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How to Reverse the Main Side Effect of TRT

One side effect of Testosterone Replacement Therapy (TRT) is testicular atrophy, also referred to as testicular shrinkage. Not all men on TRT experience shrinkage, but for those who do, there are ways to potentially reverse or prevent these effects.

Read on to learn how to maintain the size of your testes while on TRT.

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An illustration of the human body of a man with skeleton showing, to indicate the side effects of TRT.

Human Chorionic Gonadotropin (HCG) for Testicular Shrinkage

Human Chorionic Gonadotropin, or HCG, is a peptide often used in fertility treatments.

Many people know HCG as a pregnancy peptide, released in women after an egg is fertilized.

But what does HCG have to do with male sexual health?

HCG has been shown to have preventive effects against testicular shrinkage. It performs functions similar to Luteinizing Hormone (LH). LH is responsible for triggering the production of Testosterone in the testes and, in turn, sperm.

To understand how HCG can prevent testicular shrinkage, we’ll explore the effect of exogenous Testosterone (Testosterone received from medication).


TRT and Natural Testosterone Production

When you’re on a Testosterone Replacement Therapy protocol, your body receives Testosterone from an outside source — typically injections, topical application, or implantable pellets.

This is necessary because men receiving TRT typically produce too little Testosterone naturally, which leads to symptoms that decrease quality of life.

But when the body receives Testosterone exogenously, it often reduces its own natural production.

The hypothalamus is responsible for releasing a hormone called the Gonadotropin Releasing Hormone (GnRH). If the hypothalamus stops producing GnRH, the body in turn slows its production of LH. This process can be triggered by TRT.

When LH is no longer produced, the testes halt their production of Testosterone and sperm. The testes go dormant, which leads to potential testicular shrinkage and decreased fertility.

This is a normal process within the body, and it occurs with many replacement medications.

The good news is that HCG can mimic the effects of LH and encourage the testes to continue their own production of Testosterone.

If you’ve been on long-term TRT and experienced shrinking testicles, HCG may help jumpstart your Testosterone production. If you’re just starting your TRT protocol, taking HCG alongside Testosterone can help you avoid testicular shrinkage by encouraging continued Testosterone production from the start.

How to Use HCG and Common Dosages

HCG usually ships as a dry powder, which is reconstituted using provided bacteriostatic water. Vials typically come in 3,500 IUs (International Units), 5,000 IUs, or 10,000 IUs.

There are a wide range of dosages depending on your specific needs and goals. No national guidelines exist for HCG dosages, so you’ll want to work with a care team that is highly experienced in creating customized TRT and HCG plans. The dosage depends on factors like age, your TRT protocol, how your body responds to HCG, and more.

As an auxiliary medication to TRT, one study found that in younger males, using 200 mg per week of Testosterone Enanthate injections with 250 IUs of HCG every other day preserved normal testicular function.

Another study found that a 500 IU dose of HCG every other day combined with a TRT protocol helped older men preserve testicular size, function, and sperm count.

Some TRT providers recommend doses around 250–500 IUs twice a week for men. Elevated dosages like 1,000–5,000 IUs tend to show more negative effects on estradiol (Estrogen) and DHT levels.

An experienced provider can help make sure you get the benefits of HCG while minimizing the potential side effects.

Depending on your dosage, you may also require estrogen modulators like Anastrozole or Tamoxifen. These support medications help to regulate estradiol levels, so you don’t experience negative effects of increased estrogen.

Estrogen is an important hormone in men for brain health and bone maintenance. It’s only when levels elevate too high that these negative effects kick in.

HCG Availability and Cost

HCG is available commercially via brand names like Novarel and Pregnyl.

Up until recently, HCG was also widely available as compounded, generic medication at a fraction of the cost of brand names. Unfortunately for many men, an FDA regulation went into effect in 2020 that restricts compounded HCG. Insurance also typically does not cover HCG.

As a concierge clinic that has been offering hormone restoration and Men’s Health therapies for more than a decade, Defy Medical can help you navigate changing regulations related to HCG and identify solutions to help you achieve your goals. Our priority is your health and wellness — and that includes combating testicular atrophy.

To learn more about HCG access and other auxiliary medications, contact us today

Reverse the Main Side Effect of Testosterone with Defy Medical

Many Defy Medical patients have successfully reversed or prevented testicular shrinkage with our expert care. They maintain their testicular size and fertility while also seeing anecdotal improvements in sexual drive and function.

Adding another injection to your protocol may feel daunting, but patients often find the benefits to be more than worthwhile.

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