Is human chorionic gonadotropin (HCG) safe to use in patients with benign prostatic hyperplasia (BPH)?

Safety of Human Chorionic Gonadotropin (HCG) in Patients with BPH

Human chorionic gonadotropin (HCG) should be used with caution in patients with benign prostatic hyperplasia (BPH) as there is limited evidence regarding its safety and efficacy in this population.

Current Evidence on HCG and BPH

The relationship between HCG and BPH has limited research, but one small pilot study provides some preliminary insights:

• A multicenter, double-blind, placebo-controlled randomized study evaluated low-dose HCG versus placebo in 101 men (aged 50-79) with BPH 1
• This study found that low-dose HCG appeared to positively affect moderate to severe BPH symptoms according to AUA scores and sexual function
• Importantly, no HCG-induced changes were noted in prostate-specific antigen (PSA) or prostate volume 1

BPH Management Principles

According to AUA guidelines, BPH management should be based on symptom severity and degree of bother:

• Patients with mild symptoms (AUA Symptom Score <7) or those not bothered by their symptoms should be managed with watchful waiting 2
• For patients with bothersome moderate to severe symptoms (AUA Symptom Score >8), treatment options include watchful waiting, medical therapy, minimally invasive procedures, or surgery 2
• The primary medical therapies for BPH include alpha-blockers, 5-alpha reductase inhibitors (5ARIs), phosphodiesterase-5 inhibitors (PDE5i), anticholinergics, and beta-3 agonists 2

HCG in Other Conditions

HCG has been studied in other urological conditions:

• In men with hypogonadal symptoms and normal testosterone levels, HCG monotherapy improved erectile dysfunction (86%) and libido (80%) without affecting PSA levels 3
• In patients with hypogonadotropic hypogonadism, HCG therapy stimulated testicular growth and spermatogenesis 4

Risk Assessment and Monitoring

When considering HCG in patients with BPH:

1. Evaluate baseline BPH severity using the AUA Symptom Index
2. Measure baseline PSA and prostate volume
3. Consider the patient's risk for BPH progression (prostate size >30cc, age >60 years, etc.)
4. If initiating HCG, monitor for:
   • Changes in urinary symptoms
   • PSA levels
   • Prostate volume

Recommendations for Clinical Practice

For patients with BPH who require HCG for other indications:

1. First-line BPH management should follow established guidelines with alpha-blockers as initial therapy 2
2. If the patient has a prostate volume >30cc, consider adding a 5-alpha reductase inhibitor 2
3. Monitor PSA and prostate volume regularly during HCG treatment
4. Discontinue HCG if BPH symptoms worsen significantly

Conclusion

While preliminary evidence suggests HCG may not worsen BPH symptoms and could potentially improve them 1, the data is limited to a single small study. Until more robust evidence is available, clinicians should exercise caution when prescribing HCG to patients with BPH and closely monitor for changes in urinary symptoms, PSA, and prostate volume.