hCG (Human Chorionic Gonadrotropin)

Proper functioning of the testes is of course necessary for normal male health, but may be impaired by anabolic steroid use or by medical conditions. HCG, an injectable drug, is a primary tool for normalizing impaired testicular function.

What Exactly Is HCG?
HCG is a natural analog of LH, the pituitary-produced hormone which stimulates sex hormone production in the testes or ovaries. HCG binds and activates the same receptor as LH and is equally effective in stimulating testosterone production in men, or estrogen production in females.

This LH analog exists because it provides additional functions required in pregnancy which LH cannot support. These additional functions cannot occur in men and have no practical effect or consequence with regard to using HCG for improved testicular function, and so are omitted here.

Pharmaceutical HCG
HCG is typically isolated from the urine of pregnant women: the pharmaceutical process of course involves extensive purification. Despite this esoteric sourcing I know of no quality problems with any genuine pharmaceutical brands of HCG.

All or nearly all practical experience in bodybuilding is with this HCG type, which is generally sold in vials of lyophilized powder, typically at 5000 or 10,000 IU per vial.

HCG may also be produced by recombinant DNA technology, similar to modern hGH production. The Ovidrel brand is manufactured this way, and is available only in preloaded syringes.

Availability of recombinant HCG at best low at present and there is no performance advantage to be experienced from choosing this type.

A technical difference, which makes no difference for bodybuilding, exists between these types of HCG. Namely, recombinant HCG consists only of dimeric HCG with two types of subunits. In contrast, urine-sourced HCG, as with HCG found in the bloodstream during pregnancy, also includes the subunits themselves as monomers. Since it’s possible that with chronic use this could have an outcome difference, that aspect will be discussed, but later on.

HCG Dosing For Stimulation Of Testosterone Production
Medical dosing of HCG has traditionally been 5000 IU per injection. Prior to 1998, bodybuilding use for restoration of testicular function was the same. As a result, as this is extreme overdose, it was widely considered to be a harsh drug.

At that time, I introduced lower dosing of no more than 1500 IU per injection, and more preferably no more than 1000 IU, with example recommended usage being 500 IU 3x/week.

Since then my recommendation for maximum injection amount has dropped to 500 IU, because no added benefit has been found to using more than this at a time, provided that injections are reasonably frequent.

The recommended weekly dosing range is from about 700 to 1750 IU. Example dosings are 100-250 IU daily, or 200-500 IU every other day, or 250-500 IU three times per week.

In addition to such dosings being followed by a very large number of individuals over many years with excellent success, scientific study has since validated these dosings. As measured by intratesticular testosterone levels, this dosing level maximizes results. There is simply no point to more.

Multiple injections per week are recommended because the half-life of HCG is only about 36 hours. Less frequent injections result in poor maintenance of blood levels.

Administration And Storage Of HCG
Vials of HCG are first reconstituted with a convenient amount of sterile or preferably bacteriostatic. For example, a 5000 IU vial can conveniently be diluted with 2.5 mL of water. This provides a 2000 IU/mL solution, enabling easy calculation of dosing. For example, a 200 IU dose would then require 0.1 mL of solution, which would be marked “10 IU” on an insulin syringe.

If the vial’s capacity allows, 5.0 mL of water can be added to a 5000 IU vial. The resulting solution would then obviously be 1000 IU/mL, enabling even easier calculation of dosing.

Injection is intramuscular or subcutaneous according to personal preference.

Unreconstituted vials of HCG should be stored in the refrigerator or freezer. They may be shipped at room temperature. Reconstituted vials should always be refrigerated; however, if a vial is accidentally left at room temperature for a day, it will not be ruined.

It is even more important with HCG than with anabolic steroids to employ proper sterile handling of the vial. The septum (top) should always be thoroughly cleaned with alcohol, and the needle must be sterile as well. Aqueous peptide, or in this case glycopeptide solutions can support bacterial growth much more so than oil solutions can, so do not fail with regards to safe handling. Discard if cloudiness appears, or if in doubt.

Preventing Testicular Atrophy And/Or Testicular Sensitivity Loss During Anabolic Steroid Cycles
Anabolic steroid usage inhibits LH production, which in turn reduces or usually eliminates testicular stimulation. Over short periods of time this is no problem. Over extended periods, however, testicular atrophy and/or insensitivity results. When this occurs, post-cycle recovery of natural testosterone production is impaired or fails.

Prior to 1996, traditional use was to employ HCG post-cycle to correct this problem. Since then it has become a fairly accepted practice to instead prevent the problem from ever occurring. Why deliberately allow one’s testes to shrivel, lose sensitivity to LH, and lose ability to produce testosterone, even if thinking it can be cured later?

That’s poor planning.

So where an anabolic steroid cycle is long enough for testicular atrophy and/or sensitivity to possibly occur – typically but not always, 8 weeks or more – HCG is introduced during the cycle itself to prevent that. Rather little HCG is needed for this purpose: 100 IU daily, 200 IU every other day, or 250 IU 3x/week are all entirely sufficient. Usage need not be through the cycle either: it can begin at for example 4-6 weeks into the cycle and end with the last steroid injection.

The testicular function problem really is that simple to avoid.

Using HCG To Maintain Natural Estrogen Levels In Anabolic Steroid Cycles
Some anabolic steroid cycles do not include any aromatizing steroids, such as cycles using only trenbolone, Masteron, Primobolan, or oxandrolone. Unless dosing is light on such cycles or duration is very short, estrogen levels fall abnormally low. This interferes with anabolism, libido, mood, joint function, and over the long term, cardiovascular health. An obvious way to solve this problem is to include at least a small amount of an aromatizing steroid, but that won’t always be desired.

Another and quite excellent way is to include HCG, typically at the high end of the suggested dosing range. The resulting natural testosterone production

Using HCG To Correct Testicular Atrophy Or Insensitivity Which Has Already Occurred
In some cases, steroid users allow testicular atrophy to occur and then need to correct it.

In these cases, use of HCG at the high end of the suggested dosage range can restore testicular function within typically 4-8 weeks.

Using HCG To Improve Testosterone Production In Cases Of Secondary Hypogonadism
There are two fundamental causes of low natural testosterone. In primary hypogonadism, the testes themselves cannot produce sufficient natural testosterone despite normal simulation. HCG can do nothing in such cases. Testosterone replacment therapy is the only means of normalizing testosterone levels. In secondary hypogonadism, however, the problem is that not enough LH is produced, with the result that the testes are inadequately stimulated. With proper stimulation, they will produce testosterone at normal levels.

Where the cause of low natural testosterone is secondary hypogonadism, HCG dosed as above can normalize testosterone production. Dosing for at least the first two months should be a the high end of the range. However, before adopting HCG as the solution, it should be determined if the secondary hypogonadism has causes which might be corrected. For example, the cause might be abnormally high estrogen. Such a case would be better treated with an anti-aromatase to correct that problem rather than with HCG to work around it.

Undesired Increase in Estrogen With HCG Use
In men, estradiol results principally from enyzmatic conversion (aromatization) of testosterone. Accordingly, increase in testosterone results in increase of estrogen, principally estradiol, if no steps are taken. Testosterone/estradiol ratio is dependent on amount of aromatase enzyme and tends to be characteristic of the invidual, though it can change with time. Men with a normal level of aromatase maintain normal estradiol levels even as testosterone levels increase to high normal from HCG use. However, men with high aromatase levels may experience excessive estradiol levels with increase in testosterone.

Such a problem may be detected with blood testing and corrected by use of an aromatase inhibitor (AI) such as Arimidex or letrozole. Dosing of the AI should be adjusted according to the findings of followup blood testing.

For Long Term Use, A Possible Practical Difference Between HCG Types
As mentioned, recombinant HCG contains no monomers of HCG, while ordinary HCG does.

How might this be of any importance? The beta monomer form found in ordinary HCG, but not in recombinant HCG, activates the TGF-beta receptor. I don’t think this activity provides an important risk for bodybuilding use. Women, for example, experience it for 9 months on end in some cases for multiple pregnancies and do not necessarily suffer much from it, and there’s a very extensive track record of safe bodybuilding use. However, TGF-beta receptor stimulation by this HCG monomer has a potential to promote some cancers. (In contrast, intact HCG is protective.)

So, if using HCG for years on end continuously, there might be a slight safety advantage in using recombinant HCG over ordinary HCG. It may be very little advantage, since as mentioned the dimer form also found in ordinary HCG is protective and at least to some extent balances out the beta monomer form. Indeed, ordinary HCG is at the balance which nature provides. Still, if the day comes when recombinant HCG is as easy to obtain as regular HCG, one might prefer it for this reason. It might be an even safer product.

In the meantime, personally I wouldn’t worry about the difference.

Summary
Intramuscular or subcutaneous injection of HCG at doses of typically 100-200 IU per day, 200-250 IU every other day, or 250 IU three times per week is effective in supporting testosterone production and testicular size and function where the cause of reduction has been reduced LH production. Doses higher than this provide no further advantage.