Side-by-side · Research reference

HCGvsSS-31

Side-by-side comparison across mechanism, dosage, evidence, side effects, administration, and stack synergies. Citations on every claim where available.

AFDA-ApprovedHUMAN-REVIEWED12/52 cited

BPhase 3HUMAN-REVIEWED9/43 cited

HCG

Glycoprotein Hormone · LH Mimetic

2,000 IUTypical dose (2×/wk)Konsam 2026 Zachariou 2026

70–90%Sperm induction rateHuijben 2026 Zachariou 2026

12–24 moTime to sperm appearanceHuijben 2026 Nariyoshi 2025

IM or SQ · 2–3×/week

SS-31

Cardiolipin-binding · Mitochondrial protective

40 mgDaily doseSzeto 2014

Phase 3Evidence levelSzilagyi 2009 Szeto 2014

~3 hrHalf-life

SQ · Abdomen · Once daily

01Mechanism of Action

Parameter

HCG

SS-31

Primary target

LH receptors on testicular Leydig cellsSchröder-Lange 2025

Cardiolipin in inner mitochondrial membraneSzeto 2014

Pathway

hCG → Leydig cell LH receptor → Intracellular cAMP → Steroidogenesis pathway activation → Testosterone synthesis

Cardiolipin binding → cristae stabilisation → ETC integrity → reduced ROS + preserved ATP synthesisSzeto 2014 Szilagyi 2009

Downstream effect

Elevated intratesticular testosterone, restored spermatogenesis, virilization, secondary sex characteristic developmentKonsam 2026 Zachariou 2026

Mitochondrial bioenergetic preservation; cardio-, neuro-, and reno-protective effects in animal + clinical studiesSzeto 2014

Feedback intact?

No — exogenous hCG bypasses hypothalamic-pituitary axis; endogenous LH remains suppressed

—

Origin

Heterodimeric glycoprotein (alpha subunit shared with LH/FSH/TSH; beta subunit confers specificity). Available as urinary-derived or recombinant formulations.

Synthetic tetrapeptide D-Arg-Dmt-Lys-Phe-NH₂; cell-permeable, mitochondrial-selectiveSzeto 2014

Antibody development

Rare with recombinant; possible with urinary-derived formulations

—

02Dosage Protocols

Parameter

HCG

SS-31

Hypogonadotropic hypogonadism (monotherapy)

2,000 IU IM/SQ 2–3×/weekKonsam 2026 Zachariou 2026

Titrate to normalize testosterone (300–1,000 ng/dL) or achieve target AMH ~7.4 ng/mL.

—

Combined therapy (hCG + FSH)

hCG 2,000 IU 2×/wk + rFSH 75 IU 3×/wkKonsam 2026 Nariyoshi 2025

Preferred for azoospermia; FSH added after initial hCG phase or from outset.

—

Triple therapy (experimental)

hCG 2,000 IU 2×/wk + rFSH 75 IU 3×/wk + testosterone 100 mg IM q2wkKonsam 2026

May accelerate virilization; reduces hCG requirements (~30% lower cumulative dose vs monotherapy).

—

Cryptorchidism (pediatric)

500–4,000 IU IM 2–3×/week for 3–6 weeks

—

Evidence basis

RCT / Meta-analysis / FDA-approvedKonsam 2026 Huijben 2026

Multiple Phase 3 trials (Barth, AMD, ischemia-reperfusion)Szeto 2014 Szilagyi 2009

Duration to sperm appearance

12–24 months (median ~18 mo)Huijben 2026 Zachariou 2026

Congenital HH may require longer treatment; acquired HH responds faster.

—

Route

Intramuscular or subcutaneousKonsam 2026

—

Monitoring

Serum testosterone, semen analysis q3–6mo, testicular ultrasound

Thickened seminiferous tubules (>300 μm) on ultrasound predict imminent sperm appearance.Nariyoshi 2025

—

Standard dose

—

40 mg / day SQ (clinical trials)Szeto 2014

Anecdotal community range 5-10 mg/day. Phase 3 trials use 40 mg.

Frequency

—

Once daily

Lower / starter dose

—

5 mg / day (anecdotal)

Duration

—

Indefinite for mitochondrial disease; cycled for healthspan use

Reconstitution

—

Bacteriostatic water

Timing

—

Morning fasted preferred; pre-workout for exercise-induced mitochondrial stress

Half-life

—

~3 h plasma; tissue uptake longer

04Side Effects & Safety

Parameter

HCG

SS-31

Injection site reaction

Pain, erythema (mild, transient)

Erythema, mild pruritus

Gynecomastia

Aromatization of elevated testosterone to estradiol; dose-dependent

—

Testicular discomfort / Edema

Rapid testicular growth in hypogonadal males; usually self-limiting

—

Polycythemia

Elevated hematocrit from supraphysiological testosterone; monitor CBC

—

Mood / Libido changes

Variable; usually positive with normalization of testosterone

—

Acne / Oily skin

Androgen-mediated; dose-dependent

—

Prostate concerns

Monitor PSA in older males; hCG restores physiological testosterone (not supraphysiological)

—

Antibody formation

Rare with recombinant; possible with urinary-derived

—

GI symptoms

—

Nausea (uncommon)

Headache

—

Reported in some Phase 3 trials

Cardiovascular

—

Cardio-protective in studies; no signal of harm

Long-term safety

—

Phase 3 data over 24+ months; no major safety signalsSzeto 2014

Pregnancy / OB

—

Avoid — insufficient data

Absolute Contraindications

HCG

·Androgen-dependent malignancy (prostate, breast cancer)
·Hypersensitivity to hCG or excipients
·Precocious puberty

SS-31

·Pregnancy / breastfeeding
·Hypersensitivity to peptide

Relative Contraindications

HCG

·Untreated obstructive sleep apnea
·Severe cardiovascular disease (polycythemia risk)
·History of thromboembolism

SS-31

·None established

05Administration Protocol

Parameter

HCG

SS-31

1. Reconstitution (if lyophilized)

Add sterile water or bacteriostatic water per manufacturer instructions. Typically 1–2 mL per 5,000–10,000 IU vial. Roll gently — do not shake. Solution should be clear.

Add bacteriostatic water per label. Light-protected handling.

2. Injection site

Intramuscular: ventrogluteal, vastus lateralis, or deltoid. Subcutaneous: abdomen, avoiding navel (2-inch radius). Rotate sites to prevent lipohypertrophy.

SQ — abdomen or thigh. Rotate sites.

3. Timing

Administer 2–3 times per week. Consistent weekly schedule recommended (e.g., Monday/Thursday or Monday/Wednesday/Friday).

Morning fasted; pre-workout for exercise-augmented mitochondrial stress.

4. Storage

Lyophilized: room temperature, light-protected. Reconstituted: refrigerate 2–8 °C. Bacteriostatic water extends shelf life to ~30 days; sterile water use within 72 hours.

Lyophilised: refrigerate, light-protected. Reconstituted: refrigerate ≤30 days.

5. Needle selection

IM: 21–23G, 1–1.5 inch. SQ: 25–27G, 5/8 inch. Inject slowly (30–60 seconds for IM).

29–31G, 4–8 mm insulin syringe.

06Stack Synergy

HCG

— no documented stacks

SS-31

+ MOTS-c

Moderate

View MOTS-c →

SS-31 and MOTS-c address mitochondrial decline through complementary axes. SS-31 protects existing mitochondrial structure (cardiolipin binding, cristae stabilisation). MOTS-c upregulates AMPK/PGC-1α, triggering biogenesis of new mitochondria. Together they pair preservation with renewal — anecdotally favoured in healthspan and post-cardio-event recovery protocols.

SS-31: 5–10 mg SQ · daily morning
MOTS-c: 5 mg SQ · 2× per week pre-workout
Primary benefit: Mitochondrial preservation + biogenesis