Important Information for Current and Future Patients (COVID-19). Read Now

Patient Login Become a Patient 813-445-7342 News and Health Articles About


search the defy medical knowledge base:

How to Reverse the Main Side Effect of TRT

Nelson Vergel

Dec 9, 2013

From the book "Testosterone: A Man's Guide" by expert Nelson Vergel. Now available at Defy Medical .

The Use of Human Chorionic Gonadotropin to Prevent and Reverse Testicular Shrinkage in Men Using Testosterone Replacement Therapy

One of the main side effects of testosterone replacement therapy (TRT) is the reduced size of testicles in men. But there is something that can be done about this problem that most men on TRT do not know. HCG, a peptide used in fertility, has been shown to do help prevent testicular atrophy (shrinkage).

Human chorionic gonadotropin (HCG) (not to be confused with human growth hormone, or HGH) is a hormone that mimics LH (luteinizing hormone), produced in pregnancy by the developing embryo soon after conception, and later by part of the placenta. Its role is to prevent the disintegration of the corpus luteum of the ovary and to maintain the progesterone production critical for pregnancy in women. It supports the normal development of an egg in a woman’s ovary, and stimulates the release of the egg during ovulation. HCG is used to cause ovulation and to treat infertility in women.

You’re probably asking yourself why you should care about this. But in men, HCG is also used in young boys when their testicles have not dropped down into the scrotum normally. Additionally, HCG is used to increase testicular size after long-term testosterone.

How to reverse the main side effect of Testosterone Therapy

As mentioned at the beginning of the book, testosterone replacement therapy triggers the hypothalamus to shut down its production of GnRH (gonadotropin releasing hormone). Without GnRH, the pituitary gland stops releasing LH. Without LH the testicles shut down their production of testosterone and the Leydig cells that produce testosterone start to hibernate and shrink in volume. The good thing is that HCG closely resembles LH. If the testicles have shrunken after long-term testosterone use, they will likely begin to enlarge and start their testosterone production shortly after HCG therapy is instituted. Acting like LH, HCG jump-starts your testes to produce testosterone and to increase their size.

The use of HCG alone as long term testosterone replacement has shown to require frequent injections and potentially increase estradiol and DHT more than TRT. Also, the HCG doses required would make it an expensive option as a only way to boost testosterone. For that reason, several physicians are prescribing it in low doses along with testosterone injections and gels.

Brand names of HCG in regular pharmacies cost over $150 per 10,000 IUs (International Units). The same amount of IUs cost around $ 80 in compounding pharmacies. Many insurance policies do not pay for HCG since they consider its use for testicular atrophy while on TRT an off label use. So, most men using it for testicular atrophy pay for it out of their own pockets.

HCG is dispensed as a powder contained in vials of 3,500 IUs, 5, 000 IUs or 10,000 IUs or more. It comes with bacteriostatic water for reconstitution.

HCG is given as an injection under the skin or intramuscularly.

A review of the literature reveals a wide range of doses of HCG used with very little agreement among physicians. For male infertility, doses range from 1250 IU three times weekly to 3000 IU twice weekly (these studies did not include men on testosterone replacement).

Currently there are no HCG guidelines for men who need to be on testosterone replacement therapy and want to maintain normal testicular size. A study that used 200 mg per week of testosterone enanthate injections with HCG at doses of 125, 250, or 500 IU every other day in healthy younger men showed that the 250 IU dose every other day preserved normal testicular function. Another study recently published used a dose of HCG of 500 IUs every other day along with TRT in an older group of men showed good preservation of testicular function, size and sperm count.

Due to its effect on testosterone, HCG use can also increase estradiol and DHT, so it is important to have these monitored by a physician. The best dose of HCG to sustain normal testicular function while keeping estradiol and DHT conversion to a minimum has not been established. Different men respond differently due to age and other issues.

Some doctors are recommending using 250–500 IUs twice a week for men who are concerned about testicular size or who want to preserve fertility while on testosterone replacement. Higher doses, such as 1,000–5,000 IUs twice a week, have been used but I believe that these higher doses could cause more estrogen and DHT-related side effects, and possibly desensitize the testicles for HCG in the long term (this problem has not been reported in the literature). Some doctors check estradiol levels a month after this protocol is started to determine whether the use of the estrogen receptor modulators tamoxifen or anastrozole, is needed to counteract any increases in estradiol levels. High estradiol can cause breast enlargement and water retention in men but it is important at the right blood levels to maintain bone and brain health.

Some men have asked me why we cannot use HCG solely to make our own testicles produce testosterone without the use of TRT along with it. Using HCG as sole testosterone replacement option may not bring the same subjective benefit on sexual function as pure testosterone delivery systems do—even when similar serum androgen levels are produced from comparable baseline values. However, supplementing the more “traditional” transdermal, or injected options, testosterone with the correct doses of HCG stabilizes blood levels, prevents testicular atrophy, helps rebalance expression of other hormones, and brings reports of greatly increased sense of well-being and libido. But in excess, HCG can cause acne, water retention, moodiness, and gynecomastia (breast enlargement in men).

After reading this article, you probably agree with me that using HCG requires a lot of discipline since you have to remember to inject it weekly in addition to your weekly or bi-weekly testosterone injection. But I know of many men who have that type of commitment since they do not want testicular size reduction. Many report further improvements in sexual drive and function after they start this therapy.

If you have any questions about HCG or any other therapies, please call 813-445-7342. Nelson Vergel is available for health coaching. Contact patient services if you would like to schedule your appointment or order your copy of his book, Testosterone: A Man’s Guide. More articles on TRT and men’s health can be found in, and his Facebook page Testosterone Replacement Discussion.

When Testosterone Replacement Doesn't Lead to Better Erections
My Current Best Thoughts on How to Administer TRT for Men