Human chorionic gonadotropin treatment: a viable option for management of secondary hypogonadism and male infertility

ABSTRACT

Introduction: Low testosterone and its symptoms is a condition affecting many males with severe repercussions on health. Testosterone affects metabolism, bones, joints, and ligaments, the cardiovascular system, liver, sexual functions, muscle mass, and the nervous system. Nowadays, due to recent research showing the benefits of testosterone replacement therapy, this treatment is gaining in popularity among aging men. However, testosterone replacement can increase the risk of infertility.

Areas covered: Human chorionic gonadotropin (HCG) is used in the treatment of male infertility due to its luteinizing hormone (LH)-like action triggering testosterone and sperm production. Due to these positive effects on testosterone production, HCG has also been used to treat secondary hypogonadism. In this review, based on a literature review for the years 1977–2020 via Google Scholar, we summarize the current research on HCG as treatment for patients suffering from low testosterone and provide an overview of the pros and contras for HCG therapy as compared to testosterone replacement therapy for the treatment of secondary hypogonadism.

Expert opinion: The testosterone and sperm production triggering effects of HCG without the side effects on fertility seen in testosterone replacement therapy make HCG therapy a prime candidate for patients suffering from secondary hypogonadism.

KEYWORDS:

• Low testosterone
• spermatogenesis
• luteinizing hormone
• follicle-stimulating hormone

Article highlights

• When choosing a treatment method for patients with secondary hypogonadism, age, and comorbidities of the patient should be taken into consideration.

• HCG can raise endogenous testosterone while maintaining or even increasing several fertility parameters such as sperm volume and motility.

• As compared to TRT, HCG treatment has been shown to minimize side effects, especially those in hematocrit, estradiol, prostate volume, and PSA increases.

• HCG can significantly increase intratesticular testosterone in a dose-dependent manner, with dosages between 250 and 500 IU seeming to be optimal to restore physiological intratesticular testosterone levels.

• A key reason for choosing HCG over TRT in HH men would be the maintenance and/or improvement of fertility.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.