What HCG Does

Human Chorionic Gonadotropin (HCG) is a hormone that acts as a direct molecular analogue to luteinizing hormone (LH). When you're on exogenous testosterone, your pituitary stops producing LH — which means your testes stop receiving the signal to produce testosterone internally and to maintain spermatogenesis.

HCG fills that gap. By mimicking LH, it directly stimulates the Leydig cells in your testes to continue producing intratesticular testosterone. This serves two critical purposes: maintaining testicular volume (preventing the significant shrinkage that occurs without stimulation) and supporting ongoing sperm production (preserving fertility).

For men who want the benefits of TRT without sacrificing testicular function and fertility, HCG is the established standard of care — recommended by the American Urological Association as a concurrent therapy for TRT patients with fertility concerns.

Standard Dosing Protocols

HCG dosing for TRT adjunct therapy is well-established:

Standard protocol: 250–500 IU subcutaneously, 2–3 times per week. This is administered alongside your regular testosterone injections. Many patients inject HCG on the same days as testosterone for simplicity.

Higher doses (1,000–1,500 IU): Sometimes used temporarily for men actively trying to conceive who need maximum spermatogenic support. Not typically used for maintenance.

The goal is to maintain enough intratesticular testosterone to support spermatogenesis and prevent atrophy — without adding so much hormonal stimulus that it disrupts the stability of your TRT protocol. Your provider should monitor E2 carefully, as HCG can independently contribute to estradiol levels.

The HCG Availability Situation

HCG availability has been a frustrating issue since 2020, when the FDA reclassified it as a biologic. This means HCG now requires a Biologics License Application (BLA) rather than standard compounding pharmacy preparation. The practical impact: 503A compounding pharmacies can no longer legally produce HCG, and brand-name pharmaceutical HCG products have experienced intermittent shortages.

FDA warnings continue against compounded HCG versions due to potency and sterility concerns. The situation has pushed many patients toward alternatives (see below) or toward providers with established pharmaceutical supply chains for brand-name HCG products.

Patient sentiment on this issue is understandably frustrated. Many men who were stable on compounded HCG have had to switch products or explore alternatives — often at higher cost. This is a regulatory reality that your provider should be transparent about during your initial consultation.

Alternatives to HCG

Gonadorelin: A synthetic GnRH analogue that stimulates the pituitary to release LH and FSH naturally. In theory, it should replicate HCG's effects. In practice, community feedback has been widely critical — many patients and clinicians report it's significantly less effective than HCG at maintaining testicular function and spermatogenesis. The pulsatile dosing required may not adequately mimic natural GnRH patterns.

Kisspeptin: An upstream regulator of GnRH release. Emerging research shows promise, but clinical data is limited and practical availability is minimal. Not yet a mainstream option.

Enclomiphene: Avoids the need for HCG entirely by not suppressing the HPG axis in the first place. Instead of supplementing exogenous testosterone, enclomiphene stimulates your body to produce more naturally. Effective for some patients but with more modest testosterone increases. See our comparison guide.

Which Clinics Still Offer HCG

Availability varies by provider and their pharmacy partnerships. As of 2026, most reputable online TRT clinics can access pharmaceutical HCG through licensed dispensaries, though pricing may be higher than the compounded versions that were previously available.

Clinics that prominently feature HCG in their protocols include Maximus, Hone Health, and Fountain TRT. During your consultation, ask specifically: "Do you offer HCG? Through which pharmacy? And at what additional cost?" Our clinic comparison notes HCG availability for each provider reviewed.