Human chorionic gonadotrophin (hCG) treatment for low testosterone offers an alternative approach to conventional testosterone replacement therapy, particularly for men wishing to preserve fertility. Unlike standard testosterone preparations, hCG mimics luteinising hormone, stimulating the testes to produce testosterone naturally whilst maintaining testicular function and sperm production. This prescription-only medicine is regulated by the MHRA and is licensed in the UK for hypogonadotrophic hypogonadism and induction of spermatogenesis. Treatment is typically reserved for specific clinical scenarios, particularly younger men with secondary hypogonadism who wish to conceive. Proper specialist assessment, individualised dosing, and regular monitoring are essential for safe and effective use.

What Is HCG Treatment for Low Testosterone?

Human chorionic gonadotrophin (hCG) is a hormone naturally produced during pregnancy, but it also has therapeutic applications in men with low testosterone (hypogonadism). In males, hCG mimics the action of luteinising hormone (LH), which is produced by the pituitary gland and signals the testes to produce testosterone. When administered as a treatment, hCG stimulates the Leydig cells in the testes to increase testosterone production locally, which can help maintain testicular function and potentially preserve fertility.

This approach differs fundamentally from conventional testosterone replacement therapy (TRT), which involves administering licensed testosterone preparations via gels, patches, or injections. Whilst TRT effectively raises testosterone levels, it suppresses the body's natural production by providing negative feedback to the hypothalamic-pituitary-gonadal (HPG) axis. Although hCG does not restore natural LH and FSH secretion, it can maintain testicular function, making it particularly relevant for men who wish to preserve fertility, as TRT typically reduces sperm production.

hCG treatment is typically administered via subcutaneous or intramuscular injection, with dosing schedules varying based on individual clinical circumstances. Common regimens for hypogonadotrophic hypogonadism range from 1,000 to 2,000 international units (IU) administered two to three times weekly, though dosing should be individualised by a specialist. hCG is a prescription-only medicine in the UK, regulated by the Medicines and Healthcare products Regulatory Agency (MHRA), and is usually initiated by specialists.

It is important to note that hCG is licensed in the UK for male hypogonadotrophic hypogonadism and induction of spermatogenesis, but its use as monotherapy for non-fertility related low testosterone or as an adjunct to TRT is considered off-label. Its use is generally reserved for specific clinical scenarios, particularly when preserving testicular function and fertility is a priority.

Who Might Be Suitable for HCG Treatment in the UK

hCG treatment is not appropriate for all men with low testosterone, and careful patient selection is essential. The most common indication is in younger men with hypogonadism who wish to preserve or restore fertility. Because conventional testosterone replacement suppresses spermatogenesis (sperm production), hCG offers an alternative that maintains testicular function and the potential for conception. Men planning to start a family should have a baseline semen analysis, and it's important to note that for induction of spermatogenesis, additional treatment with follicle-stimulating hormone (FSH) or human menopausal gonadotrophin (hMG) is usually required.

Another key group includes men with secondary hypogonadism (also called hypogonadotropic hypogonadism), where the problem originates in the pituitary gland or hypothalamus rather than the testes themselves. In these cases, the testes retain the capacity to produce testosterone but lack adequate stimulation from LH. hCG can effectively bypass this deficiency by directly stimulating the testes. Conversely, men with primary hypogonadism (testicular failure) typically respond poorly to hCG, as their testes cannot respond adequately to hormonal stimulation.

Some men already receiving TRT may be offered hCG as an adjunctive therapy to prevent testicular atrophy (shrinkage) and maintain some degree of natural testosterone production. This combination approach is sometimes used in specialist endocrinology or andrology clinics, though it should be noted this is an off-label use in the UK with limited evidence.

Patients with known hypersensitivity to hCG and those with androgen-dependent cancers (such as prostate or breast cancer) should not receive hCG. Thyroid dysfunction, adrenal disorders, and hyperprolactinaemia should be identified and treated before starting gonadotrophin therapy. A thorough medical assessment is essential before initiating treatment, including blood tests measuring testosterone (taken before 11 am on two separate occasions), LH, FSH, prolactin, and sometimes sex hormone-binding globulin (SHBG). Urgent referral to endocrinology is warranted for visual field defects, new severe headaches, very high prolactin, or other pituitary hormone deficiencies.

Potential Benefits and Risks of HCG for Low Testosterone

The primary benefit of hCG treatment is its ability to stimulate testosterone production whilst preserving testicular size and function. For men concerned about fertility, this is a significant advantage over conventional TRT. Clinical studies have demonstrated that hCG can effectively raise testosterone levels into the normal physiological range in appropriately selected patients, with improvements in symptoms such as low libido, fatigue, and reduced muscle mass.

Another potential benefit is the preservation of testicular volume. Many men on TRT experience testicular atrophy, which can be distressing. hCG helps maintain testicular size by continuing to stimulate the Leydig cells, which may also have psychological benefits for some patients.

However, hCG treatment is not without risks and adverse effects. Common side effects include injection site reactions (pain, redness, swelling), headaches, mood changes, and fatigue. Some men may experience gynaecomastia (breast tissue enlargement) due to increased conversion of testosterone to oestradiol. Fluid retention and oedema can occur, so caution is advised in patients with cardiac or renal disease. In some cases, hCG can stimulate excessive testosterone production, leading to symptoms such as acne, oily skin, or aggressive behaviour.

Monitoring is essential during hCG treatment. Regular blood tests should assess testosterone, oestradiol, and haematocrit (taking action if levels exceed 54%). PSA and prostate assessment are important in appropriate age and risk groups. For men using hCG for fertility, periodic semen analysis is recommended to track progress. Blood pressure and lipid monitoring may also be appropriate.

Patients should be advised to report any concerning symptoms, including chest pain, shortness of breath, unilateral leg swelling, severe headaches, or visual disturbances, and to seek urgent medical attention if these occur. Any suspected adverse reactions should be reported via the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk or the Yellow Card app).

Accessing HCG Treatment Through the NHS and Private Care

Access to hCG treatment for low testosterone in the UK varies considerably depending on whether care is sought through the NHS or private healthcare. Within the NHS, hCG is not routinely offered as a first-line treatment for hypogonadism. Testosterone replacement therapy remains the standard approach recommended by the British Society for Sexual Medicine and the Society for Endocrinology. However, hCG may be prescribed in specialist endocrinology or andrology clinics for specific indications, particularly in younger men where fertility preservation is a priority.

Patients seeking hCG treatment through the NHS should expect a comprehensive assessment beginning with their GP. Initial investigations typically include blood tests to measure total testosterone (ideally taken between 8-11 am on two separate occasions), LH, FSH, prolactin, and sometimes sex hormone-binding globulin (SHBG). If hypogonadism is confirmed and fertility is a concern, referral to a specialist endocrinologist or andrologist is appropriate. Waiting times for NHS specialist appointments can vary significantly by region, and access to hCG may depend on local commissioning decisions and formulary restrictions.

Private healthcare offers more immediate access to hCG treatment, with numerous clinics specialising in men's health and hormone optimisation. However, patients should exercise caution, as prescribing practices can vary. It is essential to seek care from registered medical practitioners with appropriate qualifications in endocrinology or andrology. Patients should verify that clinics are registered with the Care Quality Commission (CQC) and that doctors are licensed with the General Medical Council (GMC). Only licensed UK medicinal products should be used; patients should avoid unlicensed formulations or products marketed for weight loss.

The cost of private hCG treatment varies considerably but typically includes consultation fees (approximately £150–£300), medication costs (approximately £50–£150 per month), and ongoing monitoring blood tests (approximately £100–£200 per panel). These expenses are not covered by the NHS and represent a significant financial commitment.

Regardless of the care setting, patients should ensure they receive proper counselling about the benefits, risks, and alternatives to hCG treatment, including conventional TRT and lifestyle interventions. Shared decision-making between patient and clinician is essential to achieve optimal outcomes whilst minimising potential harms.

Frequently Asked Questions