The pituitary gland secretes a hormone known as luteinizing hormone, or LH, which is the hormone that signals the Leydig lines in the testicles to produce testosterone. The hormone chorionic gonadotropin, often known as human chorionic gonadotropin (HCG), is a medicine that has a structure very similar to that of LH and virtually the same hormonal effect. Nonetheless, HCG has a half-life that is thirty times longer than that of LH, which is only thirty minutes, and the peak beginning of increased testosterone levels occurs approximately seventy-two to ninety-six hours after treatment. Because HCG works by raising LH activity, if the LH is already elevated (above 20 IU/L), then hCG may probably not be successful at increasing testosterone levels. This is because HCG works by increasing LH activity.

HCG has the same effect as clomiphene and anastrazole in that it stimulates the body’s natural production of testosterone. It is far more expensive than the two drugs that are taken orally, and it must be administered via injection (usually about 3 times per week subcutaneously). However, it can occasionally be more successful when the pituitary gland is not reacting to clomiphene. Additionally, it is often responsible for raising sex drive better than can anastrazole (as long as background LH values are not increased above 20 IU/L). HCG, like clomiphene, has the potential to elevate the amount of estradiol in the body to unusually high levels in some men. This occurs because the aromatase enzyme converts testosterone to estradiol.

When it comes to the treatment of male infertility, one of the most common concerns is whether or not HCG is so much more effective than letrozole or anastrazole. Remember that these medicines don’t really things are easy sperm motility, and instead exert about there of raising androgen production (and, in the situation of letrozole and anastrazole, feasibly FSH levels if this is low). Consequently, a man whom hormone is forced back up into the range of normal by either fluconazole, anastrazole, or HCG should have same potential therapeutic benefit to sperm quality. Sperm quality can be affected by a number of factors, including age, genetics, and lifestyle. It is generally believed that HCG is a more powerful medication in the sense that it drives increased testosterone production. As a result, it may be efficacious in men for whom estrogen levels have not risen enough that with clomiphene or anastrazole, and it may also be effective in women whose testosterone levels have just not risen sufficiently with letrozole or anastrazole. In contrast to clomiphene and anastrazole, human chorionic gonadotropin (HCG) does not stimulate a rise in the production of FSH; nevertheless, this should not be a clinically relevant difference for men whose FSH levels are already high.

AVAILABILITY OF HCG FOR COMMERCIAL USE

In the commercial sector, HCG is offered in a variety of distinct formats. The most frequent forms of treatment for male patients are Pregnyl and Novarel; however, compounding pharmacies are also able to produce generic HCG. In terms of both dosage and effectiveness, the three are virtually interchangeable with one another. The human chorionic gonadotropin (HCG) is collected from the urine of pregnant women and used in all three of these drugs. Ovidrel, Follutein, Profasi, Choragon, and Choropex are some of the other types of HCG that are utilised in men, though they are used far less frequently. Note that there is a tendency for males using HCG to not experience an increase in their blood LH levels. This is because the exogenous hormone does not demonstrate a significant amount of cross-reactivity with the majority of commercial laboratory assays.

As a result of a nationwide shortage, HCG is not available in the majority of local pharmacies, and it is often necessary to place an order for it through specialist pharmacies. The widespread use of HCG as a dietary supplement for weight loss is thought to be the cause of the shortage, despite the fact that controlled research have been unable to provide any proof that using HCG truly speeds up the weight loss process. At the present time, the marketing of HCG as a weight loss enhancement is considered to be deceptive. The use of HCG in “rejuvenation” health centers for men seeking an improvement in quality of life and/or sexual function has also contributed to the rise in popularity of this hormone. Additionally, bodybuilders frequently use HCG somewhere between cycles of chronic drug use to maintain scrotal function, which has also contributed to the rise in popularity of this hormone. As a result of a rule issued in 2019, the majority of compounding pharmacies are unable to stock HCG, which has contributed to a further worsening of the HCG shortage in the United States. One of the compounding pharmacies that were given an exception from the HCG manufacturing prohibition is the Empower pharmacy in Texas. This is an important fact to bring to your attention.

If you do not have insurance coverage for your medications, the section contains information about the cost of HCG at various fertility-specific and regional pharmacies. If you do not have insurance coverage for your medications, it is possible that your insurance provider will pay for HCG.

HOW HCG IS USED

Injections of HCG must be given in either the intramuscular (IM) or subcutaneous (SC) sites (SQ). Injection schedules can follow a variety of protocols, however the majority of medical professionals recommend administering the medication three times each week. The recommended initial dosage is 2,000 international units (IU) three times weekly. Two weeks after beginning HCG, or two weeks after any change in dosage or medication, I normally advise patients to return for follow-up testing. This is the same recommendation that I make with clomiphene and anastrazole. After that, the dosages might be modified based on the results of the subsequent blood hormone tests that are performed.

There is a wide range of possible HCG dosages, from 500 IU to 4,000 IU taken three times each week. The following is an example of a dose range:

SIDE EFFECTS OF HCG

Multiple research have come to the conclusion that HCG is a safe and effective treatment for hypogonadism. As a result, the majority of men who take it do not have any negative side effects. According to the findings of a study that involved 175 male participants receiving HCG injections, none of them experienced any serious unfavourable side effects. In a trial of 20 males being treated for hypogonadism with HCG, researchers found neither adverse effects nor problems.

Rare potential adverse effects include headaches, weight gain, high blood pressure, cataracts, acne, fainting, restlessness, drowsiness, mood changes (depression, irritability), and pain at the injection site. Headaches, weight gain, high blood pressure, cataracts, acne, and pain at the injection site are all rare.

If estradiol levels are checked and kept within the normal range, the likelihood of experiencing breast soreness and/or enlargement (gynecomastia) should be low; nonetheless, these side effects could still occur.

Patients who are experiencing serious unfavourable side effects from their medication should immediately stop taking it and get in touch with their doctor for additional instructions.

HEMATOCRIT LEVELS

Although the risk of developing polycythemia is modest, there have been reports of men taking HCG injections experiencing increases in their hematocrit levels. I suggest keeping an eye on hematocrit levels with the objective of maintaining a hematocrit of 54 percent or below at all times.

IN COMBINATION WITH OTHER HORMONAL MEDICINES

In the treatment of hypogonadism, the combination of anastrazole and HCG is frequent because both of these medications function in separate ways to increase testosterone levels in the body. It is possible that the remote access activity of anastrazole will be of additional benefit to male patients whose estradiol levels have increased as a result of taking HCG. Due to the fact that both clomiphene and HCG work by enhancing LH-effect, it is not normal practise to combine the two drugs ( utilised to increase an  low FSH level). It is common practise for men who are taking artificial androgens to take a low dose of HCG in order to preserve at least some of their natural testicular activity.

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