Human chorionic gonadotropin monotherapy for the treatment of hypogonadal symptoms in men with total testosterone > 300 ng/dL

This prospective study evaluated the efficacy of hCG (human chorionic gonadotropin) monotherapy for treating hypogonadism symptoms in 20 men with total testosterone above 300 ng/dL — a "borderline" population that frequently presents hypogonadal symptoms despite laboratory levels considered normal by many diagnostic criteria.

Patients received subcutaneous hCG at doses that varied according to individual response. After treatment, results demonstrated:

• Average 60% increase in testosterone levels, from 362 ng/dL to 520 ng/dL (p<0.005)
• Subjective symptom improvement in 50% of patients, including energy, libido, and general well-being
• Complete preservation of spermatogenesis, radically differing from TRT with exogenous testosterone
• Estradiol elevation, consistent with hCG stimulation of testicular aromatase

A significant advantage of hCG monotherapy compared to conventional TRT is that hCG stimulates endogenous testosterone production by Leydig cells, maintaining a functional hypothalamic-pituitary-gonadal axis and preserving fertility. This makes hCG an attractive option for men of reproductive age with hypogonadal symptoms.

The authors concluded that hCG monotherapy may be a viable alternative to TRT in men with hypogonadism symptoms and "borderline" testosterone, particularly in those who wish to preserve fertility or avoid the suppressive effects of exogenous testosterone on the gonadal axis.