekly in combination with saline placebo or IU, IU or IU hCG every other day for 3 weeks. The researchers found that intratesticular testosterone increased linearly with increasing hCG dose, demonstrating that a relatively low dose of hCG maintains intratesticular testosterone within the normal range in healthy men with gonadotropin suppression, Lipshultz said.

A small, prospective study indicated that may be true, Lipshultz said. Men underwent routine semen analyses throughout the study mean follow-up, 4.

In an expanded study assessing a larger population of 26 patients, results were similar, Lipshultz said. Low-dose hCG appeared to maintain sperm quality in men with hypogonadism using testosterone replacement therapy.

To maintain fertility in men with hypogonadism prescribed testosterone, Lipshultz said, clinicians should first insist on a semen analysis before beginning testosterone treatment.

If the man desires a future pregnancy, the clinician should prescribe hCG concurrent with testosterone therapy, typically at U subcutaneous three times per week or 1, U once weekly if the patient wishes only to prevent testicular atrophy.

The patient should cycle off of testosterone twice yearly, at a rate of 3, U three times per week for 4 weeks, adding 25 mg daily clomiphene therapy during that period, Lipshultz said.

Testosterone monotherapy is a rather short-sighted and dogmatic approach to treating Testosterone Deficiency TD when we know other hormones are suppressed through treatment. TD is typically as a result of either a primary hypogonadism, which is an issue with the testes, or a secondary problem which indicates an issue with the brain.

There is also a tertiary cause for TD, which is a disproportionate amount of oestrogen that negatively influences the negative feedback loop. HCG is used to maximise natural intra-testicular production of testosterone through stimulation of the Leydig cells 9 , it also allows the other physiological mechanisms within the testes to continue. Whilst spermatogenesis is primarily under the influence of FSH stimulating the Sertoli cells of the testis, intra-testicular testosterone and oestrogen are also integral to this process.

Spermatogenesis is the process by which haploid spermatozoa are formed from germ cells. Testosterone helps maintain the blood-testis barrier which is necessary for maturation of the sperm and their subsequent release from the testis Intra-testicular testosterone is converted to oestradiol by the aromatase enzyme, oestrogen exerts its effects by aiding germ cell proliferation, differentiation and the final maturation of spermatids, as well as germ cell survival and apoptosis Clinicians under-appreciate the complexities and importance of maintaining normal physiological function.

It is obviously logical to treat TD with testosterone, however not appreciating the importance of addressing hormones that are directly affected from using exogenous testosterone, demonstrates a short-sightedness. The use of HCG alongside testosterone is supported by the American Urological Association 12 and its role in maintaining fertility whilst on testosterone is well documented in the literature 13 , 14 , 15 , In my own practice, we have now had 21 successful pregnancies reported by patients on TRT with HCG, two of which have had two successful conceptions.

It is worth keeping in mind that the positive effects of HCG in maintaining testicular functions is very dependent on the viability of the testes at the time of diagnosis.

HCG is less likely to be as effective as a fertility aid if the patient has low testosterone as a result of a primary hypogonadism an issue with the testes.

However, reassuringly a primary hypogonadism rarely signifies complete testicular failure Despite the science and extremely positive outcomes we have had from using HCG alongside TRT, there are no certainties in medicine and so if you are concerned about fertility whilst on TRT, I would recommend having a semen sample frozen as a precautionary measure.

Irrespective of whether your family is complete, or you do not wish to preserve fertility using HCG alongside TRT, HCG will help preserve testicular size and function This may seem like a purely aesthetic consideration, however testicular atrophy can cause significant discomfort and distress Homeostasis is a about maintaining physiological stability through feedback systems. If you remove a part of the jigsaw, you will never see the complete picture.

There are also other considerations outside of the obvious benefit in maintaining testicular function. There is evidence to suggest that HCG can maximise penis size Whilst the study was conducted in men with a micro-penis, many of my patients report a fullness with HCG that they note decreases on cessation. Unfortunately it is not a dose dependent relationship and as the length of the penis is restricted by the suspensory ligament, you cant defy genetics!

Unfortunately, there is a very small proportion of men who do not tolerate HCG. Whether that be due to a disproportionate ratio of testosterone to oestradiol, or a negative effect on the Central Nervous System which manifests itself as anxiety, is unclear.

I always recommend the use of HCG to all new patients, irrespective of the need to retain fertility, for the reasons discussed above. Our emphasis is always on patient-centred care. TRT — Best Practice explains my rationalisation. Our understanding and appreciation of that inter-relationship is ever evolving.