What is the recommended dose of Human Chorionic Gonadotropin (HCG) for patients coming off chronic anabolic steroid abuse?

HCG Dosing for Patients Coming Off Chronic Anabolic Steroid Abuse

For patients coming off chronic anabolic steroid abuse, the recommended HCG dosage is 1,500-2,500 IU administered 2-3 times weekly for 3 months to restore hypothalamic-pituitary-testicular axis function. 1, 2

Dosing Regimen

• For hypogonadotropic hypogonadism in males (including that induced by anabolic steroid use), the FDA-approved dosing is 500-1,000 USP Units three times weekly for three weeks, followed by the same dose twice weekly for three weeks 2
• Alternatively, 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 2
• The American Urological Association and American Society for Reproductive Medicine (AUA/ASRM) guidelines recommend HCG injections of 500-2,500 IU, 2-3 times weekly for restoration of testosterone production and spermatogenesis 1
• Higher doses of HCG (10,000 IU twice weekly) have been used successfully in case reports of persistent azoospermia following anabolic steroid cessation 3

Treatment Duration

• Treatment duration of 3 months has shown success in restoring normal testicular function in case reports 4, 3
• Longer treatment (6-9 months) may be necessary in severe or persistent cases of hypogonadism 2
• Monitoring testosterone levels and semen parameters is essential to determine treatment response and duration 1

Administration

• HCG should be administered via intramuscular injection only 2
• After reconstitution with bacteriostatic water, HCG can be administered as a single dose or as multiple doses (refrigerated between uses) 2
• Proper disposal of needles and syringes in a closeable, puncture-resistant container is required 2

Monitoring and Follow-up

• Testosterone levels should be monitored regularly during treatment to assess response 1
• Semen analysis should be performed at baseline and after 3 months of treatment to evaluate recovery of spermatogenesis 3
• Complete recovery of spermatogenesis may take up to 6 months after initiating treatment 5

Cautions and Considerations

• Concomitant use of HCG with anabolic steroids can impair spermatogenesis and increase the proportion of morphologically abnormal sperm 5
• Patients should be counseled to completely discontinue anabolic steroid use before starting HCG therapy 4, 3
• Exogenous testosterone therapy should be avoided during HCG treatment as it can inhibit endogenous testosterone production and spermatogenesis 1
• For detection of HCG abuse in sports, a threshold of 1.0 IU/L for intact HCG in urine is recommended 6

Alternative Approaches

• In cases where HCG alone is insufficient, combination therapy with human menopausal gonadotropin (hMG) may be considered 3
• For patients with severe hypogonadism, less frequent dosing (HCG 1500 IU every six days) has shown efficacy in increasing testosterone levels and testicular size 7