Online TRT With HCG: Who Still Offers It and What It Adds to Your Bill

The Short Answer

Why Compounded HCG Went Away After 2020

Before 2020, compounding pharmacies and outsourcing facilities could prepare hCG. That changed on March 23, 2020, when a provision of the Biologics Price Competition and Innovation Act moved a group of protein drugs from ordinary drug approvals to biologics licenses. FDA's list of products deemed to be biologics licenses on that date includes chorionic gonadotropin, the active ingredient in hCG.

FDA's notice to compounders spelled out what that meant. Products that transitioned "will not be eligible for the exemptions for compounded drugs under sections 503A and 503B." FDA named human chorionic gonadotropin as one of four bulk ingredients, reported by outsourcing facilities, that the change affected.

The dividing line is size. FDA's regulations define a protein as an amino acid chain "greater than 40 amino acids in size" (21 CFR 600.3), and hCG falls on the biologic side of that line. Short peptides such as gonadorelin don't, which is why they can still be compounded.

Compounders pushed back. In 2021 the Alliance for Pharmacy Compounding asked members for data on "shortages or other interruptions in availability of HCG products," citing "restrictions on compounding HCG that have resulted from the March 2020 reclassification."

What's left is licensed product. DailyMed currently carries labels for Novarel (Ferring), Pregnyl (Organon) and a generic chorionic gonadotropin kit from Fresenius Kabi. FDA guidance describes conditions under which it won't take action against pharmacies that mix, dilute or repackage a licensed biologic, so your hCG may arrive in different packaging. What a pharmacy can't do under 503A or 503B is make "hCG" from bulk powder. For the longer background, see our HCG and TRT guide.

What HCG Does on TRT, and How Strong the Evidence Is

Testosterone therapy shuts down LH and FSH, the pituitary signals that tell the testes to make their own testosterone and sperm. HCG steps in for LH. The Novarel label says "the action of HCG is virtually identical to that of pituitary LH," stimulating the Leydig cells of the testes to produce androgens.

The human data are small but consistent:

• Coviello et al., JCEM 2005: 29 healthy men took 200 mg testosterone enanthate weekly for three weeks. With placebo, LH and FSH fell to about 5% and 3% of baseline, and testosterone inside the testes dropped 94%. With hCG every other day, intratesticular testosterone rose with the dose: it ended 25% below baseline at 125 IU, 7% below at 250 IU and 26% above baseline at 500 IU.
• Hsieh et al., J Urol 2013: 26 men on testosterone injections or gel plus 500 IU hCG every other day were followed for a mean of 6.2 months. None became azoospermic, and 9 contributed to a pregnancy. It was a retrospective series without a control group.

Neither study is large, long or a randomized trial of pregnancy rates. The AUA testosterone guideline reflects that: clinicians "may use" hCG, SERMs or aromatase inhibitors for men with testosterone deficiency who want to maintain fertility, a conditional recommendation with Grade C evidence. The same guideline says, as a strong recommendation, that testosterone "should not be prescribed to men who are currently trying to conceive." The AUA/ASRM infertility guideline goes further and covers men interested in current or future fertility.

So hCG on TRT is a reasonable hedge, not a fertility guarantee. Using hCG with testosterone to preserve fertility is also off-label, because the licensed labels cover other uses. Dosing and day-to-day use are covered in HCG alongside TRT, and the wider fertility trade-off in TRT and sperm count.

Which Online Clinics List HCG (Checked October 12, 2026)

We checked each clinic's own website on October 12, 2026. "Listed" means the site names hCG as part of a plan or treatment. It doesn't tell you which product they dispense or whether it's available in your state.

Sources: TRT Nation, Maximus, Marek Health, Defy Medical, Hone Health, Fountain TRT. Clinic menus change often, so confirm hCG availability with the clinic before you pay. Our TRT Nation review and Maximus review cover the rest of each program.

What HCG Adds to Your Monthly Bill

TRT Nation is the clearest example because it prices hCG as its own plan. The figures below are our arithmetic from its listed prices; both plans carry a 2.5-month minimum purchase.

Labs aren't included in either plan. TRT Nation charges a $129 lab fee for its required panel (total testosterone, CBC, CMP, sensitive estradiol, and PSA for men over 40), or you can submit your own results up to 6 months old. If you already have recent bloodwork, see clinics that accept outside labs. TRT Nation treats patients 24 and older, doesn't serve Alabama, Alaska, Arkansas, Missouri, North Dakota or Hawaii, and notes that California pricing may vary.

At any clinic, a few cost details are worth pinning down:

• Vial size and shelf life. The Fresenius Kabi label lists a 10,000-unit multi-dose vial and says to refrigerate it after mixing and discard it 60 days later. Ask how many vials each shipment includes and how the clinic handles unused product.
• Bundled or separate billing. Several clinics don't publish an hCG price at all. Get the all-in monthly number in writing before you start.
• Supplies. HCG is a separate injection from your testosterone, so ask whether syringes are included.

Questions to Ask Before You Pay for HCG

1. Which hCG product will I receive? Expect a licensed product such as Novarel, Pregnyl or Fresenius Kabi's chorionic gonadotropin. If the answer is "compounded hCG," ask how the pharmacy is making it after the 2020 change.
2. Which pharmacy dispenses it? TRT Nation says its medications are dispensed through regulated U.S. pharmacies. Any clinic should be able to name the pharmacy.
3. What happens if hCG is back-ordered? Find out whether they'd pause it, substitute something else, or change your plan price.
4. What will you monitor? The Fresenius Kabi hCG label lists headache, irritability, edema, gynecomastia and injection-site pain among adverse reactions. Ask whether estradiol is part of follow-up labs (it's on TRT Nation's required panel) and, if fertility is your goal, whether you'll get a semen analysis.
5. Is my goal fertility or testicular size? The answer changes the plan. The AUA recommends a reproductive health evaluation before treatment for men with testosterone deficiency who are interested in fertility.

Alternatives If HCG Isn't Available or Affordable

Enclomiphene instead of testosterone

Enclomiphene is a pill that prompts your own body to make more testosterone instead of replacing it, which is why clinics pitch it to men who care about fertility. "By itself, enclomiphene has not been approved by FDA for any use," according to the Defense Department's Operation Supplement Safety. Telehealth versions are compounded, and FDA lists enclomiphene citrate among bulk substances still "under evaluation" for 503A compounding (list updated May 14, 2026).

Listed prices: TRT Nation $99.99/mo for 30 × 25 mg capsules; Maximus from $99.99/mo; Hone Health from $42/mo plus membership. Full breakdown in what enclomiphene really costs online.

Clomiphene

Clomiphene is FDA-approved for ovulatory dysfunction in women and isn't approved for any condition in men. Its label says there are no adequate, well-controlled studies showing it works for male infertility and notes reports of gynecomastia and testicular tumors in men. Hone Health lists it from $38/mo plus membership.

Gonadorelin

Gonadorelin is a synthetic copy of the brain's GnRH signal, and it's marketed as an hCG substitute partly because it can still be compounded. It's compounded and not FDA-approved, and its human evidence comes mostly from around-the-clock pump therapy, not the injections TRT clinics use. We compare the two in gonadorelin vs HCG.

Not starting, or pausing, testosterone

If you're trying to conceive now, both AUA guidelines say testosterone isn't the right tool. That's a conversation for your prescriber or a urologist, not something to change on your own.

The Bottom Line

HCG is the add-on with published studies in men actually taking testosterone, but it's now a licensed-only product, and at TRT Nation it adds $80.01 a month to the testosterone-only price. Here's how to approach it:

1. Decide whether you want hCG for fertility, testicular size, or both, and tell the clinic up front.
2. If fertility matters, get a semen analysis before starting TRT so you have a baseline.
3. Get the product name, the pharmacy and the all-in monthly price in writing.
4. Compare programs side by side with our clinic comparison or the clinic-matching quiz.