Human Chorionic Gonadotropin – HCG Injection

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Human Chorionic Gonadotropin (hCG) is a polypeptide hormone produced naturally by the placenta during pregnancy, but chemically synthesized or purified for clinical therapeutic applications. In clinical endocrinology, hCG acts as an analogue to Luteinizing Hormone (LH). By binding to LH receptors, it stimulates the production of endogenous testosterone in males and triggers ovulation and progesterone production in females.

Indications & Usage

• Male Hypogonadism (Hypogonadotropic): Indicated for the treatment of hypogonadotropic hypogonadism secondary to a pituitary defect or hypothalamic deficiency, helping restore testicular function and endogenous testosterone production.

• Male Infertility & Spermatogenesis: Used to stimulate Leydig and Sertoli cells to support spermatogenesis and improve sperm count and quality.

• Cryptorchidism: Indicated for prepubertal cryptorchidism not due to anatomical obstruction.

• Female Infertility: Used to induce ovulation and pregnancy in anovulatory infertile women when the cause of anovulation is secondary and not due to primary ovarian failure.

How It Works (Mechanism of Action)

Because hCG shares an identical alpha subunit and a structurally similar beta subunit with Luteinizing Hormone (LH), it acts as an LH receptor agonist:

1. Leydig Cell Stimulation: In men, hCG binds to LH receptors on testicular Leydig cells, stimulating the synthesis and secretion of testosterone.

2. Maintenance of Intratesticular Testosterone (ITT): Crucial for men undergoing Testosterone Replacement Therapy (TRT) to preserve testicular volume, fertility, and natural hormonal feedback loops.

3. Follicular Maturation: In women, it mimics the LH surge, triggering final oocyte maturation and ovulation within 36 to 48 hours following administration.

Dosage & Administration

hCG is administered via subcutaneous (SQ) or intramuscular (IM) injection following reconstitution with sterile or bacteriostatic water. Dosage and protocol vary significantly based on clinical indication:

Important Safety Information & Precautions

Regulatory Warning: Weight Loss Disclaimer

hCG has not been demonstrated to be effective adjunct therapy in the treatment of obesity. There is no substantial evidence that hCG increases weight loss beyond that resulting from caloric restriction, nor does it cause a more attractive or “normal” distribution of fat.

Contraindications

• Known hypersensitivity to hCG or any component of the formulation.

• Prostatic carcinoma or other androgen-dependent neoplasms in males.

• Precocious puberty.

• Primary ovarian failure or primary testicular failure.

Key Warnings

• Ovarian Hyperstimulation Syndrome (OHSS): Severe cases may result in massive ovarian enlargement, ascites, and thromboembolism in female patients.

• Fluid Retention & Gynecomastia: Androgen stimulation in males may cause fluid retention or gynecomastia; use with caution in patients with cardiac or renal disease, asthma, or migraines.

• Precocious Puberty in Males: Monitor bone age in pediatric patients to prevent premature epiphyseal closure.

Common Side Effects

Side effects depend on gender, dose, and individual sensitivity:

• Injection site pain, swelling, or redness

• Headache

• Irritability or restlessness

• Fatigue

• Gynecomastia (breast tissue enlargement in males)

• Fluid retention or mild edema

Storage & Handling

• Unreconstituted (Powder): Store dry powder vials at room temperature between 20°C to 25°C (68°F to 77°F). Protect from light.

• Reconstituted Solution: Once reconstituted with Bacteriostatic Water, store in a refrigerator between 2°C to 8°C (36°F to 46°F).

• Shelf Life After Mixing: Reconstituted multidose vials must be used within 30 to 60 days (refer to manufacturer specs) or discarded. Do not freeze reconstituted solution.