Placental hormone

You are here

Human Chorionic Gonadotropin (HCG)

August 9, 2019

Human Chorionic Gonadotropin (HCG) occurs in the mother’s body during pregnancy and it can be isolated from the urine of pregnant women. Its structure and effects resemble the luteinizing hormone (LH) that is secreted from the pituitary gland [1]. HCG maintains pregnancy by stimulating the secretion of progesterone and minimal quantities of estradiol as well.

Various tumours and cancers, such as gynecological and urological cancers, secrete HCG as well. Thus, the HCG level of blood and urine tests refers to pregnancy or certain tumours [2].

Medical use

HCG in pharmaceutical form is used in fertility treatments for women, generally as a single injection of 5,000–10,000 international units (IU) [3].

For men, HCG can be used therapeutically for fertility, cryptorchidism, and delayed puberty treatments because HCG stimulates testosterone production in the testes.  In therapeutic use, the doses of HCG for men are 1,000–2,000 IU two to three times per week for at least three months [3, 4].

The effects of HCG on men have been studied already since the 1950s and it has been proved to raise testosterone levels effectively. By contrast with something, such as clomiphene, HCG affects the testes directly and not indirectly through the pituitary gland and induces a quick response in testosterone production. Accordingly, HCG can be regarded as the corner stone of male fertility treatments. On the other hand, its price, its subcutaneous administration and its short half-life prevent its use as the primary medicine in the treatment of hypogonadism [5, 6]. However, because there is no certainty about the potential adverse effects of HCG, it is not recommended for the treatment of long-term hypogonadism (i.e. lowered testosterone). Nevertheless, it can be used temporarily in the treatment of hypogonadism to improve fertility [7].

Use as a doping substance

According to decree 705/2002, which Chapter 44, Section 16 of the Finnish Criminal Code refers to, HCG is a doping substance.

Through HCG, people who use anabolic steroids aim to prevent the hormone recession induced by a round of steroids and to restart their body’s testosterone production [8, 9]. On the other hand, HCG is thought to have a mild anabolic (i.e. muscle-growing and strength-increasing) effect. Specifically, it increases the secretion of testosterone from the testes in a manner similar to that of the luteinizing hormone. HCG supplements do not raise testosterone in women or do so very slightly only, so women hardly benefit from HCG use [2].

HCG combined with antiestrogens may fully restore sperm and semen production in approximately five months if there is a history of infertility caused by anabolic steroids [10]. However, the most important means of recovering from hormone recession and infertility is to discontinue the use of testosterone and anabolic steroids. Recovery can be accelerated with HCG. However, if testosterone were not discontinued, it would appear that the concurrent use of HCG during testosterone replacement therapy maintains the testosterone production of the testes. The doses are then 250–500 IU every second day [5].

Research has also detected the opposite effect, however. The concurrent use of HCG and anabolic steroids in high doses is found to further weaken the quality of semen [8].

If the use of anabolic steroids in high doses has continued for a number of years, HCG can raise the testosterone levels, but to a much lesser degree than in people who have never used anabolic steroids [11]. Age can also have an effect on the potency of HCG [12].

Adverse effects

The adverse effects of HCG can include hormonal disturbances [13]. That is why the recommendation is for HCG to be administered only under the supervision of a medical specialist or a doctor who works in a hospital specialized in this field.

HCG rarely poses any risks to the health of women. However, it can increase the risk of multiple gestation and ovarian hyperstimulation syndrome (OHSS) [2, 3].

If a man receiving HCG treatment has latent or overt cardiac failure, renal failure, epilepsy or migraine, the patient must be monitored closely because increased androgen production can cause the aggravation or relapse of these conditions. Elevated androgen production can also cause gynecomastia (3, 14].

Other possible adverse effects include swelling, breast tenderness (also in men), and vein thromboses in some cases [3, 15].

The harm from long-term use is not known very well and more research is demanded in this respect [4, 7].

 

Some known trade names (8/2019): Novarel, Pregnyl, Profasi, Ovidrel.

 

Timo Seppälä
Medical Director
Finnish Center for Integrity in Sports FINCIS (previously the Finnish Antidoping Agency FINADA)

Updated by
Dopinglinkki

 

[1] Huupponen R. 2018. Gonadotropiinit. Lääketieteellinen farmakologia ja toksikologia. Duodecim lääketietokanta. Terveysportti

[2] Handelsman D. The rationale for banning human chorionic gonadotropin and estrogen blockers in sport. J Clin Endo Metab. 2006;91(5):1646–1653

[3] Duodecim lääketietokanta. 2019. Koriongonadotropiini. Terveysportti

[4] Bu Q, Pan Z, Jiang S, Wang A, Cheng H. The effectiveness of hCG and LHRH in boys with cryptorchidism: A meta-analysis of randomized controlled trials. Horm Metab Res. 2016;48(5):318–24

[5] Tatem A, Beilan J, Kovac J, Lipshultz L. Management of anabolic steroid-induced infertility: Novel strategies for fertility maintenance and recovery. World Mens Health. 2019;37: e16

[6] Ring J, Lwin A, Köhler T. Current medical management of endocrine-related male infertility. Asian J Androl. 2016;18(3):357–363

[7] Dohle G, Arver S, Bettocchi C, Jones T, Kliesch S. European Association of Urology Guidelines for Male Hypogonadism. 2017

[8] Karila, Hovatta, Seppälä. Concomitant abuse of anabolic androgenic steroids and human chorion gonadotropin impairs spermatogenesis in power athletes. International Journal of Sports Medicine. 2004; 25: 257–263

[9] Stenman, Hotakainen, Alfthan. Gonadotropins in doping: pharmacological basis and detection of illicit use. British Journal of Pharmacology. 2008; 154(3): 569–83

[10] Wenker E, Dupree J, Langille G, Kovac J, Ramasamy R, Lamb D, Mills J, Lipshultz L. The use of HCG-based combination therapy for recovery of spermatogenesis after testosterone use. J Sex Med. 2015;12(6):1334–7

[11] Flanagan J, Lehtihet M. The response to gonadotropin-releasing hormone and hCG in men with prior chronic androgens steroid abuse and clinical hypogonadism. Horm Metab. 2015;47(09):668–673

[12] Kohn T, Louis M, Pickett S, Lindgren M, Kohn J, Pastuszak A, Lipshultz L. Age and duration of testosterone therapy predict time to return of sperm count after hCG therapy. Fertil Steril. 2017;107(2):351–357

[13] Binder, Dittrich, Einhaust, Krieg, Müller, Strauss, Beckmann, Cupisti. Update on ovarian hyperstimulation syndrome: part 2--clinical signs and treatment. International Journal of Fertility and Women’s Medicine. 2007; 52(2–3): 69–81

[14] Zitzmann M, Nieschlag E. Hormone substitution in male hypogonadism. Mol Cell Endocrinol. 2000;161(1–2):73–88

[15] Thorsson, Christiansen, Ritzén. Efficacy and safety of hormonal treatment of cryptorchidism: current state of the art. Acta Paediatr. 2007;96(5):628-30.



Was this article useful?
Total votes: 1472