Human Chorionic Gonadotropin or Traditional Testosterone Replacement For Male Hypogonadism – Is one better than the other?

Authors

Gregory J. Miller, University of LynchburgFollow

Specialty

Endocrinology

Advisor

Dr. Thomas Colletti

Abstract

ABSTRACT

This narrative review examines diagnostic and treatment strategies for testosterone deficiency in aging men, which often presents with nonspecific symptoms—fatigue, low libido, mood disturbances—that poorly correlate with serum testosterone levels, particularly when values fall in the borderline range of 300–350 ng/dL, complicating clinical assessment. While testosterone replacement therapy (TRT) remains the standard for men with total testosterone < 300 ng/dL, it suppresses spermatogenesis and may jeopardize fertility. Human chorionic gonadotropin (hCG) offers a fertility‐preserving alternative by sustaining endogenous testosterone production and maintaining sperm counts. We evaluate diagnostic thresholds—including an Aging Male Symptom (AMS) and symptom‐based assessment tools, advocating for standardized instruments to complement biochemical markers. Evidence suggests hCG monotherapy may alleviate hypogonadal symptoms in men with borderline testosterone levels, though long-term luteinizing hormone receptor responsiveness warrants further study. Adjunctive agents—including selective estrogen-receptor modulators, aromatase inhibitors, and selective androgen-receptor modulators—are increasingly used for post-androgenic recovery and anabolic steroid–induced hypogonadism, now showing promise in restoring endogenous testosterone and improving clinical outcomes. A personalized approach integrating diagnostic precision, systematic biomarker surveillance, and fertility-conscious treatment regimens is essential for optimizing care in hypogonadal men.

Recommended Citation

Miller GJ. Human Chorionic Gonadotropin or Traditional Testosterone Replacement For Male Hypogonadism – Is one better than the other?. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2025; 7(3).