HCG with Testosterone Replacement Therapy

Human chorionic gonadotropin (HCG) is a hormone normally found in huge amounts during pregnancy.  It is made by the placenta and helps maintain pregnancy.  During pregnancy women may make up to one million units of HCG daily.  It is conventionally used by doctors to treat female patients for infertility or boys for delayed puberty.

HCG is a polypeptide hormone produced by the human placenta, composed of an alpha and a beta subunit. The alpha subunit is essentially identical to the alpha subunits of the human pituitary gonadotropins, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), as well as to the alpha subunit of human thyroid-stimulating hormone (TSH). The beta subunits of these hormones differ in amino acid sequence.

HCG works to stimulate the testes because of the similarity to the naturally occurring LH and FSH which normally stimulate testosterone and sperm production.  When taking testosterone replacement therapy (TRT) the pituitary stops sending these signals and over time the testes may shrink in size leading to a decrease in native testosterone production and a decline in fertility.  After a number of years if men stop taking TRT  their native production of testosterone, albeit low in the first place, might not return.  Taking HCG can keep this from happening.  HCG can also help maintain fertility during TRT.

HCG is self administered as an injection into the subcutaneous fat, similar to insulin, with a tiny needle.  Dosage protocols vary, but since it stays in the system for about 3 days most doctors prescribe 250-500 units 1-2x/week.

Indications for the use of HCG for the management of infertility in hypogonadal men

HCG from the pharmacy

When you get HCG from a pharmacy it comes in a glass vial with 10,000 units of HCG powder.  It is typically accompanied with a 10mL bacteriostatic water for reconstitution.  The shelf life after mixing is listed as 30 days.  The cash price is typically at least $250.

HCG from our clinic

We special order HCG for patients in 5000 unit vials as it is far less expensive and none will get wasted.  We have found that the HCG is effective for closer to 60 days.  With our dosing this should last about 60 days.

Mixing and administration

Necessary materials:

• One 5 mL (cc) syringe with attached 22 gauge needle for mixing
• One bottle of HCG 5,000 units (powder)
• One 5 ml sterile bacteriostatic water bottle
• Insulin syringes (1mL) for injection
• Alcohol swabs

1. Snap off the cap from both the water and HCG powder (medication) bottles
2. Make sure the needle  is secured tightly on the attached 5mL syringe
3. Turn sterile water vial (Sodium Chloride) upside down and draw up 5mL sterile water into the 5mL syringe with the attached needle
4. Inject the drawn up 5mL of sterile water into the HCG powder bottle, and allow to dissolve
   1. (you may gently swirl the solution until the powder dissolves completely, but DO NOT SHAKE the bottle)
5. The resulting solution is now mixed.  The concentration is 1000 units/mL.  A 250 unit dose would equal 0.25mL, and a 500 unit dose would equal 0.5mL.
6. Using one of the insulin syringes, hold the HCG vial upside down and draw up either 0.25mL or 0.5mL depending on your prescription.
7. To remove any air bubbles, you usually need to draw up slightly more than the final amount and gently tap on the syringe until all the bubbles rise to the top, then push the plunger until the air bubbles go back into the HCG vial and you are at the correct dosage line.  Remove the syringe and replace the cap until ready to give the injection.
8. Wipe skin with alcohol swab at intended injection site and let dry.
9. Remove cap off of needle and administer medication subcutaneously:
   • The injection should be given in the subcutaneous fat anywhere around the abdomen
   • Pinch skin at injection site into a mound between thumb and forefinger and hold the syringe like a pencil with the other hand
   • Push the needle through skin at a 90-degree angle until needle disappears
   • Gently pull back on plunger until a small air bubble appears in the syringe (if blood appears in the syringe, do not panic, pull the needle out a bit, change direction, push back all the way in until needle disappears under skin), then inject medication
   • Pull needle out of skin and wipe injection site with an alcohol swab, rubbing the site gently (this will help the absorption of the medication); occasionally a small amount of blood will be visible, which is not a reason for any concern

Possible skin reaction: A red area may appear around the injection site and/or the injection site might itch and/or bruising may occur. These are all excepted reactions and will disappear over time. Please notify us if redness/bruising around the injection site appear to be enlarging or spreading.

Possible ADVERSE REACTIONS:  (from HCG package insert) Headache, irritability, restlessness,depression, fatigue, edema, precocious puberty, gynecomastia, pain at the site of injection. Hypersensitivity reactions both localized and systemic in nature, including erythema, urticaria, rash, angioedema, dyspnea and shortness of breath, have been reported.

Storage: HCG should be stored in room temperature but we prefer to refrigerate.  The main thing is to not let it get warm/hot.