At a glance

What it is

What hCG does in a man’s body

The pituitary gland releases LH and follicle-stimulating hormone (FSH). LH tells the Leydig cells in the testicles to make testosterone. That testosterone stays inside the testicle at very high levels and is needed to make sperm. hCG is a close relative of LH, so the testicle responds to it the same way.

This matters because testosterone given from outside the body tells the brain that levels are already high. The pituitary then cuts LH and FSH. The testicles get a weaker signal, and sperm production can fall. In one study summary, testosterone therapy led to a complete absence of sperm (azoospermia) in about 40 percent of men (Hsieh 2013, see sources).

hCG is one way to keep a signal reaching the testicle while a man is on testosterone. Another is a different approach altogether: a pill such as clomiphene that raises the body’s own LH and FSH. The two are not the same, and which fits depends on your goals. The main testosterone page is here.

Approval and regulation

FDA-approved uses, off-label use, and compounding

The labels for the two FDA-licensed hCG products, Novarel and Pregnyl, list three uses: prepubertal cryptorchidism (undescended testicles) not caused by a blockage, selected cases of hypogonadotropic hypogonadism in males (low testosterone from a pituitary problem), and induction of ovulation in certain women. The label gives intramuscular dosing only.

For the male hypogonadism indication, the Novarel label lists regimens such as 500 to 1,000 USP units three times a week for three weeks, then twice a week for three weeks, or a larger dose three times a week for six to nine months. Those are label regimens for a different goal than the one most men on testosterone have. The label does not describe adding hCG to testosterone therapy.

Using hCG alongside testosterone to protect fertility is off-label. Off-label means the FDA has not reviewed that use for approval. It is a legal and common practice, and your physician decides whether it fits you. It is not a standard of care that every guideline endorses.

Why compounded hCG is not an option

On March 23, 2020, hCG and other protein products that had been approved as drugs were transitioned to being licensed as biologics under the Public Health Service Act. FDA’s notice to compounders says biological products licensed under section 351 are not eligible for the compounding exemptions in sections 503A and 503B of the Federal Food, Drug, and Cosmetic Act, and it lists human chorionic gonadotropin among the affected substances. In plain terms, hCG is supposed to come as an FDA-licensed product, not as a compounded preparation. We checked this against FDA’s March 2020 notice and have not found a later change; the page will be updated if FDA acts again.

The evidence

What the studies show about sperm, testicles and testosterone

The evidence for hCG with testosterone is small. It is mostly short studies and one retrospective case series. It does not include a large trial that compared pregnancy rates.

Testicular size follows the same logic. When the LH signal drops, testicles can shrink. hCG supplies a substitute signal. We could not verify a trial that measured testicular volume with hCG and testosterone together, so we do not quote a number.

Safety

Side effects, estradiol and what to watch

The Novarel label lists headache, irritability, restlessness, depression, fatigue, swelling (edema), gynecomastia and pain at the injection site. Allergic reactions, including hives and rash, have been reported. Pregnyl’s label adds bruising, redness and itching at the injection site.

Estradiol. When the testicle is stimulated, it makes more testosterone, and some testosterone is converted to estradiol. That is why gynecomastia (breast tenderness or enlargement) appears on the label and why estradiol is checked. A higher estradiol is a lab number and not a diagnosis. Treatment depends on symptoms. The first step is usually a change in the dose or schedule. A drug that blocks estrogen production is a later option, and we cover it on the anastrozole page.

hCG does not replace a fertility evaluation. If you and your partner are trying to conceive, a semen analysis before starting and again afterwards tells you what is happening. A hormone level does not tell you whether a pregnancy will happen.

Monitoring

Labs and visits while on hCG

These checks are standard practice, not label requirements:

• Total testosterone and estradiol, usually within the first months and after any dose change.
• Hematocrit and PSA as part of routine testosterone monitoring, as set out in the testosterone page and the Endocrine Society guideline.
• A semen analysis before starting and again if fertility is the goal.
• A check for breast tenderness, swelling and mood at each visit.

If you stop hCG, the extra stimulation ends. Your testicles then depend on whatever signal your pituitary still sends. If you are also on testosterone, that signal may be low. Recovery of sperm after stopping testosterone takes months and varies from man to man, which is why a plan for stopping belongs in the first visit.

Summit’s role

What Summit does with hCG

Dr. Miranda decides whether this fits you after your history and labs. Summit is telehealth only. Testosterone for men follows state telehealth rules and requires symptoms plus two morning total testosterone readings below 300, and it is a Schedule III controlled substance. Nothing here promises that any treatment will be prescribed.

If you want to have children now or later, say so on your application. That changes the plan before anyone writes a prescription. If hCG is ever used, it would be an FDA-licensed product, not a compounded one. See pricing for what is included, including labs.

Keep reading

Related medications

Sources

Where this comes from

All retrieved November 10, 2026.

1. Novarel (chorionic gonadotropin for injection) prescribing information. DailyMed. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=ac6918ff-9dc3-40d9-8619-54b26e4bdfc8
2. Pregnyl (chorionic gonadotropin for injection) prescribing information. DailyMed. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=1e94155f-19be-4944-b197-be4edbb4faf9
3. FDA. Notice to Compounders: Changes that affect compounding as of March 23, 2020. https://www.fda.gov/drugs/human-drug-compounding/notice-compounders-changes-affect-compounding-march-23-2020
4. Coviello AD et al. Low-dose human chorionic gonadotropin maintains intratesticular testosterone in normal men with testosterone-induced gonadotropin suppression. J Clin Endocrinol Metab 2005. https://pubmed.ncbi.nlm.nih.gov/15713727/
5. Hsieh TC et al. Concomitant intramuscular human chorionic gonadotropin preserves spermatogenesis in men undergoing testosterone replacement therapy. J Urol 2013. https://pubmed.ncbi.nlm.nih.gov/23260550/
6. Bhasin S et al. Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2018. https://pubmed.ncbi.nlm.nih.gov/29562364/
7. Mulhall JP et al. Evaluation and Management of Testosterone Deficiency: AUA Guideline. J Urol 2018. https://pubmed.ncbi.nlm.nih.gov/29601923/