HCG Dosage for Maintaining Fertility During TRT
For men on testosterone replacement therapy (TRT) who wish to maintain fertility, the recommended HCG dosage is 500-1,000 IU administered 2-3 times weekly. 1, 2
Rationale and Mechanism
- Exogenous testosterone administration suppresses the hypothalamic-pituitary-gonadal axis through negative feedback, resulting in decreased gonadotropin secretion, reduced intratesticular testosterone, and impaired spermatogenesis 1
- TRT alone can lead to oligospermia or azoospermia in up to 40% of patients, making it contraindicated for men seeking fertility 1, 2
- HCG mimics luteinizing hormone (LH) action, stimulating Leydig cells to produce intratesticular testosterone, which is essential for maintaining spermatogenesis 3
Recommended Dosing Protocol
- Initial dosage: 500 IU of HCG administered subcutaneously or intramuscularly every other day (3-4 times weekly) 4, 2
- Maintenance dosage: 500-1,000 IU administered 2-3 times weekly 1, 2
- Duration: Continue throughout the entire period of TRT if fertility preservation is desired 2
Evidence Supporting Efficacy
- Studies demonstrate that low-dose HCG (500 IU every other day) maintains intratesticular testosterone levels within normal range in men with gonadotropin suppression 3
- Concomitant administration of HCG with TRT preserves semen parameters, with no patients becoming azoospermic during combined therapy 2
- Higher doses of HCG (2,000-3,000 IU three times weekly) may be required for men attempting to restore fertility after previous TRT use 5
Monitoring Recommendations
- Assess semen parameters (volume, density, motility) at baseline and periodically during treatment 2
- Monitor serum testosterone, estradiol, and gonadotropin levels every 3-6 months 6
- Evaluate testicular volume regularly, as maintenance indicates preserved spermatogenic function 7
Important Considerations and Caveats
- For men with hypogonadotropic hypogonadism seeking fertility, gonadotropin therapy (HCG with or without FSH) is the standard treatment rather than TRT 1
- Adding FSH (75 IU 2-3 times weekly) may be necessary for optimal spermatogenesis in cases where HCG alone is insufficient 7, 5
- Recent evidence suggests that concurrent testosterone therapy does not impede HCG/FSH-mediated spermatogenic recovery when appropriate HCG dosing is used 5
- Patient compliance is critical for maintaining fertility during TRT, and regular follow-up is essential 7
Alternative Approaches
- For men with secondary hypogonadism planning fertility in the near future, gonadotropin therapy alone (without TRT) may be preferable 1
- If TRT must be discontinued to restore fertility, recovery of spermatogenesis may take months or even years 1
- Combined HCG and FSH therapy provides optimal outcomes for fertility preservation 1