Back to 2014 Annual Meeting Abstracts

BACKGROUND: Administration of human chornionic gonadotropin (hCG) is an FDA approved treatment for hypogonadotrophic hypogonadism. hCG stimulates the testicles to produce testosterone and unlike testosterone therapy, preserves fertility and testicular volume. We present our experience with hCG monotherapy for symptomatic testosterone deficiency at an outpatient andrology clinic.
METHODS: An institutional review board approved retrospective chart review identified 42 men who started on hCG monotherapy for symptomatic testosterone deficiency at Men’s Health Boston (Brookline, MA). All men had a total T <350ng/dL or free T <1.5ng/dl, received instruction with a nurse educator on drug preparation and self-injection, and were seen in follow-up. Starting dose was 1500IU three times a week and adjusted based on symptomatic response and lab results.
RESULTS: Mean age was 39.6y (range 20 - 62 years) and mean follow-up was 12.9 months (range 1.5-49 months). The primary reason for pursuing hCG therapy was to maintain fertility for 34(80.9%) men and to preserve testicular volume and function for 8(19.1%) men. 24 men (50.7%) were on clomiphene citrate or T prior to switching to hCG therapy. hCG therapy resulted in a satisfactory biochemical and symptomatic response in 40 men (95.2%). Mean total T levels increased by 709 ± 303.9 ng/dL (p <0.001) and mean free T levels increased by 2.02 ± 0.87 ng/dL (p<0.0001). Successful treatment was noted over a broad range of baseline LH levels, ranging from 0.9-14.3 IU/ml, mean 3.9 IU/ml. 27 men (64.3%) continued on 1500IU three times weekly for the duration of therapy, 8 men (19%) had their dose increased and 7 men (16.7%) had their dose decreased. Two men (4.8%) discontinued hCG due to lack of efficacy and 7 men (16.7%) discontinued hCG in favor of T when infertility no longer was an issue. 6 (14.2%) men developed nipple sensitivity or breast swelling, which resolved in 5 men after reducing the dose or with the addition of an aromatase inhibitor or SERM. 2 men (4.8%) developed hematocrit over 54, one of whom continued hCG at a lower dose.
CONCLUSIONS: hCG is an effective and durable treatment modality for men with testosterone deficiency, even in men with LH levels in the high-normal range. Advantages over standard testosterone therapy include preservation of fertility and testicular volume. The primary limitation of this treatment is inconvenience, as it requires subcutaneous injections three times weekly.