hCG - Intramuscular or Subcutaneous?

[phaedo]

As the title says, is hCG usually delivered IM or sub-q? I just picked up my prescription and the vial clearly states "for Intramuscular Injection Only," but was under the impression it was a sub-q injection. I called my doctor and he confirmed the IM method.

I'm guessing it's pharmaceutical company dependent? The brand-name I have is Novarel by Ferring Pharmaceuticals.

I asked the pharmacist if I could mix both the testosterone cypionate and hCG in the same syringe to save myself an extra pin, and she said recommended each medication as a separate injection.

On the other hand, the hMG I have is sub-q.

Thanks for any insight.

~ phaedo

[austinite]

Just keep it simple and inject subQ.

[HRTstudent]

the old way of dosing HCG was large, more infrequent injections. subQ is not suitable for large volume injections. the literature would reflect the studied, proven ways. and it would be up to the prescribing physician to instruct a patient to use something in a unique or off-label fashion.

talk to your doctor first of course and ask them questions because, after all, they are treating you and not us.

[phaedo]

Just keep it simple and inject subQ.

I would very much like to keep things simple and inject subQ! But the packaging, website, and vial are all clearly marked for IM, despite the similar (if not same) nature of other hCG medications. :-/

Which brings me to HRTstudent's post:

the old way of dosing HCG was large, more infrequent injections. subQ is not suitable for large volume injections. the literature would reflect the studied, proven ways. and it would be up to the prescribing physician to instruct a patient to use something in a unique or off-label fashion.

talk to your doctor first of course and ask them questions because, after all, they are treating you and not us.

Yes, traditionally hCG was usually given in larger doses than modern practice, which may explain the IM instructions. I'm speculating here, but hCG was originally created for female fertility and stimulating ovulation, which requires larger doses than prescribed for hypogonadotropic hypogonadism in males. This may explain the "old dosing practice" and the trend toward smaller, more frequent dosing we see today. I am following what HRTstudent mentioned and abiding by my physicians instructions for IM injections.

I do have another question: my reproductive urologist, a fertility specialist, and hCG medication pamphlet instruct for much larger hCG doses than often suggested on this board. I'm currently taking 3,000 IU every Monday, Wednesday, and Friday, along with 75 IU of hMG. Both doctors agreed typical dosing is anywhere between 1,000 - 3000 IU, where we opted for the higher end since we're already fighting an uphill battle, so to speak. It's important to caveat that I'm trying to regain fertility (not maintain spermatogenesis) after becoming azoospermia following about two years of TRT.

My question (finally) is where does this "250-500 IU" dosing recommendation stem? I understand Dr. Crisler is often cited, but I've yet to find any clinical studies, medical literature, or the like conveying the impendent "Leydig cell desensitization." My anecdotal experience seems contrary to this forum's recommendation, and I would like to where the discrepancy possibly arises?

~ phaedo

[100%]

I would very much like to keep things simple and inject subQ! But the packaging, website, and vial are all clearly marked for IM, despite the similar (if not same) nature of other hCG medications. :-/

Which brings me to HRTstudent's post:



Yes, traditionally hCG was usually given in larger doses than modern practice, which may explain the IM instructions. I'm speculating here, but hCG was originally created for female fertility and stimulating ovulation, which requires larger doses than prescribed for hypogonadotropic hypogonadism in males. This may explain the "old dosing practice" and the trend toward smaller, more frequent dosing we see today. I am following what HRTstudent mentioned and abiding by my physicians instructions for IM injections.

I do have another question: my reproductive urologist, a fertility specialist, and hCG medication pamphlet instruct for much larger hCG doses than often suggested on this board. I'm currently taking 3,000 IU every Monday, Wednesday, and Friday, along with 75 IU of hMG. Both doctors agreed typical dosing is anywhere between 1,000 - 3000 IU, where we opted for the higher end since we're already fighting an uphill battle, so to speak. It's important to caveat that I'm trying to regain fertility (not maintain spermatogenesis) after becoming azoospermia following about two years of TRT.

My question (finally) is where does this "250-500 IU" dosing recommendation stem? I understand Dr. Crisler is often cited, but I've yet to find any clinical studies, medical literature, or the like conveying the impendent "Leydig cell desensitization." My anecdotal experience seems contrary to this forum's recommendation, and I would like to where the discrepancy possibly arises?

~ phaedo

Dr. Crislers "250-500 IU" dosing recommendation come from lab work of his patents. Basically he says you can wait ten years for the study or listen to me now. This protocal is just to keep basic size and function.
"Leydig cell desensitization." is a highly debated topic. Dr Scally claims it simply does not exist in clinical doses. He does not deny Leydig cell desensitization exist just not in clinical doses. I looks like your reproductive urologist is following Gonadotropin Therapy for Induction of Spermatogenesis see attached.

[austinite]

I would very much like to keep things simple and inject subQ! But the packaging, website, and vial are all clearly marked for IM, despite the similar (if not same) nature of other hCG medications. :-/

So is my B12 vial, it's marked IM use only and I never inject IM. If your volume is less than .6ML, inject subQ. Anything higher can cause irritating lumps. Talk to your doctor as HRTs suggested.

[phaedo]

Dr. Crislers "250-500 IU" dosing recommendation come from lab work of his patents. Basically he says you can wait ten years for the study or listen to me now. This protocal is just to keep basic size and function.
"Leydig cell desensitization." is a highly debated topic. Dr Scally claims it simply does not exist in clinical doses. He does not deny Leydig cell desensitization exist just not in clinical doses. I looks like your reproductive urologist is following Gonadotropin Therapy for Induction of Spermatogenesis see attached.

Got it! Thanks for the explanation. I briefly spoke to my urologist about my concern with Leydig cell desensitization and he was unaware of it. Perhaps since I'm starting from ground zero, a significant dose of hCG maybe warranted, at least initially? I don't know...

Thanks for the PDF attachment. I specially find the following statement extremely useful in showing an unaware doctor prescribing TRT the importance of conjoining hCG therapy:

If pregnancy occurs, the patient’s regimen can be switched to only hCG to allow continued spermatogenesis for subsequent potential pregnancies.

Thanks 100%.

So is my B12 vial, it's marked IM use only and I never inject IM. If your volume is less than .6ML, inject subQ. Anything higher can cause irritating lumps. Talk to your doctor as HRTs suggested.

Alright, sounds good. I'll see if I can switch over to subQ. Like you said, keep things simple.

I'm not gonna finish this post without another question, though!

When hCG is introduced with TRT, what's the average increase in testosterone from the testicular stimulation? In other words, how much should exogenous testosterone be reduced when accompanied by hCG? 10%? 50%? I'm sure it's individual dependent, so I suppose my question is one of those "on average" types.

I'm currently injecting 100 mg of testosterone cypionate every five days, with my latest labs demonstrating a peak 863 ng/dL and trough at 690 ng/dL. With the introduction of hCG, hypothetically, what increase in total testosterone levels should I expect or how much do you speculate my testosterone dose will need to be reduced?

(If it matters, I'm not taking an AI. I've managed my protocol to reflect 28 and 23 E2 levels, respective to the above TT levels.)

Labs will be drawn shortly, of course, but for curiosity's sake...