HCG
also known as human chorionic gonadotropin, chorionic gonadotrophin, hCG, recombinant hCG, urinary hCG
Placental glycoprotein hormone structurally homologous to luteinizing hormone (LH). Binds LH receptors on Leydig cells, stimulating testosterone synthesis and spermatogenesis. FDA-approved for cryptorchidism, prepubertal cryptorchidism, and hypogonadotropic hypogonadism. In males with hypogonadotropic hypogonadism, hCG monotherapy or combined with FSH restores spermatogenesis in 70–90% of azoospermic patients, achieving pregnancies in 60–80% of cases.
At a glance
IM or SQ · 2–3×/week
Primary target — LH receptors on testicular Leydig cells [schrderlange-2025].
Pathway — hCG → Leydig cell LH receptor → Intracellular cAMP → Steroidogenesis pathway activation → Testosterone synthesis.
Downstream effect — Elevated intratesticular testosterone, restored spermatogenesis, virilization, secondary sex characteristic development [konsam-2026][zachariou-2026].
Origin — Heterodimeric glycoprotein (alpha subunit shared with LH/FSH/TSH; beta subunit confers specificity). Available as urinary-derived or recombinant formulations..
Feedback intact — No — exogenous hCG bypasses hypothalamic-pituitary axis; endogenous LH remains suppressed.
| Parameter | Value |
|---|---|
| Hypogonadotropic hypogonadism (monotherapy) | 2,000 IU IM/SQ 2–3×/week [konsam-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×/wk [konsam-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 q2wk [konsam-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-approved [konsam-2026][huijben-2026] |
| 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 subcutaneous [konsam-2026] |
| Monitoring | Serum testosterone, semen analysis q3–6mo, testicular ultrasoundThickened seminiferous tubules (>300 μm) on ultrasound predict imminent sperm appearance. [nariyoshi-2025] |
Reconstitution
A pure mass-to-volume utility. Enter what you have in the vial; the atlas computes the volume per dose. No prescription information.
- — Androgen-dependent malignancy (prostate, breast cancer)
- — Hypersensitivity to hCG or excipients
- — Precocious puberty
- — Untreated obstructive sleep apnea
- — Severe cardiovascular disease (polycythemia risk)
- — History of thromboembolism
- 01Reconstitution (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.
- 02Injection site
Intramuscular: ventrogluteal, vastus lateralis, or deltoid. Subcutaneous: abdomen, avoiding navel (2-inch radius). Rotate sites to prevent lipohypertrophy.
- 03Timing
Administer 2–3 times per week. Consistent weekly schedule recommended (e.g., Monday/Thursday or Monday/Wednesday/Friday).
- 04Storage
Lyophilized: room temperature, light-protected. Reconstituted: refrigerate 2–8 °C. Bacteriostatic water extends shelf life to ~30 days; sterile water use within 72 hours.
- 05Needle selection
IM: 21–23G, 1–1.5 inch. SQ: 25–27G, 5/8 inch. Inject slowly (30–60 seconds for IM).
Sources
of 52 rendered claims carry a resolvable citation.
- [huijben-2026]Huijben 2026 — Boosting Male Fertility: The Impact of Gonadotropin Therapy on Hypogonadotropic Hypogonadism-A Systematic Review and Meta-Analysis.
journal, 2026 - [konsam-2026]Konsam 2026 — Comparing the response of triple therapy and conventional treatment in male congenital hypogonadotropic hypogonadism: a randomized controlled trial.
journal, 2026 - [nariyoshi-2025]Nariyoshi 2025 — Alterations in the ultrasound appearance of seminiferous tubules after gonadotropin treatment in patients with azoospermia because of hypogonadotropic hypogonadism.
journal, 2025 - [schrderlange-2025]Schröder-Lange 2025 — Molecular characterization of the murine Leydig cell lines TM3 and MLTC-1.
journal, 2025 - [zachariou-2026]Zachariou 2026 — Fertility Outcomes in Men with Nonobstructive Azoospermia Due to Hypogonadotropic Hypogonadism After Gonadotropin Therapy.
journal, 2026