What is the recommended dose of Human Chorionic Gonadotropin (HCG) and Clomiphene (Clomid) for stimulating natural testosterone production in men post Testosterone Replacement Therapy (TRT)?

HCG and Clomiphene Dosing for Post-TRT Recovery

For men recovering from testosterone replacement therapy who wish to restore natural testosterone production and fertility, the optimal approach is hCG 3,000 IU plus FSH 75 IU three times weekly, which restores spermatogenesis in 74% of men, or alternatively clomiphene citrate 25-50 mg every other day as monotherapy, which increases testosterone by 223% while preserving fertility. 1, 2

Critical Pre-Treatment Requirement

You must discontinue testosterone therapy and allow 2-4 weeks washout before initiating recovery protocols to permit hypothalamic-pituitary-gonadal axis recovery. 3 Attempting to diagnose or treat while still on testosterone will yield misleading results and compromise outcomes. 3

Primary Treatment Options

Option 1: HCG + FSH Combination (Preferred for Fertility)

The most effective regimen for post-TRT recovery is hCG 3,000 IU plus FSH 75 IU administered three times weekly (Monday/Wednesday/Friday). 1 This protocol demonstrated:

• 74% of men showed improved sperm concentrations 1
• Works equally well whether you continue low-dose testosterone concurrently or not 1
• Represents the most recent (2024) and highest-quality evidence for post-TRT recovery 1

Alternative HCG dosing: 500 IU intramuscularly every other day can maintain spermatogenesis during ongoing TRT. 4 This lower-dose approach preserved semen parameters in all 26 men studied, with 9 achieving partner pregnancy during treatment. 4

Option 2: Clomiphene Citrate Monotherapy (Simpler, Cheaper)

Start clomiphene citrate 25 mg every other day, titrating to 50 mg every other day if needed, targeting testosterone 550 ± 50 ng/dL. 5 This approach:

• Increased testosterone by 223% (from 2.31 to 5.17 nmol/L) over 3 months 2
• 70% of men achieved target levels on just 25 mg every other day 5
• Proved equally effective as hCG monotherapy or combination therapy 2
• Mean treatment duration 19 months with excellent safety profile 5

Clomiphene is particularly attractive as first-line therapy because it's oral, inexpensive, and avoids injections while achieving equivalent testosterone restoration to hCG. 2

Option 3: HCG + Clomiphene Combination

For men with hypogonadotropic hypogonadism specifically, combine hCG (average dose 5,579 IU every 3 days) with clomiphene 25 mg daily until testosterone normalizes. 6 This combination:

• Produced statistically significant improvements in testosterone and secondary sexual characteristics at 6 and 12 months 6
• Resulted in sperm appearance in 47.4% of men after 12 months 6
• Showed superior symptom improvement (qADAM scores) compared to monotherapy 2

Expected Outcomes and Timeline

Testosterone levels increase significantly within 1 month and continue improving through 3 months on any of these regimens. 2 Specifically:

• Testosterone restoration occurs in all treatment groups by 3 months 2
• Spermatogenesis recovery takes longer—expect 6-12 months for sperm to appear 6
• Subjective symptom improvement (libido, energy, erectile function) occurs progressively over the first year 5

Important caveat: Initial sperm quality may be poor, with most sperm showing complete deformity (<1% normal forms) and low progressive motility (<8%) even when sperm counts recover. 6 Continued treatment beyond 12 months may be needed for optimal sperm quality.

Monitoring Requirements

Measure morning total testosterone at baseline, 1 month, and 3 months, then every 6 months once stable. 2, 5 Target mid-normal range (500-600 ng/dL or 550 ± 50 ng/dL). 3, 5

For men seeking fertility, obtain semen analysis at 6 and 12 months to assess spermatogenic recovery. 6, 1 Don't expect normal parameters immediately—recovery is gradual. 6

Monitor for side effects, though these protocols demonstrate excellent safety profiles with no major adverse events reported. 6, 5

Treatment Selection Algorithm

If fertility is the primary concern and cost is not prohibitive: Use hCG 3,000 IU + FSH 75 IU three times weekly, as this represents the most recent evidence with optimal spermatogenic recovery. 1

If seeking simpler, more economical approach with good testosterone restoration: Start clomiphene 25 mg every other day, which is oral, inexpensive, and equally effective for testosterone recovery. 2, 5

If you have documented hypogonadotropic hypogonadism (low LH/FSH with low testosterone): Consider combination hCG + clomiphene for superior symptom improvement, though testosterone recovery is equivalent to monotherapy. 2, 6

Critical Pitfalls to Avoid

Never attempt these recovery protocols while still on testosterone therapy without first completing a 2-4 week washout period. 3 The exception is the novel finding that concurrent low-dose testosterone doesn't impede hCG/FSH-mediated recovery, but this applies only to the specific high-dose hCG/FSH protocol. 1

Don't expect immediate fertility restoration—47-74% of men show sperm recovery, but initial sperm quality is often poor, requiring extended treatment. 6, 1

Don't assume all men will respond equally—approximately 26% may not show improved sperm concentrations even with optimal therapy. 1

For men over 40, complete baseline PSA, hematocrit, and cardiovascular risk assessment before initiating any testosterone-stimulating therapy. 7 These protocols will increase testosterone and carry similar monitoring requirements as direct TRT. 3