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HCG Monotherapy
Human chorionic gonadotropin (HCG) is an LH analog. Meaning, it is biochemically similar enough to the LH hormone that it interacts with the same receptors. This means it can be used to turn on the testicular machinery, sperm, and testosterone production.
There are stories about HCG increasing ejaculation volume (this is true), and increasing penis size (this is true too, but it may only be the case for those with hypogonadism or "micro-penis"). The internet chat boards certainly are not without their stories of slight enlargement with HCG in normal men.
In the two studies7,8 I found on micro-penis, the gains were three-quarters of an inch in length and girth. Anyone who has normal penis size and has gained these effects with HCG, I am sure all of us men would be eager to hear.
HCG is a great option because, unlike testosterone, it may actually help the hypothalamus gonadal axis as opposed to suppressing it. It also seems to have less impact on estrogen, prostate mass, and cardiovascular parameters compared to the more traditional TRT, being equal or better than traditional TRT in raising testosterone.
I realize this information may contradict other information around the internet as it pertains to HCG, but this assessment is evidence based and taken from a well-done study on men aged 45-53 with low T.9 The study compared HCG against transdermal test, and two different injectables.
In fact, many doctors give HCG along with their testosterone therapies to keep the hypothalamus working and the testicles from shrinking.10
Why would the testicles shrink, you wonder? Testosterone from an outside source turns off the hypothalamus/pituitary secretion of LH; and therefore, the testicles stop producing sperm and testosterone. This is why ejaculate volume and testicles can shrink in men taking testosterone. This, usually, is not a huge issue if the drug is not abused. HCG helps keep this from happening.
As an aside, steroids do not shrink the size of the glans penis (i.e. the shaft), just the testicles, and only if used in very high amounts for too long.
Using HCG alone is a reliable promoter of testosterone and may be the safer, more natural option to start with, in those with HPG issues. It also may be the best approach for those of you who have been on testosterone for a long period of time.
Based on the studies, there are a few approaches. If using TRT, then 250 IU of HCG taken as an intramuscular injection (IM) daily is the approach recommended. If you are using HCG alone, according to the study above where it was directly compared to TRT, the dose was 2000 IU per week.
Most doctors don't like giving such a high dose of HCG all at once for fear of excess estrogen production and desensitization of LH receptors. Although this study did not show that, it may be a consideration.
Keeping any daily dose to 500 IU or less seems wise, which means you would be injecting 500 IU one to four times per week (500 IU – 2000 IU) for HCG monotherapy.
Clomid is another option in this regard. Clomid works by blocking estrogen hormone feedback at the hypothalamus. This increases natural LH production, which then stimulates testosterone production.
The dose for Clomid, at 25 mg per day or 50 mg every other day, has been shown effective in restoration of the HPG axis in men and very safe as well. At least in one study, Clomid compared directly to TRT outperformed testosterone treatment with no side effects from long-term use (up to 40 months).11
For those with secondary testosterone deficiency coming from the hypothalamus-pituitary axis, which is usually the case for younger men (<50 years), HCG and Clomid MAY be superior to TRT. As an aside, the cost of Clomid is vastly cheaper compared to TRT.
Testosterone Replacement Therapy (TRT)
The first consideration to be aware of is that steroids do not equal testosterone. Many men I have worked with will assume that, if they are taking anabolic steroids, they are taking testosterone. This is not the case, and an important distinction.
Anabolic steroids can be testosterone or androgen derivatives. Drugs like Anavar, Trenbolone, Winstrol, Primobolan, etc. have anabolic and androgenic effects similar to testosterone, but they are not testosterone. This means they are NOT suitable for TRT. Such drugs are also frequently the culprit for erection issues and low testosterone, especially after stopping them.
These "non-testosterone steroids" will shut down the body's own production of testosterone, like any other steroid, but will not be able to replace testosterone's full effects in the body. These are best left to bodybuilding circles.
Another consideration is the creams, gels, and orals of the pharmaceutical world. You can't patent testosterone; so to make money off of the therapy, drug companies tinker around with different delivery systems. These approaches are far inferior to injectable testosterone, and I would not use them, unless you are completely averse to injections.
The main drugs to consider are testosterone cypionate, testosterone enanthate, and testosterone propion-ate. The different compounds bound to the testosterone determine its half-life and, therefore, the dosing frequency. Cypionate (50-100 mg) is usually dosed one to two times per week, as is enanthate (50-100 mg). Propionate dosage is every other day at 25-100 mg per day.
There are two others: testosterone suspension and Sustanon. Testosterone suspension is 100% testosterone, while the three above are testosterone bound to esters that increase the half-life of the drug and make for a slower absorption. Suspension is rarely used due to the need for daily dosing and the rapid spikes and falls that occur with its use. Sustanon, too, is rarely used in medical circles, mostly because it is not as widely available. It is a mix of the different testosterones and is a great option if you can find it.
Everyone has a favorite. For my taste, I like propionate more than enanthate, and enanthate more than cypionate. For some reason, propionate causes me to hold less water and just gives me a "cleaner look" and more even effects. But this is very much an individual thing.
Other Considerations
Of course, the biochemical pathways involved with testosterone therapy should be considered. Testosterone can be converted to estrogen via the enzyme aromatase. The use of aromatase inhibitors is beneficial in this regard, which is why many people will use Arimidex (anastrozole) along with their TRT.
Testosterone can also be converted into DHT, which may contribute to some side effects, including hair loss and acne; although, DHT may be a major libido enhancer.12 This occurs via the enzyme 5-alpha reductase, which is why finasteride is often used with TRT as well.
The herbal world is filled with great aromatase and 5-alpha reductase inhibitors, often having both actions in one herb. I have found the use of products containing nettles, saw palmetto, pygeum, chrysin, and DIM a reliable way to control these two biochemical pathways without pharmaceuticals. The supplement I use is Androgen Complex (Metabolic Effect). The dose is six capsules daily.
Final Considerations
The final things to know when it comes to TRT are regarding testing and retesting. With TRT, we want to make sure we are not elevating prostate cancer and cardiovascular disease risks or other complications. You may want to consider monitoring PSA. This is a test, becoming more and more controversial, but still, may be the best we have to assess prostate changes over time.
You will also want to make sure hemoglobin and hematocrit levels are not going up while on therapy. This can increase the risk for blood clots.
Finally, watch estrogen levels and the liver enzymes ALT and AST to make sure you are not over aromatizing, and the liver is handling the therapy respectively.
Always take a close look at the free (direct), and total testosterone levels.
If you are doing things correctly, you should see favorable changes in your blood labs on TRT. Cholesterol, triglycerides, blood sugar, and inflam-matory markers usually fall.
Obviously, testosterone is a require-ment for male health, and proper TRT should be improving energy, mood, libido, erections, and body composition while also making you healthier.
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References .pdf
 Dr. Jade Teta is an integrative physician, author and sought after expert in the realm of metabolism and self-development. He spent the last 25 years immersed in the study of strength and conditioning, hormonal metabolism and the psychology of change and success. He is the founder and creator of the international health and fitness company, Metabolic Effect, and the author of several books including the best sellers, Metabolic Effect Diet and Metabolic Aftershock. He has also contributed both, the exercise and sports nutrition chapters, to The Textbook Of Natural Medicine.
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