Indications for Human Chorionic Gonadotropin (HCG) Injections in Males
The primary indication for HCG injections in males is hypogonadotropic hypogonadism, where it serves as first-line therapy for restoration of testosterone production and spermatogenesis, especially in men concerned about fertility. 1
Primary Indications
Hypogonadotropic hypogonadism (HH): HCG is the first-line treatment for males with HH who need testosterone restoration while preserving fertility potential 1
Fertility preservation in HH: For men with HH who desire fertility, HCG is preferred over exogenous testosterone which suppresses spermatogenesis 1
Idiopathic hypogonadotropic hypogonadism (IHH): HCG is specifically indicated for men with IHH to restore testosterone production and initiate spermatogenesis 1
Dosing and Administration
Standard dosing: 500-2500 IU, administered 2-3 times weekly via subcutaneous or intramuscular injection 1, 2
Treatment sequence: Initial treatment with HCG alone to normalize testosterone levels, followed by FSH injections when indicated for optimal sperm production 1, 3
Duration: Treatment typically continues for 12-24 months when used for fertility purposes 3
Secondary Indications
Non-obstructive azoospermia: HCG may be used off-label to optimize male reproductive hormones before surgical sperm retrieval, though evidence is limited 1
Alternative to testosterone therapy: For men with functioning pituitary glands but low testosterone who wish to maintain fertility potential 1
Treatment Response Factors
Baseline testicular volume: Higher baseline testicular volume correlates with better response to HCG therapy 1, 3
Prior androgen exposure: Previous testosterone therapy does not necessarily impair response to subsequent HCG treatment 4
Negative prognostic factors: Multiple pituitary deficits and history of cryptorchidism may reduce treatment success 4
Clinical Outcomes
Testosterone normalization: Most patients achieve normal male testosterone levels with appropriate HCG therapy 4, 5
Spermatogenesis: Approximately 80% of HH patients develop sperm in ejaculate with combined HCG and FSH therapy 3
Physical changes: Patients typically experience increased testicular volume, development of secondary sexual characteristics, and improved physical strength 5
Important Considerations and Cautions
Exogenous testosterone avoidance: Men interested in current or future fertility should not receive exogenous testosterone as it suppresses spermatogenesis 1
Recovery time after testosterone: If a patient has been on testosterone therapy, recovery of spermatogenesis after cessation may take months or rarely years 1
Side effects: Gynecomastia is the most common side effect due to HCG stimulation of aromatase causing increased estradiol secretion 3
HCG therapy remains a cornerstone treatment for male hypogonadotropic hypogonadism, particularly when fertility preservation is desired, with high rates of successful testosterone restoration and reasonable rates of induced spermatogenesis when combined with FSH therapy.