hCG
Human chorionic gonadotropin (not a peptide) · S-tier (Dr. Alex Tatem) · Strong evidence
Keeps the testes producing testosterone and sperm while you’re on testosterone therapy, which would otherwise shut them down.
Dr. Tatem’s take
S-tier: “one of the most goatated compounds of all time” for keeping the testes working during TRT and supporting fertility. He criticizes the pharmaceutical industry for limiting compounded supply.
In Dr. Tatem’s tier list
- “One of my favorite compounds of all time, period” and one of the highest-quality compounds in the whole series — though it’s a glycoprotein, not a peptide.
- It mimics luteinizing hormone, so it keeps the testicles making testosterone (via Leydig cells) even while someone is on testosterone therapy.
- Hypothesis he discusses: hCG may preserve neurosteroids that are lost when natural production shuts down — one suspected reason some men on TRT lose libido a year or two in.
- On its own it can raise natural testosterone and has been a game-changing fertility drug.
- He criticizes pharmaceutical gatekeeping: a decades-old drug that should be cheap was pushed out of compounding. Verdict: S tier.
History & background
hCG is the pregnancy hormone; its detection in urine became the basis of pregnancy tests in the 1920s, and urine-derived hCG has been used medically since the 1930s for fertility and undescended testicles. Recombinant hCG (Ovidrel) was approved in 2000.
In March 2020 hCG was reclassified by FDA as a biological product under the Biologics Price Competition and Innovation Act, which took it out of the normal compounding pathway — the change Dr. Tatem is criticizing. Its use alongside TRT to preserve fertility is off-label but common in men’s health.
Benefits
- Preserves sperm production during TRT.
- Maintains testicular size and your own testosterone production.
- Fertility treatment.
Risks
- Higher estrogen (E2); monitor with labs.
- Gynecomastia risk from excess estrogen.
- Injection-site reactions.
Dosing protocols (informational, labeled by evidence)
- Clinical trial / label: FDA label – male hypogonadotropic hypogonadism — 500–1000 USP units 3x/wk × 3 wk, then 2x/wk × 3 wk; OR 4000 units 3x/wk × 6–9 mo, then 2000 units 3x/wk × 3 mo, IM, As stated, As stated
- Physician / clinic: With TRT to preserve fertility — 500 IU, IM/SubQ, Every other day, Throughout TRT
- Physician / clinic: With TRT, testicular size only — 1500 IU, SubQ/IM, Weekly, Ongoing
- Physician / clinic: Monotherapy (secondary hypogonadism / post-steroid) — 1500–2000 IU (HH); 1500–5000 IU (steroid recovery), SubQ/IM, 2–3x weekly, 3–6 mo; add FSH if no sperm by 4–6 mo
- Community (bro science): Community TRT adjunct — 250–500 IU, SubQ, 2–3x weekly, Ongoing
Status: FDA-approved (e.g., Pregnyl, Novarel) for male hypogonadotropic hypogonadism and other uses. Use alongside TRT is off-label.
Grade and commentary: Dr. Alex Tatem. Watch: Truth About Popular Peptides Tier List (What Works, What’s Overhyped) | Pt. 3, TRT, Peptides & Fertility: A Deep Dive With Dr. Larry Lipshultz. Subscribe: @DrAlexTatem.