What Every Man Should Know About TRT dosage, hCG and Testicular Size.
Testosterone is one of the most important hormones for a man's health.
While most people see it as the men fertility hormone, it does so much more:
- It plays a role in the development of facial and body hair
- It promotes an increase in both muscular mass and strength
- It helps to maintain sex drive
- It protects against degenerative bone and muscle diseases
- It increases energy metabolism, helping to reduce body fat and maintain a healthy body mass
- It boosts self-esteem and sparks aggression and competitiveness
- As you can see, testosterone is vital to your health and wellness as a man!
Low Testosterone 101
Testosterone levels are at their highest during adolescence, when they are helping to make the transition from boy to man. They peak during the early years of adulthood (the early 20's).
However, by the time you reach the age of 30, testosterone production in your body begins to decline. The decrease in production is roughly 1% per year. After 15 to 20 years of this (by your 40's and 50's), you may begin to suffer from low testosterone levels, also known as male hypogonadism. The symptoms of low testosterone include:
- Reduced sperm count
- Decrease in muscle mass
- Lower sex drive/libido
- Erectile dysfunction/impotence
- Hair loss
- Testicle shrinkage
- Increase in breast size
- Hot flashes
Testosterone Replacement Therapy (TRT ): A Solution?
Male hypogonadism (low testosterone) is often treated using Testosterone Replacement Therapy. TRT involves the use of testosterone patches, gels, pellets, or injections, which are meant to provide the testosterone your body is no longer producing. TRT dosage is usually 100-200 mg per week of testosterone injections, 1 cc of 200 mg/ml testosterone cream, or 700-1000 mg of testosterone in pellets every 2-3 months.
Those undergoing TRT often report feeling more vigorous, having more energy, noticing a boost in their sex drive, an enhancement of their memory and focus, and even (in some cases) a reduction of testicle shrinkage. For aging men looking to prevent low testosterone levels, TRT is an option worth considering.
However, despite science's best efforts, Testosterone Replacement Therapy comes with a number of risks, including:
- Sleep apnea.
- High hematocrit and blood viscosity.
- Testicle shrinkage
- Acne/skin reactions
- Reduced male fertility and sperm count
TRT decreases the production of two vital hormones:
Luteinizing hormone (LH) -- This hormone helps to regulate the testes' production of testosterone, and converts androstenedione to testosterone. Together with FSH (see below), it is needed to maintain healthy testosterone levels.
Follicle-stimulating hormone (FSH) -- This hormone controls the production of sperm in the testicles. It is necessary to begin the spermatogenesis process: turning male primordial germ cells into sperm.
Both of these hormones play pivotal roles in male fertility. Without them, the testicles are unable to produce healthy, viable sperm in sufficient quantities. The fact that TRT affects these two hormones means that testosterone replacement therapy may have the OPPOSITE of the desired effect! Instead of boosting fertility, TRT can cause azoospermia (no viable sperm produced) by up to 40%)
All of these risks could make testosterone replacement therapy a less-than-effective infertility treatment for men. Unless, of course, scientists discovered a way to counteract the negative side effect.
A New Addition to TRT To Save the Day: HCG
According to TWO separate studies, HCG injections may be the solution to the problems posed by Testosterone Replacement Therapy (TRT.)
Before we take a look at the studies, it's important to know what HCG is.
HCG, or human chorionic gonadotropin, is a hormone that plays a vital role in fertility and fetal development. HCG triggers the female body to release eggs during ovulation, and it supports the development of the egg in the ovaries. Once the egg has been fertilized, HCG keeps the fetus protected by maintaining the corpus luteum.
However, what makes HCG useful for treating low testosterone levels is the fact that it's similar in structure to luteinizing hormone. Not only is this useful for stimulating ovulation in women, but it can increase the testicles' production of testosterone. HCG can also normalize the size of Leydig cells in the testicles that shrink as TRT shuts down LH. HCG is used in fertility treatments for both men and women and can be obtained by prescription cheaply from compounding pharmacies.
But how do you prevent testicular shrinkage and increase sperm production on TRT?
Let's review a few studies that combined HCG plus TRT:
Study #1: A 2013 study published in the Journal of Urology discovered that low-dose HCG injections helped to prevent a reduction in sperm count as a result of testosterone replacement therapy.
- 26 men (mean age: 35.9 years old) participated in the study.
- 19 were given testosterone injections once per week
- 7 were given transdermal testosterone gel once per day
- In addition to the testosterone, the men were given 500 IU of HCG every 2 days.
- The researchers measured blood testosterone levels, free testosterone, estradiol, and semen parameters, both before and during the treatment. Pregnancy rates among the men were also measured to determine the outcome of the therapy.
The results were fascinating:
- All hormone levels increased. Blood testosterone, free testosterone, and estradiol levels all increased significantly as a result of the treatments.
- 9 of the men contributed to pregnancy with a partner.
- Semen parameters remained the same for more than 1 year of treatment. This means the HCG treatments prevented the TRT from reducing sperm count, motility, and viability.
That last result was the most important of all. Not only did the study prove that HCG injections help to increase the levels of testosterone, but they also prevent sperm reduction as a result. The low-dose injections of HCG preserved the fertility of the men treated.
Study #2: A 2005 study conducted at the University of Washington School of Medicine examined the effects of HCG on the intra-testicular testosterone (ITT).
While serum (blood) and free testosterone levels are a good marker of overall health, intra-testicular testosterone is a more accurate measure of male fertility. According to an older study, low ITT levels leads to reduced sperm production and poor sperm health.
The 2005 study examined how HCG helped to maintain healthy ITT levels, maintaining proper sperm productip\on among the men the participated in the study.
29 men were evaluated as part of the research, all with "normal reproductive physiology". They were divided at random into four groups:
- Group 1 (Control): This group received a saline placebo.
- Group 2 (Experimental 125): This group received 125 IU of HCG every two days.
- Group 3 (Experimental 250): This group received 250 IU of HCG every two days.
- Group 4 (Experimental 500): This group received 500 IU of HCG every two days.
In addition to the HCG injections, the men were also given testosterone enanthate at different TRT dosage. During the three-week study, the researchers measured both baseline serum (blood) testosterone levels and intra-testicular testosterone. The men's LH and FSH levels were suppressed greatly in order to examine the effects of the HCG/testosterone levels without interference from the other fertility hormones.
The results of this test proved one fact beyond a doubt: the higher the dose of HCG, the lesser the effects of the TRT.
- The Experimental 125 group saw a 25% reduction in their ITT levels as a result of the testosterone treatment.
- The Experimental 250 group saw only a 7% reduction in their ITT levels throughout the 3-week study.
- The Experimental 500 group saw a 26% INCREASE in their ITT levels by the time the study had run its course.
This study backs up the evidence discovered in the first study. Just 500 IU of HCG every 2 days is enough to counteract the negative effects of Testosterone Replacement Therapy. Not only will it help to promote healthy sperm, but it can maintain healthy sperm count, motility, and viability. Injections of HCG may be just the thing to make your TRT more effective at boosting fertility and testosterone levels.
Note: HCG drops or supplements are NOT a viable alternative to medical-grade HCG. Your doctor will need to write you a prescription for HCG injections.
Not only will HCG help to restore your fertility and sperm production, but it can reduce the testicle shrinkage caused by the TRT. Using HCG with TRT can restore your testicles to their normal, healthy size and function. Thanks to the TRT/HCG therapy, you may experience normal intra-testicular testosterone production, leading to increased fertility and overall health.
More information about HCG use in Men on TRT:
J Clin Endocrinol Metab. 2005 May;90(5):2595-602. Epub 2005 Feb 15.
J Urol. 2013 Feb;189(2):647-50. doi: 10.1016/j.juro.2012.09.043. Epub 2012 Dec 20.