Human chorionic gonadotropin (hCG) is a glycoprotein hormone made by the placenta in pregnancy. Its action on the testes and ovaries is virtually identical to that of luteinizing hormone (LH), the pituitary signal that tells the testes to make testosterone. Prescription hCG has been sold in the US since the 1970s, as urine-derived Novarel, Pregnyl and generics, and since 2000 as recombinant Ovidrel.
In men, the label covers selected cases of hypogonadotropic hypogonadism (low testosterone caused by pituitary failure), and in boys, prepubertal cryptorchidism (undescended testes). In women it is used to trigger ovulation in fertility treatment. Outside medicine it is widely used alongside or after anabolic steroids to keep the testes working. The urinary hCG labels also carry a capitalized statement that hCG has not been shown to work for weight loss.
This page summarizes what the FDA labels, clinical studies and regulators report. It is for education only and is not medical advice.
| Property | Detail |
|---|---|
| Drug class | Gonadotropin; glycoprotein hormone that acts like LH |
| Brands / US approval | Novarel (1974), Pregnyl (1976), generic chorionic gonadotropin (urinary); Ovidrel (recombinant, 2000) |
| Route | Intramuscular (urinary products); subcutaneous (Ovidrel) |
| Strengths | 5,000 and 10,000 USP unit vials (urinary); 250 µg prefilled syringe (Ovidrel) |
| Labeled male dose | 500–4,000 USP units 2–3 times weekly, depending on the regimen and indication |
| Half-life (label) | ≈29 h terminal after subcutaneous injection; 26.5 h after IV (Ovidrel) |
| Key mechanism | Binds the LH receptor on Leydig cells and drives testicular testosterone production |
| US status | Prescription only; regulated as a biologic since March 2020; not on the DEA controlled substances list; not approved for weight loss |
| WADA status | Prohibited at all times in males (S2.2.1) |
What it is
hCG has two subunits. The alpha subunit is essentially identical to the alpha subunits of LH, follicle-stimulating hormone (FSH) and thyroid-stimulating hormone (TSH). The beta subunit differs and gives each hormone its identity (Novarel label). Recombinant hCG has an alpha chain of 92 amino acids and a beta chain of 145, with sugar chains attached at several sites (Ovidrel label).
The labels describe its action this way:
- In men, it stimulates the Leydig cells (the testosterone-producing cells of the testis) to make androgens.
- In women, it can stand in for the mid-cycle LH surge that triggers ovulation, and it supports the corpus luteum.
- It appears to have a small degree of FSH activity as well.
Because hCG acts on the testis directly, it bypasses the hypothalamus and pituitary rather than switching them back on. That matters for how it is used after steroid use (see below).
| Product | Source | Route | Labeled indications |
|---|---|---|---|
| Novarel, Pregnyl, generic chorionic gonadotropin | Purified from the urine of pregnant women | IM | Cryptorchidism; male hypogonadotropic hypogonadism; ovulation induction |
| Ovidrel | Recombinant, made in Chinese hamster ovary cells | SC | Women only: final follicle maturation in ART and ovulation induction |
Pharmacokinetics
The only US label with pharmacokinetic data is Ovidrel’s, from studies in women (Ovidrel label):
| Parameter (250 µg SC, healthy women) | Value |
|---|---|
| Peak concentration | 121 ± 44 IU/L |
| Time to peak | Median 24 h (range 12–24 h) |
| Absolute bioavailability | ≈40% |
| Terminal half-life after SC dose | 29 ± 6 h |
| Terminal half-life after IV dose | 26.5 ± 2.5 h |
| Share excreted unchanged in urine | ≈10% |
In 24 healthy young men given 5,000 IU urinary hCG, the peak came later and the half-life was longer after subcutaneous than after intramuscular injection. The testosterone response was the same with either route (Saal et al., Fertil Steril 1991).
The testosterone response outlasts a single dose. In normal men given single IM injections of up to 6,000 IU, testosterone rose at 2 hours, then rose again to a peak at 48 hours. At 6,000 IU it was still raised 6 days later. Estradiol also rose in a dose-dependent way, peaking at 24 hours (Padrón et al., JCEM 1980).
Approved medical use
The urinary hCG labels list three indications (Novarel label; Pregnyl label):
- prepubertal cryptorchidism not due to an anatomical obstruction, usually started between ages 4 and 9;
- selected cases of hypogonadotropic hypogonadism in males;
- induction of ovulation in anovulatory infertile women whose ovaries still work, after pretreatment with other gonadotropins.
The labels list regimens “advocated by various authorities” rather than one fixed dose:
| Indication | Labeled regimens (IM) |
|---|---|
| Hypogonadotropic hypogonadism (males) | 500–1,000 USP units 3 times a week for 3 weeks, then the same dose twice a week for 3 weeks; or 4,000 USP units 3 times weekly for 6–9 months, then 2,000 USP units 3 times weekly for 3 more months |
| Prepubertal cryptorchidism | 4,000 USP units 3 times weekly for 3 weeks; or 5,000 USP units every second day for 4 injections; or 15 injections of 500–1,000 USP units over 6 weeks; or 500 USP units 3 times weekly for 4–6 weeks |
| Ovulation induction | 5,000–10,000 USP units one day after the last dose of menotropins |
Regulatory status
- Biologic since 2020. hCG was first approved as a drug. On March 23, 2020, the Novarel, Pregnyl, generic and Ovidrel approvals were all “deemed to be” biologics licenses under the Public Health Service Act (FDA list of deemed BLAs).
- Not approved for weight loss or without a prescription. FDA advises consumers to avoid HCG weight-loss drops, pellets and sprays. It states that hCG “is not approved for use without a prescription for any purpose” (FDA consumer update).
- Not a federally controlled substance. hCG does not appear on the DEA’s list of controlled substances, unlike testosterone and other anabolic steroids (DEA list).
- Banned in male athletes. The 2026 Prohibited List bans chorionic gonadotrophin and LH in males at all times, under S2.2.1 “testosterone-stimulating peptides” (2026 Prohibited List, official Dutch Treaty Series copy).
What the research shows
Inducing fertility in hypogonadotropic hypogonadism
This is where hCG has the most evidence. A 2014 meta-analysis pooled 44 studies of gonadotropin therapy in azoospermic men (men with no sperm in the ejaculate) with hypogonadotropic hypogonadism (Rastrelli et al., Andrology 2014):
| Outcome | Result |
|---|---|
| Sperm appeared in semen (overall) | 75% (95% CI 69–81%) |
| Mean sperm concentration reached | 5.92 million/mL (95% CI 4.72–7.13) |
| Onset before puberty vs mixed populations | 68% vs 84% success |
| Prior testosterone therapy | Did not affect the result |
A 2026 meta-analysis of 50 studies and 1,583 men found similar numbers (Huijben et al., Andrology 2026):
- sperm induction in 74% (95% CI 66–82%), after a mean of 11.8 months;
- pregnancy in 52% (95% CI 42–62%) of couples trying to conceive, after a mean of 19 months;
- hCG combined with FSH worked better than hCG alone.
The authors noted that most included studies were of poor methodological quality.
An Australian cohort followed 75 gonadotropin-deficient men through 116 treatment courses (Liu et al., JCEM 2009). Thirty-eight became fathers. The median time to first sperm was 7.1 months, and to conception 28.2 months. Larger testis volume at the start predicted a faster response.
Keeping the testes working during testosterone therapy
External testosterone suppresses LH, and with it the very high testosterone levels inside the testis that are thought to be needed for sperm production. In a randomized trial, 29 healthy men received 200 mg/week testosterone enanthate for 3 weeks plus either placebo or hCG every other day (Coviello et al., JCEM 2005):
| Added to testosterone | Intratesticular testosterone vs baseline |
|---|---|
| Placebo | −94% |
| hCG 125 IU every other day | −25% |
| hCG 250 IU every other day | −7% |
| hCG 500 IU every other day | +26% |
The trial measured hormone levels, not sperm counts, and lasted only 3 weeks.
A retrospective review looked at 26 hypogonadal men on testosterone plus 500 IU hCG every other day (Hsieh et al., J Urol 2013). Over a mean follow-up of 6.2 months, semen parameters did not change, no man became azoospermic, and 9 of the 26 contributed to a pregnancy. There was no control group.
Recovery after testosterone or anabolic steroid use
No randomized trials have tested hCG for recovery after anabolic steroid use. The evidence is observational:
- Testosterone-related azoospermia. A case series of 49 men with azoospermia or severe oligospermia (under 1 million sperm/mL) on testosterone used 3,000 IU hCG every other day plus other drugs chosen by the physician. Sperm returned or improved in 47 men (95.9%) after a mean of 4.6 months (Wenker et al., J Sex Med 2015).
- Recreational steroid users. A retrospective two-center cohort included 79 men who had used steroids for 6 months or less, with normal hormone and semen tests before use (İbis et al., BJU Int 2026). Men had no treatment, clomiphene 25 mg/day, or clomiphene plus hCG 1,500 IU three times weekly. Hormones normalized in all groups by month 6.
| Outcome at 12 months (İbis 2026) | No treatment | Clomiphene | Clomiphene + hCG |
|---|---|---|---|
| Normal semen analysis | 58.6% | 69.2% | 87.5% |
| Testicular volume up by 20% or more | 6.9% | — | 70.8% |
Treatment was not randomized, so differences between the men in each group may explain part of the result. The authors called for randomized trials. Because hCG drives the testes directly and cross-reacts with LH in lab tests, a blood test taken while on hCG does not show whether the pituitary has recovered on its own (see Clomid and Nolvadex for drugs that act on the pituitary instead).
Cryptorchidism
A 1995 meta-analysis covered 3,282 boys (Pyörälä et al., JCEM 1995). In the randomized trials, the testis descended in 19% (95% CI 13–25%) of boys on hCG, against 4% on placebo. The authors called the data “scanty.” The 2014 American Urological Association guideline recommends surgery (orchiopexy) and does not recommend hormonal therapy (Kolon et al., J Urol 2014).
Weight loss: not supported
The “hCG diet” pairs hCG with a diet of about 500 calories a day. A meta-analysis of 24 trials found the methods were mostly poor (Lijesen et al., Br J Clin Pharmacol 1995). Of the 12 better-quality studies, all of them controlled, only one called hCG a useful adjunct. The authors concluded there was no scientific evidence that hCG causes weight loss or fat redistribution, or that it reduces hunger.
About hCG for weight loss. The Novarel and Pregnyl labels state there is “no substantial evidence” that it increases weight loss beyond calorie restriction. FDA attributes any weight lost on these programs to the severe calorie restriction, not to hCG.
Side effects and risks
Labeled adverse reactions
The Novarel and Pregnyl labels list:
- headache, irritability, restlessness, depression and fatigue;
- edema, and water and sodium retention at high doses, attributed to the extra androgen;
- gynecomastia (breast tissue growth) in males;
- precocious puberty in boys treated for cryptorchidism;
- injection-site pain, bruising, redness or swelling;
- hypersensitivity reactions, including anaphylaxis, reported with urine-derived hCG.
Gynecomastia fits the hormone data: hCG raises estradiol as well as testosterone, with estradiol peaking about 24 hours after an injection (Padrón 1980).
The Novarel label also notes sporadic reports of testicular tumors in otherwise healthy young men receiving hCG for secondary infertility. A causal relationship has not been established.
Risks in women
When used to trigger ovulation, the main serious risks on the labels are:
- ovarian hyperstimulation syndrome (OHSS), sudden ovarian enlargement with fluid shifts that can become life-threatening;
- rupture of ovarian cysts;
- multiple pregnancies;
- arterial and venous blood clots;
- ovarian torsion.
Who should not use it
The Novarel label contraindicates hCG in:
- precocious puberty;
- prostate cancer or other androgen-dependent tumors;
- prior allergic reaction to hCG;
- pregnancy.
The Pregnyl label adds uncontrolled thyroid, adrenal or pituitary disorders and tumors of the hypothalamus or pituitary. In males it also lists breast or prostate tumors. Both labels advise caution in heart or kidney disease, epilepsy, migraine and asthma, because the androgens it raises can cause fluid retention.
Lab test interference
hCG can cross-react in immunoassays for gonadotropins, especially LH, and the labels ask prescribers to tell the laboratory. Ovidrel’s label also notes that it may interfere with pregnancy tests.
Products sold outside pharmacies
hCG “diet” drops, pellets and sprays sold online and in stores are not FDA-approved. FDA advises consumers to stop using them (FDA consumer update).
Key takeaways
- An LH stand-in. hCG binds the LH receptor and makes the testes produce testosterone. It acts on the testis directly, bypassing the pituitary.
- Approved for narrow uses. US labels cover male hypogonadotropic hypogonadism, prepubertal cryptorchidism and ovulation induction. Ovidrel is approved for women only.
- Best evidence is for fertility. In hypogonadotropic hypogonadism, about three in four men develop sperm on gonadotropin therapy, and hCG plus FSH works better than hCG alone.
- Steroid-recovery data are observational. Low-dose hCG preserved intratesticular testosterone in a 3-week trial, and cohorts suggest faster semen recovery, but no randomized trials exist for post-steroid use.
- It does not help weight loss. Labels, FDA and a meta-analysis agree that weight lost on the “hCG diet” comes from the calorie restriction.
- Banned in sport, but not a controlled substance. WADA prohibits it in males at all times; in the US it is a prescription biologic not on the DEA schedules.
Sources
- Ferring Pharmaceuticals. Novarel (chorionic gonadotropin) for injection, prescribing information. DailyMed.
- Organon. Pregnyl (chorionic gonadotropin) for injection, prescribing information, revised 03/2025. DailyMed.
- EMD Serono. Ovidrel PreFilled Syringe (choriogonadotropin alfa injection), prescribing information. DailyMed.
- Food and Drug Administration. List of approved NDAs for biological products that were deemed to be BLAs on March 23, 2020. FDA.
- Food and Drug Administration. Avoid dangerous HCG diet products. Consumer update, content current as of July 13, 2020. FDA.
- Drug Enforcement Administration, Diversion Control Division. Controlled substances, alphabetical order. DEA.
- World Anti-Doping Agency. The 2026 Prohibited List, as published in the appendix amendment to the Anti-Doping Convention (ETS No. 135). Tractatenblad. 2026;25. Officiële bekendmakingen.
- Saal W, Glowania HJ, Hengst W, Happ J. Pharmacodynamics and pharmacokinetics after subcutaneous and intramuscular injection of human chorionic gonadotropin. Fertil Steril. 1991;56(2):225–229. PubMed.
- Padrón RS, Wischusen J, Hudson B, Burger HG, de Kretser DM. Prolonged biphasic response of plasma testosterone to single intramuscular injections of human chorionic gonadotropin. J Clin Endocrinol Metab. 1980;50(6):1100–1104. PubMed.
- Rastrelli G, Corona G, Mannucci E, Maggi M. Factors affecting spermatogenesis upon gonadotropin-replacement therapy: a meta-analytic study. Andrology. 2014;2(6):794–808. PubMed.
- Huijben M, Prinsen A, de Kort L, van Breda J. Boosting male fertility: the impact of gonadotropin therapy on hypogonadotropic hypogonadism—a systematic review and meta-analysis. Andrology. 2026;14(7):1971–1987. PubMed.
- Liu PY, Baker HW, Jayadev V, et al. Induction of spermatogenesis and fertility during gonadotropin treatment of gonadotropin-deficient infertile men: predictors of fertility outcome. J Clin Endocrinol Metab. 2009;94(3):801–808. PubMed.
- Coviello AD, Matsumoto AM, Bremner WJ, et al. Low-dose human chorionic gonadotropin maintains intratesticular testosterone in normal men with testosterone-induced gonadotropin suppression. J Clin Endocrinol Metab. 2005;90(5):2595–2602. PubMed.
- Hsieh TC, Pastuszak AW, Hwang K, Lipshultz LI. Concomitant intramuscular human chorionic gonadotropin preserves spermatogenesis in men undergoing testosterone replacement therapy. J Urol. 2013;189(2):647–650. PubMed.
- Wenker EP, Dupree JM, Langille GM, et al. The use of HCG-based combination therapy for recovery of spermatogenesis after testosterone use. J Sex Med. 2015;12(6):1334–1337. PubMed.
- İbis MA, Yap T, Satchi M, et al. Post-cycle therapy after short-term anabolic-androgenic steroid use: comparative outcomes in recreational bodybuilders. BJU Int. 2026;137(1):154–165. PubMed.
- Pyörälä S, Huttunen NP, Uhari M. A review and meta-analysis of hormonal treatment of cryptorchidism. J Clin Endocrinol Metab. 1995;80(9):2795–2799. PubMed.
- Kolon TF, Herndon CD, Baker LA, et al. Evaluation and treatment of cryptorchidism: AUA guideline. J Urol. 2014;192(2):337–345. PubMed.
- Lijesen GK, Theeuwen I, Assendelft WJ, Van Der Wal G. The effect of human chorionic gonadotropin (HCG) in the treatment of obesity by means of the Simeons therapy: a criteria-based meta-analysis. Br J Clin Pharmacol. 1995;40(3):237–243. PubMed.