Is hCG therapy an alternative treatment for hypogonadism?
Although less frequently used in the general population, hCG therapy with or without testosterone supplementation represents an alternative treatment. Keywords: Hypogonadism, Selective estrogen receptor modulator, Male fertility, Clomiphene, Human chorionic gonadotropin
Which Gonadotropins are used in the treatment of hypogonadism?
Although testosterone (T) therapy is sufficient for maturation and maintenance of secondary sex characteristics in hypogonadal men, gonadotropins are required for stimulation of spermatogenesis. Thirteen men with hypogonadotropic hypogonadism received treatment with hCG, followed in 12 by the addition of human menopausal gonadotropin (hMG).
When should hCG be adjusted for hypogonadism?
The dose of hCG should be adjusted until trough serum testosterone levels are restored to about the lower limit of the adult male range. Many patients with congenital hypogonadotropic hypogonadism require hCG and FSH to complete spermatogenesis while acquired hypogonadotropic hypogonadism may be managed with hCG alone [143,144].
What is the indication for follicle stimulating hormone (FSH) treatment in male infertility?
In male infertility, the indication for treatment with follicle stimulating hormone (FSH) is the induction and maintenance of spermatogenesis in patients with hypogonadotropic hypogonadism ( 1 ).
Why is hCG and FSH used to treat hypogonadism?
hCG stimulates the Leydig cells in the testis to produce testosterone in hypogonadotropic hypogonadism patients without associated primary testicular disease. The dose of hCG should be adjusted until trough serum testosterone levels are restored to about the lower limit of the adult male range.
Why is hCG given for hypogonadism?
To help address hypogonadism In men, doctors prescribe hCG to help address the symptoms of hypogonadism, such as low testosterone and infertility. hCG can help the body increase its production of testosterone and sperm, which can help reduce infertility.
Does hCG treat hypogonadism?
hCG is a safe and efficacious alternative or adjunct to TRT in men desiring to preserve fertility while treating their hypogonadism. hCG can also be used help restore spermatogenesis in men hypogonadal hypogonadism or steroid induced impairment of spermatogenesis.
Why is hCG used in the treatment?
HCG is used in combination with other fertility drugs to increase a woman's chance of pregnancy. In men or adolescent boys, HCG helps the production of testosterone and sperm. HCG is also used in male children with cryptorchidism, a specific birth problem of the testes.
Does hCG increase LH and FSH?
Treatment with hCG increased testosterone into the adult range and suppressed FSH and LH levels com- pletely. Inhibin B levels increased in response to hCG in the youngest prepubertal children only, whereas no changes or even decreases were seen in the oldest pre- pubertal/early pubertal boys with cryptorchidism.
Which is better hCG or testosterone?
Our results show that in adolescent pre-pubertal males with HH, pubertal induction with hCG therapy yields significantly better outcomes for testicular size when compared to testosterone therapy after about 12 months of therapy, with no difference in testosterone levels between the 2 groups.
Does hCG increase testosterone production?
The hCG treatment increased the serum testosterone level, penile length, and testicular volume in IHH patients. Our results suggest that hCG treatment has a beneficial effect on gonadal function and penile growth in patients with IHH presenting with micropenis.
Does hCG increase free testosterone?
Previous studies have demonstrated that hCG increased testosterone levels compared to placebo. In another study, men taking testosterone along with hCG were able to maintain adequate sperm production and testicle volume.
Will hCG reverse testicular atrophy?
HCG is available via prescription and it reverses testicular atrophy even in men on long term testosterone replacement. It is not covered by ADAP but it can be purchased cheaply from compounding pharmacies (cost is about 7 dollars per week if two 500 IU injections are used weekly).
How does HCG treat infertility?
HCG is very similar in structure to Luteinizing Hormone (LH), which is one of the pituitary hormones responsible for stimulation of the ovary in normal ovulation. HCG is given by injection to stimulate final development and release of mature eggs at the time of ovulation during fertility treatment.
How quickly does HCG increase testosterone?
Our data suggests that hCG can be a safe and efficacious treatment option for patients with symptoms of hypogonadism who do not desire fertility. We observed significant increases in testosterone over an average therapy duration of 6 months.
How does HCG help with fertility?
A boost of hCG can stimulate production of testosterone, which can increase sperm production — and therefore, in cases where sperm count may be low, fertility. Most men receive a dosage of 1,000 to 4,000 units of hCG injected into a muscle two to three times a week for several weeks or months.
How does hCG affect sperm count?
hCG can be extracted from urine as well as other recombinant sources. Exogenous hCG increases serum testosterone levels and ITT concentrations. hCG alone can only maintain spermatogenesis for a short period of time. In a small case series directed by Depenbusch et al[24], thirteen azoospermic men with hypogonadotropic hypogonadism were initially administered hCG and human menopausal gonadotropin (hMG) to induce spermatogenesis. hCG was then administered 500-2500 IU hCG subcutaneously biweekly alone for up to two years (range 3-24 mo). After 12 mo of treatment, sperm counts decreased gradually but remained present in all patients, except for one who became azoospermic. The declining sperm counts demonstrate that FSH is crucial for the continuation of normal spermatogenesis.
How many men are affected by symptomatic hypogonadism?
According to a recent study by Mulligan et al[1], symptomatic hypogonadism affects approximately 40% of men aged 45 years or older. With the maturation of the Baby Boomer population, it is anticipated that there may be a significant increase in men desiring children at an older age.
How many men will have hypogonadism by 2025?
In addition, this study demonstrated that cessation of therapy led to recovery of spermatogenesis in most infertile males. More startlingly, an estimated 6.5 million men in the United States will have hypogonadism by 2025[3].
What is the recovery of spermatogenetic function?
Recovery of spermatogenetic function, increases in testosterone levels
Is clomiphene citrate good for hypogonadism?
Clomiphene citrate is an effective and less expensive treatment option:Taylor et al[17] conducted a study in which CC gave rise to significant increases in testosterone levels from baseline values.
Does hCG help with azoospermia?
Prevention of azoospermia and maintenance of fertility in hypogonadal men on TRT with low dose hCG:Hsieh et al[10] also studied the effect of hCG administration with testosterone replacement therapy on spermatogenesis. In this small series, ten men received short-acting testosterone preparations in addition to low doses of hCG. The key finding of this study was that spermatogenesis was maintained. Although there was a relatively small decrease in sperm density, no men became azoospermic.
Does chorionic gonadotropin help with ITT?
Low-dose human chorionic gonadotropin maintains ITT in normal men with testosteron e-induced hypogonadism:Low dose human chorionic gonadotropin (hCG) with intramuscular testosterone enanthate (200 mg/wk) can also maintain ITT and serum testosterone levels[9]. Some men are reluctant to stop testosterone therapy due to the symptomatic benefit, despite understanding the fertility risk. Use of hCG with testosterone may be a viable alternative for this select group of men. The use of hCG with intramuscular testosterone was initially studied for the development of a male contraceptive agent. Coviello et al[9] administered low doses of hCG (0, 125, 250, or 500 IU every other day) to normal men during this 3 wk study and measured serum and ITT levels. While the administration of testosterone alone resulted in profound decreases in ITT concentrations (94% from baseline in the TE and placebo hCG group), the addition of low dose hCG resulted in maintenance of the ITT levels. Although serum T increased from baseline in all groups, ITT remained significantly higher than serum T in all four groups after treatment. Despite supraphysiologic doses of exogenous testosterone, high levels of ITT can be maintained with the low-dose hCG.
What are the two types of hypogonadism?
There are two types of hypogonadism. Primary hypogonadism is caused by disorders in the male testes or female ovaries, and secondary hypogonadism , which arises due to problems with the pituitary gland or surrounding hypothalamus, a brain region at the base of the brain. 1 This small gland coordinates the function of others to regulate sexual and physical development.
What is a transdermal testosterone gel?
Transdermal gels: A range of formulations of testosterone can be applied in gel form, including Androgel, Testim, and Axiron, among others.
How to get testosterone in men?
In fact, exercise, particularly weightlifting and strength training, can boost the amount of testosterone men with the condition produce. 7
Is hypogonadism a chronic condition?
In many cases, hypogonadism is a chronic condition, requiring consistent and constant management. No doubt, this disorder—and its complications, such as osteoporosis, infertility, and others—presents unique challenges and severely impacts quality of life.
Can hypogonadism cause weight gain?
Hypogonadism in women, most commonly experienced as menopause, can cause weight gain and related issues. In addition, osteoporosis (a weakening of bones) is associated with excessive weight, increasing the chances of injury. 4 As such, you may be counseled on dietary changes, exercises, and other changes you can incorporate to lose weight.
Does Evista affect fertility?
Selective androgen receptor modulators (SERMs), such as Evista (raloxifene), can also boost levels of testosterone and don’t affect fertility. While the efficacy and safety of long-term use are still being researched—and currently SERMs are an off-label approach to hypogonadism—this approach has shown a great deal of promise.
Does fenugreek help with hypogonadism?
A wide range of over-the-counter, herbal supplements are touted for male hypogonadism. These typically promise to raise testosterone levels, alongside other claims. While evidence is lacking for many of them, studies suggest that supplements of fenugreek seeds are effective and well-tolerated. Zinc has also shown promise as deficiency of this mineral is associated with some symptoms of hypogonadism. 9
What is the therapy of choice for hypogonadism?
The therapy of choice in patients with hypogonadotropic hypogonadism due to various pathophysiologic causes as mentioned above is—for most of the time of the life-span—the exogenous substitution of testosterone to maintain all androgen-dependent functions. This therapy is well established over decades, relatively convenient for the male patients and comparably inexpensive ( 5 ).
Why is male infertility a sign of hypogonadism?
In patients with hypogonadotropic hypogonadism, male infertility is due to the lack of stimulation of spermatogenesis by the gonadotropins FSH and luteinizing hormone (LH). In so-called idiopathic/isolated/congenital hypogonadotropic hypogonadism (IHH or CHH) and Kallmann syndrome, the core pathophysiological feature is the disturbed hypothalamic synthesis or secretion of gonadotropin-releasing hormone (GnRH) ( 4 ). This leads to diminished or absent LH and FSH synthesis or secretion by the unstimulated pituitary gland and finally to endocrine hypogonadism with low testosterone serum levels and infertility with azoospermia or severe oligozoospermia as the respective laboratory markers. Various other diseases including secondary GnRH deficiency lead to the same pathophysiology ( 4 ).
How often should I take hCG?
FSH two or three times a week in combination with 1000–2500 I.U. of hCG two times per week ( 4 ). Several physicians start treatment with hCG alone for e.g., 3 months, as some patients—maybe those with some residual FSH activity—achieve stimulation of spermatogenesis by hCG alone ( 13, 20, 25, 26 ). However, the sperm concentrations seen after hCG therapy alone appear to be lower than those with the combined treatment with FSH plus hCG ( 27 ). Therefore, FSH should also be added in these hCG-treated patients at some time-point to achieve best treatment outcome. In addition, it has been shown that induction of spermatogenesis achieved by FSH plus hCG treatment in hypogonadotropic hypogonadism can be maintained qualitatively, but not quantitatively in most of the patients with hCG alone ( 28 ). On this line, a sequential therapy with 3 months treatment with FSH plus hCG alternated by hCG therapy alone for another 3 months has been proposed to reduce the relatively high costs of gonadotropin therapy ( 29 ). However, it is not known if this dosing regimen has the same high efficacy on the primary outcome clinical pregnancy rate.
What is FSH in infertility?
In male infertility, the indication for treatment with follicle stimulating hormone (FSH) is the induction and maintenance of spermatogenesis in patients with hypogonadotropic hypogonadism ( 1 ). As these patients are normally azoospermic without gonadotropin stimulation and during testosterone therapy, the presence of sufficiently high numbers ...
What causes hypogonadism in the pituitary?
Other causes for hypogonadotropic hypogonadism are pituitary insufficiency due to tumors (especially makro-prolactinomas), metastases of the pituitary and the hypophyseal stalk, post- operative states, radiotherapy of the pituitary region, traumata, infections, hemochromatosis, vascular disorders, and others ( 4 ). Hypogonadotropic hypogonadism is caused by the insufficiency of the pituitary gland to secret significant levels of LH and FSH. The clinical picture in these patients is additionally influenced by possible disturbances of the other pituitary hormones.
Can recombinant LH be used in Germany?
In Germany, recombinant hCG and LH preparation are approved for reproductive hormone therapy in women. In men, so far no adequate studies have been published comparing these preparations with urinary hCG. A combination of recombinant FSH with recombinant LH or hCG in one injection pen would allow easier self-administration, more fine tuning of individual therapy, higher compliance and maybe higher treatment efficacy. In addition, it could be speculated that LH instead of hCG therapy in combination with FSH could lead to much better clinical efficacy regarding stimulation of spermatogenesis and pregnancy rate in male hypogonadotropic hypogonadism ( 6, 30 ). So far injection pens with recombinant LH are only approved for treatment of females and it is about time to provide these options also to male hypogonadotropic patients. The pharmaceutical companies should be encouraged to initiate the respective clinical studies.
Is there a randomized controlled trial for FSH?
No adequate large, randomized controlled trials (RCTs) have been performed to compare efficacy of recombinant or highly purified FSH with the urinary hMG preparations in males—quite in contrast to the application of FSH preparations in females for ART. From the available information, it seems that the efficacy of the various FSH preparations in male patients with hypogonadotropic hypogonadism is quite comparable, regarding stimulation of spermatogenesis and inducing the desired pregnancy in the female partner ( 13, 18, 20 – 25 ). Today, in Germany only recombinant FSH and no longer urinary FSH preparations are approved for this therapy in male patients.
Home Remedies and Lifestyle
- Unless the root causes of hypogonadism—hormone deficiencies—are reversed, the condition persists. That said, lifestyle and dietary changes can help manage symptoms or take on associated conditions that lead to hypogonadism. Specific approaches vary somewhat based on sex at birth.
Over-The-Counter (OTC) Therapies
- There aren’t many OTC approaches to hypogonadism; however, some supplements and medications can help manage the condition. For females, supplements of certain vitamins may help, including:4 1. Vitamin D 2. Calcium 3. Magnesium A wide range of over-the-counter, herbal supplements are touted for male hypogonadism. These typically promise to raise testosterone l…
Prescriptions
- Since hypogonadism is, at its core, defined by a lack of testosterone in males and estrogen in females, medical management focuses on replacing these levels and spurring their production. Hormone replacement therapy (HRT)does exactly that for men and premenopausal women with the condition, and there are several forms it takes.
Surgeries and Specialist-Driven Procedures
- There are two types of hypogonadism. Primary hypogonadism is caused by disorders in the male testes or female ovaries, and secondary hypogonadism, which arises due to problems with the pituitary gland or surrounding hypothalamus, a brain region at the base of the brain.1This small gland coordinates the function of others to regulate sexual and physical development. A commo…
A Word from Verywell
- In many cases, hypogonadism is a chronic condition, requiring consistent and constant management. No doubt, this disorder—and its complications, such as osteoporosis, infertility, and others—presents unique challenges and severely impacts quality of life. However, management of this condition has come a long way. HRT and other approaches have helped countless people w…