💡 HCG and Testosterone Replacement Therapy (TRT): What Every Man Should Know

Human Chorionic Gonadotropin (HCG) isn’t testosterone — but it plays a crucial role for many men on TRT. In this evidence‑based guide, we explain what HCG does, why it’s used with TRT, and how it affects fertility, hormones, and well‑being.

🧬 What Is HCG?

HCG is a hormone that mimics luteinizing hormone (LH) — the signal your brain sends to your testicles to make testosterone. Unlike TRT, which delivers testosterone externally, HCG stimulates your own testicles to keep functioning Ramasamy et al., 2025.

⚙️ How Does TRT Affect the Body?

When you begin TRT, your brain senses the high testosterone levels and reduces production of GnRH, LH, and FSH — key hormones that trigger testicular activity. As a result:

• Natural testosterone production drops
• Testicles reduce sperm production
• Testicular size can shrink significantly

This suppression is a well-documented mechanism in TRT therapy Endocrine Society, 2023.

🧠 What Does HCG Do on TRT?

HCG works by acting like LH. It binds to receptors on Leydig cells in the testes, keeping them active — maintaining intratesticular testosterone (ITT) and promoting sperm production Coviello et al., 2005.

Without HCG, TRT can reduce ITT by up to 94%. With low-dose HCG, this drop is prevented — in fact, ITT can return to near baseline or above with proper dosing Ramasamy et al., 2025.

👶 Can HCG Preserve Fertility on TRT?

Yes. This is one of the most important clinical uses of HCG.

Studies show that using low-dose HCG alongside TRT helps preserve sperm production in many men, supporting fertility during treatment Shiraishi et al., 2024.

In men planning to conceive, HCG is often the preferred add-on therapy to avoid TRT-induced infertility González & Clavijo, 2022.

📊 What Does the Evidence Say?

Key Findings:

• HCG with TRT preserves fertility in hypogonadal men and maintains semen quality Shiraishi et al., 2024.
• Intratesticular testosterone is preserved or restored with proper HCG co-administration Coviello et al., 2005.
• HCG monotherapy can raise testosterone levels effectively in men recovering from TRT or anabolic steroid use González & Clavijo, 2022.

These studies reflect both longstanding research and the latest clinical reviews in male hormone therapy.

🔬 How Is HCG Administered?

HCG is typically injected 2–3 times per week in doses ranging from 250 IU to 1,500 IU, depending on:

• Fertility goals
• Baseline hormone levels
• Co-use with testosterone

Protocols may vary, but patient-specific plans are standard best practice Endocrine Society, 2023.

📍 Who Should Consider HCG?

HCG is especially recommended for men who:

• Want to preserve fertility while on TRT
• Are concerned about testicular shrinkage
• Are planning for children in the future
• Prefer to retain some natural testosterone production

For other patients, it may not be essential — but for fertility preservation, it’s the gold standard Shiraishi et al., 2024.

⚠️ Side Effects and Considerations

HCG is generally well tolerated but may cause:

• Mild fluid retention
• Acne or oily skin
• Temporary emotional fluctuations

These side effects are less common than those from high-dose TRT alone, but monitoring is essential González & Clavijo, 2022.

🧠 Summary

• TRT can suppress natural testosterone and sperm production.
• HCG mimics LH to keep the testes active and preserve function.
• Evidence shows HCG helps maintain fertility and intratesticular testosterone.
• HCG dosing is tailored and should be supervised by a medical team.
• Combining TRT and HCG may help improve libido, mood, fertility, and testicular health.

📲 Want to know if HCG should be part of your TRT plan?
At Eden Clinic, we’ll assess your goals, symptoms, and labs — and design a treatment that supports not just hormones, but your long-term health and future.

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