Welcome to this discussion about adding human chorionic gonadotropin (HCG) to testosterone therapy (TRT). We’ll delve into the biology behind TRT’s effects on the body, the potential advantages and drawbacks of adding HCG, alternatives like clomiphene and enclomiphene, and practical guidance on usage.
At MD Total Wellness in Brea, CA, we specialize in hormone therapy personalized for your specific needs and goals. Schedule a free consult and in-office testosterone test to learn more about low testosterone, TRT treatment options, and whether TRT is right for you.
Testosterone replacement therapy (TRT) is a common treatment for men with low testosterone levels, alleviating symptoms like fatigue, low libido, and muscle loss. However, TRT can suppress the body’s natural testosterone production through negative feedback on the hypothalamic-pituitary-gonadal (HPG) axis. When exogenous testosterone is introduced, the pituitary gland reduces luteinizing hormone (LH) and follicle-stimulating hormone (FSH) secretion, leading to decreased signaling to the testes. This results in lower endogenous testosterone synthesis.
The ramifications of this suppression are significant. Primarily, it leads to decreased sperm production (oligospermia or azoospermia), lowered intra-testicular testosterone (ITT) levels, testicular shrinkage, and impaired fertility.
Men on TRT may experience a decline in sperm count, with studies showing that prolonged use can cause infertility in up to 90% of cases while on TRT. Fertility typically returns after stopping TRT, but recovery can take 3-6 months on average, and in some instances, up to 1-2 years or longer, depending on age, duration of therapy, and individual factors.
Additionally, very low intra-testicular testosterone levels—often 100 times lower than normal during TRT—may contribute to sexual function issues, such as reduced ejaculate volume or diminished orgasm intensity, though evidence is mixed and largely anecdotal.
When discontinuing TRT, the time for endogenous testosterone production to rebound can vary, often requiring supportive therapies to accelerate recovery and mitigate symptoms like lethargy during the interim.
Human chorionic gonadotropin (HCG) is a hormone naturally produced by the placenta during pregnancy, but it has been used off-label in men’s hormone health for decades to mimic LH and support testicular function. HCG binds to LH receptors in the testes, stimulating Leydig cells to produce testosterone and promoting spermatogenesis via Sertoli cell activation. While not FDA-approved for male hypogonadism or fertility preservation in TRT patients, it has a long history of clinical use in treating conditions like hypogonadotropic hypogonadism.
One key benefit is maintaining high ITT concentrations, which are crucial for sperm production. Studies demonstrate that HCG can preserve fertility during TRT; for instance, doses of 250 IU or 500 IU twice weekly have been shown to maintain spermatogenesis and prevent azoospermia in men on testosterone therapy. A randomized trial found that 500 IU every other day preserved ITT and sperm parameters effectively, while lower doses like 250 IU offered similar protection with fewer side effects.
Beyond fertility, HCG may provide independent benefits unrelated to serum testosterone levels, such as improved sexual function, mood, and energy. These effects are often reported anecdotally, where users describe enhanced libido and well-being, potentially due to elevated ITT or LH receptor stimulation in the brain and other tissues. However, scientific evidence for these non-fertility benefits remains limited and primarily observational.
On the downside, HCG can elevate estrogen levels through increased aromatization of testosterone to estradiol, leading to symptoms like gynecomastia, water retention, or mood swings—occurring in about 10-20% of users, often necessitating a reduction in TRT dose or addition of an aromatase inhibitor. Other risks include injection site pain, headaches, acne, or restlessness, though these are generally mild and dose-dependent.
For men seeking to stimulate endogenous testosterone without direct TRT or to preserve fertility, selective estrogen receptor modulators (SERMs) like clomiphene citrate (Clomid) and its isomer enclomiphene offer alternatives. These work indirectly by blocking estrogen feedback at the hypothalamus and pituitary, increasing LH and FSH release to boost natural testosterone and sperm production. Unlike HCG’s direct LH-mimicking action, SERMs rely on the body’s intact HPG axis, making them most suitable for younger men with secondary hypogonadism.
In terms of maintaining sperm production and fertility during or after TRT, clomiphene and enclomiphene perform comparably to HCG in some patients, with studies showing preserved spermatogenesis and testosterone levels without significant suppression. Enclomiphene, the trans-isomer of clomiphene, may have an edge with fewer side effects like visual disturbances or estrogenic activity compared to clomiphene, which contains a zu-isomer that can act estrogenically.
At MD Total Wellness, we provide brand-name HCG (Pregnyl), as compounding pharmacies largely ceased offering it following an FDA rule change that reclassified hCG as a biologic – a policy still in effect as of 2025. This reclassification made access to hCG more challenging.
HCG is typically administered via subcutaneous injection twice weekly, with doses ranging from 250-500 IU per injection to balance benefits and minimize risks. A standard 10,000 IU vial of Pregnyl lasts at least 2 months at these dosages, reconstituted with bacteriostatic water for stability. We recommend starting low and monitoring via bloodwork to adjust for optimal hormone balance, fertility parameters, and side effect management.
Adding HCG to TRT offers compelling benefits, including preservation of fertility through maintained spermatogenesis, prevention of testicular atrophy, and potential enhancements in sexual function, mood, and energy beyond what TRT alone provides. While risks like elevated estrogen exist, they are manageable with personalized dosing. For those prioritizing natural stimulation, alternatives like enclomiphene may suffice, but HCG remains a gold standard for direct testicular support.
MD Total Wellness specializes in personalized men’s health, including testosterone therapy, peptide therapy, and comprehensive wellness plans. We offer free consultations and in-office testosterone tests to assess your needs and craft a tailored approach. Ready to optimize your TRT? Schedule your free consult today and take the first step toward renewed vitality.
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