16th March 02:38
A Primer on HCG and Dr. Shippen's HCG Protocol (2 of 8) (hypothalamus depression nail testicular down)
Human Chorionic Gonadotrophin (HCG) is a hormone found in men and women.
Women secrete large amounts of HCG during pregnancy and men secrete
large amounts during puberty.
HCG is administered as a form of TRT. HCG is an alternative to standard
TRT in men with low LH and FSH (i.e., secondary hypogonadism). To
determine if you are a candidate for HCG you must have a blood test
showing low T, LH and FSH. This blood test cannot be taken while you're
on standard TRT because standard TRT shuts down LH and FSH production
and thereby distorts the test results. Alternatively, a Clomid
Stimulation Test can also demonstrate secondary hypogonadism (see
separate posting on this topic).
Rather than shutting down your body's natural T production system (like
standard TRT does), HCG stimulates it back towards normal function. Your
body produces it's own T. I believe that HCG is vastly superior to
standard forms of TRT for the following reasons:
1. Better mimics the body's own natural physiologic rhythm of T
2. Easier to maintain normal T levels when administered properly.
3. More physiologic T levels minimize excess estradiol production (i.e.,
4. Maintains normal size of testicles (in contrast, standard TRT shrinks
5. Stimulates sperm production (thereby increasing/restoring fertility).
In contrast, standard TRT reduces, if not eliminates, sperm production
thereby making you infertile.
6. Restores normal function to testicles - the benefits of normal
testicular function are not fully known. In his book "Saw Palmetto:
Nature's Prostate Healer", Ray Sahelian, M.D. says that the testicles
and the prostate exchange enzymes. I don't know what purpose these
enzymes serve, but I'd rather have them working than not working.
7. Restarts the pituitary/hypothalamus axis (see Medline article
4044781). My HCG dosage is very small (currently 480 IU per week). This
means that my body is responding to HCG by producing more LH and FSH on
the "off days." Some have claimed that HCG can restart your system
completely so that you can get off the shots and your body will maintain
on it's own. While, I've yet to hear of someone for whom this has
actually happened, my HCG dosage has steadily declined over 3 years from
1000 IU to 480 IU per week. Also, I feel good about the fact that my
pituitary/hypothalamus axis is being stimulated to return towards normal
The only disadvantage of HCG is that doctors are unaware of this
Doctors are usually down on what they are not up on. If you ask about
HCG, most doctors will give you a variety of lame, ill-conceived reasons
for not prescribing HCG. These excuses all add up to the fact that they
don't know how to administer it properly and don't want to take the time
to learn. I wonder what percentage of doctors would take the time to
learn about HCG if they were diagnosed with secondary hypogonadism?
Typical excuses for not prescribing HCG are (1) that the insurance
company won't pay for it and (2) it's expensive. Both are absolutely
untrue. As far as I know, all insurance companies pay for it (if the
doctor clearly states in writing that it's for hypogonadism only) and it
's actually cheaper than standard forms of TRT.
The current guidelines of the American Association of Clinical
Endocrinologists (AACE) indicate that HCG should only be prescribed when
a man is interested in fertility. As a result, most doctors will not
prescribe HCG unless you tell them you are currently trying to have
children. The AACE guidelines can be found at:
1. The guidelines call for intramuscular HCG injections. Subcutaneous
injections are much more convenient, much less painful and equally
effective (see discussion below and/or just ask the many men who inject
HCG subcutaneously or look at their blood test results).
2. The excessive HCG dosage levels suggested in the guidelines cause a
variety of problems as discussed throughout this primer. In particular,
excessive HCG dosages cause elevated estradiol (E2), which defeats many
of the positive effects of increased T.
3. The guidelines cite expense and inconvenience as the reasons why one
wouldn't use HCG otherwise. Aren't those my judgements to make? Of
course they are! The funny thing is, if I were injecting 2000 to 6000 IU
per week intramuscularly, I too would consider HCG therapy expensive and
inconvenient, but also ineffective (due to E2 overload). Duh?! But
instead, I inject 480 IU/week subcutaneously and find it to be
inexpensive, convenient and highly effective.
Unfortunately, doctors are unwilling to stray too far from their
professional guidelines. Also, they are unwilling to devote the amount
of time to each patient required for effective HCG therapy monitoring
and education. That's just human nature. But we're talking about our
health and future here! Think for yourself and you will see the
fallacies in these doctors' arguments against it.
Each day more and more doctors are becoming more and more aware of the
benefits of HCG. In his landmark book, The Testosterone Syndrome, Dr.
Eugene Shippen makes a strong case for HCG as an alternative to standard
TRT in cases of secondary hypogonadism. This book is considered by many
as the definitive book on TRT.
Unfortunately, the vast majority of doctors are woefully ignorant about
the proper dosage for HCG. In fact, the AACE clinical guidelines call
for HCG dosages of 1000 to 2000 IU, two or three times a week.
Scientific studies have demonstrated that HCG dosage levels of about
5,000 IU per week or more administered long-term cause permanent damage
to the testicles (see Medline articles 6210708 and 3583230). These
studies have shown that such excessive HCG dosages taken long-term
result in testicular desensitization (to future stimulation by LH or
HCG). In other words, long-term, such excessive dosages of HCG will
result in primary hypogonadism!
Also, the AACE guidelines call for intramuscular injections when
scientific studies show that subcutaneous injections work equally as
well (see Medline article 8075787). My experience as well as hundreds of
other men's experience proves this point. Subcutaneous injections are
much easier to administer and far less painful than intramuscular
The ONLY protocol that should be used is Dr. Shippen's HCG protocol. Dr.
Shippen's protocol calls for low dose shots (about 300 to 500 IU) at
bedtime, 2 to 5 times a week depending upon your responsiveness. This
protocol more closely mimics the body's natural physiologic rhythm of LH
Below is a copy of Dr. Eugene Shippen's HCG protocol that he emailed to
me on 3/17/01. If you are interested in HCG therapy, I suggest that you
show this protocol to your doctor. If your doctor has any questions,
he/she should contact Dr. Shippen.
Prior to HCG therapy, Shippen gave me a Clomid Stimulation test to rule
out any hypothalamus/pituitary issues such as tumors, etc. My response
to this test was good. He then put me on Selegiline, which raised my T,
but not enough for me.
HCG is available in shots only. It is self-administered at bedtime using
the smallest of needles (0.5 cc, 30 gauge, 5/16"). Shots are simple and
Chorionic Gonadotrophin Stimulation Test (males < 75 years old)*
Chorionic Gonadotrophin is presently available through most pharmacies
or distributors as Profasi, Pregnyl or generic Chorionic Gonadotrophin
10,000 units per 10 cc vial. Various stimulation tests have been
described, from high dose, short course testing to more normal
physiologic doses over a longer time period. I have found that a typical
treatment course for three weeks is best for determining those
individuals who will respond well to this type of treatment. It is
administered by injection 500 units (0.5 cc) SQ, Monday through Friday
for three weeks. Teach patient to self administer with 50 Unit Insulin
Syringes with 30 gauge needles in anterior thigh, seated with both hands
free to perform the injection. Measure: Testosterone, total and free,
plus E2 before starting CG and on the third Saturday AM after 3 weeks of
stimulation (salivary testing may be more accurate for adjusting doses).
Studies have shown that SQ is equal in efficacy to IM administration.
1. <20% rise suggests poor testicular reserve of leydig cell function
(primary hypo-gonadism or eu-gonadotrophic hypo-gonadism indicating
combined central and peripheral factors).
2. 20-50% increase indicates adequate reserve but slightly depressed
response, mostly central inhibition but possibly decreased testicular response as well.
3. > 50% increase suggests primarily centrally mediated depression of
Options for treatment vary both with the response to CG and patient
1. If there is an inadequate response (< 20%), then replacement with
testosterone will be indicated.
2. The area in between 20-50% will usually require CG boosting for a
period of time, plus natural boosting or "partial" replacement options.
I believe that full replacement with exogenous testosterone is always
the last option in borderline cases since improvement over time may
frequently occur as leydig cell regeneration may actually happen. Much
of this is age dependent. Up to age 60, boosting is almost always
successful. 60-75 is variable, but will usually be clear by the results
of the stimulation test. Also, disease related depression of
testosterone output might be reversible with adequate treatment of the
underlying process (depression, AMI, obesity, alcohol, deficiency, etc.)
This positive effect will not occur if suppressive therapy is instituted
in the form of full replacement.
3. If there is an adequate response, >50% rise in testosterone, there is
very good leydig cell reserve. Natural boosting or CG therapy will
probably be successful in restoring full testosterone output without
replacement, a better option over the long term and a more natural
restoration of biologic fluctuations for optimal response.
4. Chorionic Gonadotrophin can be self-administered and adjusted
according to response. In younger, high output responders (T >
1100ng/dl), CG can be given every third or fourth day at bedtime or in
the AM. This also minimizes estrogen conversion. In lower level
responders(600-800ng/dl), or those with a higher E2 output associated
with full dose CG, 300-500 units can be given Mon-Wed-Fri. At times,
sluggish responders may require a higher dose to achieve full
Testosterone response. In these cases, the diluent is lowered to 7.5cc
or even to 5 cc, which increases the CG concentration 1 ½ - 2 X. This
can be administered in variable doses 0.3 - 0.5cc given every 3rd day.
Check salivary levels on the day of the next injection, but before the
next injection to determine effectiveness and to adjust the dose
accordingly. Keep in mind that later as leydig cell restoration occurs,
a reduction in dose or frequency of administration may be later needed.
5. Monitor both Testosterone and E2 levels to assess response to
treatment after 2 - 3 weeks after change in dose of CG as well as
periodic intervals during chronic administration. Sublingual testing is
very easy and cost effective. It will also better reflect the true free
levels of both estrogens and testosterone. (Pharmasan Labs 888-342-7272
is very good)
6. Adjustment of dosage is a result of symptomatic response and hormone
level boosting. It is based on clinical judgement as much as actual
hormone levels. Remember that "Normal" ranges are for populations, not
7. Except for reports of antibodies developing against CG (I have not
seen this), there are no adverse effects of chronic CG administration.
An additional benefit is the boosting of Growth Hormone output which has
also been reported, either as a direct effect of CG or as an effect of
increased levels of testosterone.
*Protocol adapted from "The Testosterone Syndrome" by Eugene Shippen, M.
D. (M Evans and Co, NY 1998).
Posted on ASI with permission of Eugene Shippen, M. D.
If the only tool you have is a hammer, you tend to see every problem as
a nail. - A. Maslow
To email me, omit the 789 from the above address.