HCG Protocol After Long-Term TRT Discontinuation

Introduction to HCG Recovery Protocols

The American Urological Association recommends against using supraphysiologic hCG doses, as they can cause Leydig cell desensitization, paradoxically reducing testosterone production 2
The typical therapeutic range of hCG for hypogonadotropic hypogonadism is 500-2,500 IU per week, with dosing of 250-500 IU administered 2-3 times weekly 2

The Endocrine Society suggests starting with 500 IU hCG subcutaneously 3 times weekly, providing 1,500 IU weekly, to maintain intratesticular testosterone in the normal range 2
Testosterone levels should be checked at 2-3 months to assess testicular response, and LH and FSH should be measured to confirm they remain suppressed initially, then gradually recover 2, 3
If testosterone remains low after 3 months on hCG alone, consider adding FSH 75-150 IU three times weekly, as recommended by the American Society for Reproductive Medicine 2

Clomiphene citrate 25-50 mg daily or enclomiphene 12.5-25 mg daily may be used as alternatives to hCG, stimulating endogenous LH/FSH production rather than replacing it, as suggested by the American Urological Association 1, 2

Approximately 67-90% of men eventually recover spermatogenesis after TRT cessation, but this can take 6-24 months, according to the European Association of Urology 2
Older age and longer duration of TRT predict slower and less complete recovery, as stated by the International Society for the Study of the Aging Male 2