HCG Protocol for Low Testosterone in Men

Studies are showing that one in five males have low testosterone under the age of 40.

In younger males, or more mature males with function testes, Human Chorionic Gonadotropin (HCG) is the preferred treatment to raise testosterone. Testosterone injections should not be used, unless there is failure of the testicles to produce testosterone with the use of HCG, especially in younger men.

HCG is a protein-based hormone with an alpha and a beta sub-unit. The alpha sub-unit is almost identical to the alpha sub-units of Luteinizing Hormone, the signal from the brain to produce more testosterone, and Follicular Stimulating Hormone, the signal from the brain to produce more sperm. For this reason, HCG stimulates the testicles in a manner like Luteinizing Hormone (LH), the signal from the brain to the testes to produce more testosterone.

The advantage of using HCG in younger males is that you get no loss of testicle volume and no decrease in sperm count that you get with testosterone replacement treatment, such as injections of testosterone, testosterone patches, gels or creams, and testosterone pellets.

Antibodies can develop with use, so most protocols suggest using HCG two months on and one month off. Total, free, and bio-available testosterone usually increases about 25% and symptoms of testosterone deficiency are improved.

• Tsujimura, A., et al., “Treatment with human chorionic gonadotropin for PADAM: a preliminary report,” Aging Male 2005; 8(3-4):175-79.
• Roden, E., et al., “A medical progress: risks of testosterone-replacement therapy and recommendations for monitoring,” NEJM 2004; 350:482-92.

You need to buy a bottle of rubbing alcohol, cotton balls, and a needle disposal kit (see DISPOSAL at the bottom of the page).

From the Pharmacist you will receive your medication, syringes, and needles. You will receive a box (or boxes) holding a vial of chorionic gonadotropin (HCG) powder and a vial of STERILE WATER. Before mixing the powder and the sterile water, all bottles should be kept at room temperature. Mix only one bottle at a time and use this bottle until gone before mixing another bottle.

After mixing, the bottle should be kept in the refrigerator (but not frozen). However, we have found that if you must travel on a plane or in a car, if you keep the HCG solution out of the sunlight in a cool car or in your airplane onboard luggage, it does not lose potency. If you travel to a destination without a refrigerator (where possible do refrigerate), and you leave it in a cool air room, out of light (especially sunlight), in general the HCG solution does not lose its potency. The manufacturer does recommend always refrigerating the HCG.

You have also received two different sized needles and syringes.

• First: Large Mixing Syringes, usually a 10mL syringe with 22-gauge needle which is 1” in length (or 5 mL syringes without needles and 22gauge 1” needles not yet combined).
• Second: Packets of 31g ultra-fine short insulin needles with 0.5 cc. If this is not what you receive, ask your pharmacist.

If you were given syringes with the needles attached (usually a 10cc syringe with 22-gauge needle, which is 1” in length), you will simply pop the syringe plus needle out of its package by pressing it through the paper side. Skip to MIXING THE HORMONE.

For those that received the syringe (10cc syringe) and the needle (22-gauge needle) in a separate sealed packages (usually paper on one side and plastic on the other), simply push the syringe through the paper side of the package being careful not to touch the exposed tip of the syringe to your fingers or other objects. Next poke the needle through the paper side of its package being careful not to touch the exposed open (not the sharp end) of the needle but by holding the needle by the rigid plastic covering that covers it. Now simply take the open end of the needle (not the sharp end) and screw it tightly onto the end (the tip) of the syringe.

Remove the plastic cap from the top of the sterile water vial. Cleanse the rubber portal with a sterile alcohol swab. We recommend that you simply buy cotton balls and a bottle of rubbing alcohol, as it is the least expensive way, and will last you a long time. Remove the rigid plastic covering from the needle and draw 4 cc of air into the syringe. Insert the needle into the rubber top of the sterile water vial. Inject some of the air into the vial, as this will keep the vial from building up a vacuum and making it more difficult in the future to withdraw the sterile water. Invert the vial and syringe while keeping the needle below the fluid line. Pull back on the plunger to the mark on the syringe that measure 4 mL. Remove the needle from the vial, hold the syringe so that the needle points straight up, push the plunger into the syringe slowly until the top of the plunger (the end of the plunger in contact with the sterile water) reaches the 5.5mL mark.

Now insert the syringe holding the sterile water into the second vial holding the HCG powder while the vial is sitting upright on the counter. Slowly inject the water into the bottle by aiming the stream of liquid against the wall of the vial.

As you inject the liquid, you will notice a feeling of increased pressure against your thumb on the plunger. After injecting the liquid, you may equalize the pressure by withdrawing the needle above the level of the solution in the bottle and pulling back on the plunger. Air will rush into the syringe and the pressure will equalize. After all the sterile water has been injected into the vial holding the HCG powder, withdraw the syringe from the bottle of solution.

Keep the bottle on the countertop, swirl it gently to mix, but DO NOT SHAKE. If it does not dissolve at once, do not worry. Put it in the refrigerator so it will stay cold and check the solution in 1 hour or so. The white powder will have dissolved. Replace the needle, cover, and dispose of the syringe.

One vial of HCG holds 10000 USP units (IU) mixed with 4ml sterile water gives the following measurement based on HCG prescribed and then shown as what amount you will draw into the insulin syringe.

• Prescribed 750 IU – 25 Units
• Prescribed 500 IU – 20 Units – Most common
• Prescribed 375 IU – 15 Units
• Prescribed 250 IU – 10 Units

1. Take the Insulin Syringe and dip the cotton ball with the rubbing alcohol.
2. Remove the vial of prepared solution from the refrigerator last, so that it will not become warm while you are gathering the other supplies.
3. Wipe the top of the vial holding the HCG solution.
4. Remove the needle cover from the insulin syringe.
5. Draw into the syringe an amount of air equal to the dosage prescribed.
6. Insert the needle into the bottle of HCG solution and inject the air into the bottle.
7. Tip the bottle so that the bottom of the bottle is pointing straight up, and the insulin syringe points towards the ceiling.
8. Withdraw past the amount of HCG prescribed and then keep the bottle inverted push the plunger until the top of the plunger reaches the amount prescribed.  Example: if 10 units were prescribed, draw first to 15 units then slowly inject back into the vial until the top of the plunger reaches 10 units.
9. Recap the needle.
10. Return the vial of solution to the refrigerator.

Locate the spot: Assume a standing position. Select an area of fatty tissue on your abdomen that you can pinch between your thumb and forefinger and wipe the area with the alcohol cotton ball. This area should be more than 3 inches away from your belly button, not higher than the bottom of the lowest rib, and above the area where your belt rides.

Remove the needle cover of the insulin syringe holding the HCG solution. Make sure that the needle does not accidentally touch any other surface. If this happens, you must dispose of the syringe and its contents and begin the process over again with a sterile needle. Holding the area, you locate with one hand and then using the other hand to hold the syringe as if you were going to throw a dart. Touch the needle to your skin pointing straight in and gently apply pressure until the needle pierces the skin. Advance the needle into pinched area until the entire needle is in the skin. The goal is to have the needle in the fat area but not piercing the muscles underneath. While you are holding the syringe firmly, push the plunger all the way in with your index finger, thereby injecting the solution into the fat. Pull the needle out and recap the needle.

Never use a needle and syringe more than once. They get dull after one injection and if used twice increases not only your pain, but also it increases the chance of getting an infection. Dispose of the needle and syringe appropriately. Most pharmacies that dispense the needles will also have a needle container you may use, and once full that pharmacy should have a place to dispose of your used needles and syringes. Do not throw them in the garbage as who knows when a small child may find it and hurt themselves. You may also get needle disposal kits online at www.wastemd.com as they have an online service.

After starting the treatment, you may experience transient discomfort in your testicles. This is merely your body healing, and you should take Tylenol and continue treatment. Some people experience water retention. This eases as treatment progresses. If the swelling around your ankles or in your fingers becomes significant, notify your physician.

You should check your blood pressure every 2 to 3 days for the first three weeks as in some individuals your blood pressure will go up. If the top number goes over 140 or the bottom number over 95, discontinue use and contact your physician. If you develop a headache, significant swelling, or redness in the face, then discontinue the medication and contact your physician.

If you develop severe anxiety, acne, irritability, aggressive behavior, nipple tenderness or pain, breast development, or difficulty with urination, please consult your physician. These are side effects of the HCG increasing your testosterone production too much. Contact your physician who will have you discontinue the use of HCG and start at a lower dose.