Human chorionic gonadotropin (hCG) acts like LH, so it keeps the testes making testosterone and sperm when testosterone therapy would otherwise switch them off. It is used with testosterone to preserve fertility. The published evidence is observational, and the randomized evidence is still missing.
What hCG does
Testosterone therapy lowers the pituitary's LH and FSH, which lowers testicular testosterone and sperm production. hCG stimulates the testes directly, which is the reason for adding it.
The retrospective series
Hsieh and colleagues reviewed 26 men with a mean age of 35.9 on testosterone replacement with intramuscular hCG 500 IU every other day. The mean follow-up was 6.2 months. Semen parameters were maintained during treatment, according to the authors (J Urol 2013). The study is retrospective and small.
The real-world cohort
A 2026 cohort of 6,999 men found that 91% of them were prescribed hCG with testosterone. hCG with testosterone suppressed LH and FSH, while clomiphene alone raised them at six months. All treatments raised total and free testosterone to physiological levels (Clift et al., World J Mens Health 2026).
Compared with SERMs
In a 2025 pooled analysis, total testosterone was about 134 ng/dL with hCG alone, against about 153 to 158 ng/dL in the arms with a SERM alone or with a SERM plus hCG (Hohl et al., 2025). These are averages across studies with high variation.
What this does not say
- There is no published randomized trial showing that hCG preserves sperm or improves pregnancy rates in men on testosterone. A 2026 trial protocol for men with non-obstructive azoospermia says so directly and is not yet reporting results (Chandra et al., 2026).
- The 2026 cohort is observational. Prescribing patterns do not show that hCG caused any change in outcome.
- Dosing varies between clinics, and compounded hCG was not the product in these studies.
How we use this
When fertility matters on testosterone, hCG is one option that we discuss with clomiphene and enclomiphene. We check testosterone and estradiol, and we review semen when fertility is the goal.
We do not say that hCG protects fertility as a proven fact. We say that the evidence is observational and that a randomized answer is still missing.
Explore weight loss treatmentsSources
- 1.Hsieh TC et al. Concomitant intramuscular human chorionic gonadotropin preserves spermatogenesis in men undergoing testosterone replacement therapy. J Urol 2013. The Journal of Urology
- 2.Clift AK et al. Pituitary axis impacts and effectiveness of clomiphene and human chorionic gonadotropin in treating hypogonadism: cohort study. World J Mens Health 2026. World Journal of Men's Health
- 3.Hohl A et al. Clomiphene or enclomiphene citrate for the treatment of male hypogonadism: a systematic review and meta-analysis of randomized controlled trials. Arch Endocrinol Metab 2025. Archives of Endocrinology and Metabolism
- 4.Chandra V et al. Gonadotropin therapy in idiopathic hypogonadal non-obstructive azoospermia (APHRODITE Groups 3-4): a multicenter randomized controlled trial (protocol). Front Reprod Health 2026. Frontiers in Reproductive Health