Recommended Dosage of Pregnyl (hCG) for Men
The recommended dosage of Pregnyl (human chorionic gonadotropin, hCG) for men depends on the specific indication, with hypogonadotropic hypogonadism typically requiring 500 to 1,000 USP Units three times weekly for three weeks, followed by the same dose twice weekly for three weeks, or alternatively 4,000 USP Units three times weekly for six to nine months, followed by 2,000 USP Units three times weekly for an additional three months. 1
Dosage Based on Indication
Hypogonadotropic Hypogonadism
- First regimen option: 500 to 1,000 USP Units three times weekly for three weeks, followed by the same dose twice weekly for three weeks 1
- Second regimen option: 4,000 USP Units three times weekly for six to nine months, followed by 2,000 USP Units three times weekly for an additional three months 1
Cryptorchidism (Prepubertal, Not Due to Anatomical Obstruction)
- 4,000 USP Units three times weekly for three weeks, or
- 5,000 USP Units every second day for four injections, or
- 15 injections of 500 to 1,000 USP Units over six weeks, or
- 500 USP Units three times weekly for four to six weeks 1
- If initial treatment fails, a second course may begin one month later with 1,000 USP Units per injection 1
Age-Based Dosing for Cryptorchidism
- Ages 1-4 years: 250 USP Units twice weekly for five weeks
- Ages 4-7 years: 500 USP Units twice weekly for five weeks
- Ages 7-12 years: 1,000 USP Units twice weekly for five weeks 2
Administration Method
- Pregnyl is administered via intramuscular injection only 1
- Studies show that subcutaneous administration produces comparable testosterone levels to intramuscular administration and may be preferred by patients 3
- Reconstitution options:
- 1 mL bacteriostatic water: Results in 10,000 IU/mL (for 10,000 IU vial) or 5,000 IU/mL (for 5,000 IU vial)
- 10 mL bacteriostatic water: Results in 1,000 IU/mL (for 10,000 IU vial) or 500 IU/mL (for 5,000 IU vial) 1
Clinical Efficacy and Monitoring
- For hypogonadotropic hypogonadism, hCG therapy is the first-line treatment for men seeking fertility, with approximately 75% of patients achieving sperm production when combined with FSH 4
- Combined therapy with hCG and FSH is often recommended for optimal outcomes, especially in cases of complete hypogonadotropic hypogonadism 5, 4
- Regular monitoring of testosterone levels and semen analyses every 3-6 months is recommended to assess treatment response 4
Safety Considerations
- No significant changes in hematocrit, prostate-specific antigen, or hemoglobin A1c have been observed with hCG treatment 6
- Thromboembolic events were not reported in clinical studies of hCG monotherapy 6
- Recombinant hCG and urinary-derived hCG demonstrate similar pharmacokinetics and effects on serum testosterone levels 7
Important Clinical Pearls
- hCG is contraindicated in men with prostate cancer or other androgen-dependent neoplasms
- Testosterone therapy (including hCG) is contraindicated in men seeking fertility, but hCG specifically can maintain testosterone levels while preserving fertility 5
- Self-administered subcutaneous hCG produces comparable testosterone levels to intramuscular administration and may be preferred by patients 3
- For men with symptoms of hypogonadism but normal testosterone levels (>300 ng/dL), hCG monotherapy has shown improvement in erectile dysfunction (86%) and libido (80%) 6
- Single-agent clomiphene citrate has been shown to be as effective as hCG in restoring testosterone levels and may be a simpler and less expensive option when fertility preservation is desired 8