What is the recommended dose of Pregnyl (human chorionic gonadotropin, hCG) for treating testosterone withdrawal symptoms?

Pregnyl (hCG) Dosing for Testosterone Withdrawal Treatment

For treating testosterone withdrawal symptoms, the recommended dose of Pregnyl (human chorionic gonadotropin, hCG) is 500-1,000 USP Units administered three times weekly for hypogonadotropic hypogonadism in males. 1

Dosing Regimens for Hypogonadotropic Hypogonadism

The FDA-approved dosing regimens for hypogonadotropic hypogonadism in males include:

1. 500 to 1,000 USP Units three times a week for three weeks, followed by the same dose twice a week for three weeks 1
2. 4,000 USP Units three times weekly for six to nine months, followed by dose reduction to 2,000 USP Units three times weekly for an additional three months 1

Administration Method

Pregnyl can be administered through two routes:

• Intramuscular injection (traditional method): The FDA label specifies "intramuscular use only" 1
• Subcutaneous injection: Research shows bioequivalent absorption compared to intramuscular administration 2

While the FDA label specifies intramuscular administration, studies have demonstrated that subcutaneous administration produces comparable testosterone levels and may be preferred by patients due to ease of self-administration 3.

Reconstitution Guidelines

For proper reconstitution of Pregnyl:

• For multiple dose administration: Dilute with 10 mL bacteriostatic water for injection to achieve 1,000 IU/mL (10,000 IU vial) or 500 IU/mL (5,000 IU vial) 1
• Refrigerate between doses 1
• Inspect visually for particulate matter before administration 1

Monitoring During Treatment

When initiating hCG therapy, monitor:

1. Testosterone levels: Check midway between injections (day 7-10 for biweekly injections) 4
2. Hematocrit/hemoglobin: Monitor regularly as testosterone therapy can increase risk of erythrocytosis 4
3. Cardiovascular risk factors: Assess before and during treatment 5

Clinical Benefits and Considerations

hCG therapy for testosterone withdrawal has shown several benefits:

• Improvement in erectile dysfunction (86%) and libido (80%) 6
• Preservation of spermatogenesis, which is important for men interested in fertility 7
• Establishment of physiological diurnal testosterone rhythm in some patients 3

Potential Side Effects and Precautions

Be aware of potential adverse effects:

• Erythrocytosis: Injectable testosterone formulations carry greater risk of increased hematocrit 4
• Gynecomastia: While uncommon, monitor for breast symptoms 5
• Fertility impact: Discuss implications for future fertility with patients 5

Contraindications

hCG therapy is contraindicated in:

• Prostate cancer
• Male breast cancer
• Uncontrolled congestive heart failure
• Hematocrit >54% 5, 4

Follow-up Schedule

• Initial follow-up: 1-2 months after initiating therapy
• Subsequent monitoring: Every 3-6 months during the first year
• Long-term: Yearly once stable 4

hCG therapy can effectively manage testosterone withdrawal symptoms while potentially preserving fertility, making it a valuable option for men experiencing symptoms after discontinuing testosterone therapy.