This is not a David Goggins, 24-hour pull-up challenge, or a Jocko Willink wake up at 0-dark-30 kind of challenge. An HCG challenge is a diagnostic tool to evaluate a client's ability to produce their own testosterone. If successful, many men can avoid TRT and remain on HCG or Enclomiphene monotherapy.

 

Who is this for?

 

Primarily for younger men who are still hoping to retain fertility, HCG can maintain LH and FSH levels allowing for reproduction. Over time, HCG can be suppressive to endogenous testosterone production... enter Enclomiphene. Our patients can cycle off HCG for a few months and get back on or remain on Enclomiphene permanently.

​

Many men come to us with a testosterone level of 350 ng/dl.

​

LH and FSH around 1.4 & 2.2 respectively.

 

These demonstrate that the pituitary and testes work... but just aren't producing adequate levels likely due to secondary or adult-onset (andropause) hypogonadism. This can be corrected with TRT. But are the big guns necessary if a less invasive approach could be first utilized? We know the testes work - we just aren't happy with what they are producing.

 

An HCG challenge or Enclomiphene challenge will ramp up LH and FSH (gonadotropins) with many men producing 10x their original numbers. We then recheck labs and evaluate for symptom resolution. If high LH and FSH in the body resolves symptoms, permanent enclomiphene therapy (oral pill) can be an excellent solution to allow the body to ramp up its own internal LH and FSH production. This more affordable than TRT and nearly completely natural! There is no replacement of your own hormones.. you actually produce them yourself with enclomiphene just in greater degree. ​

​

What do we typically find?

​

This dramatically varies depending on the unique etiology of the patient's hypogonadism. With that being said, most men experience 50%-200% increases in their endogenous testosterone production. Symptoms usually improve dramatically and energy mildly improves. If this works for the patient and he has no adverse side effects, TRT would be contraindicated as a primary treatment. Can he still choose TRT? I would encourage him not to as his deficiency is being adequately managed with less invasive means.

​

For another large group of men, symptoms improve, testosterone rises, but SHBG increases which reduces free testosterone availability. Imagine having 100k in your bank account, but only 20 bucks in your wallet. This increase in total T, but decrease in free T results in no improvement. Some men may even feel worse. There are adjuncts we prescribe man to counteract SHBG, but if those too fail this patient has failed the challenge and is a candidate for TRT.

​

Some men feel better but just aren't happy with the degree of improvement. They remain symptomatic. These men require a more aggressive therapeutic approach - TRT. Many of our patients enjoy HCG or enclomiphene monotherapy but eventually decide to make the switch to TRT and are satisfied with that decision. Some patients switch off TRT to HCG or enclomiphene monotherapy's.

​

HCG or Enclomiphene can be a great first step if you suffering from symptomatic hypogonadism related to an LH/FSH production issue. If you are interested in an HCG challenge to see if your body can ramp up its own testosterone production without exogenous help, please contact us today to see one of our expert providers!