hCG for PFS: what is known so far

Some people with post-finasteride syndrome (PFS) say hCG helped them. But no study has tested it in PFS, so nobody knows whether it works or who it might suit.

PFS is more than sexual problems. The 2022 diagnostic criteria say finasteride can also bring problems with cognition, depression and suicidality, which can occur without any sexual difficulties. A hormone injection aimed at testosterone may not touch most of that.

Here is what hCG does, what the research shows, and what to ask before you try it.

What is hCG, and why do people with PFS try it?

hCG (human chorionic gonadotropin) is a hormone made in pregnancy. In men it acts like LH, the signal that tells the testes to make testosterone. Doctors use it for some hormone and fertility problems.

The idea behind trying it in PFS is simple: if testosterone or related hormones are off, hCG might push them back up. It’s a theory. Nobody has tested it in people with PFS.

There is a catch. In a Harvard study, men with lasting symptoms after finasteride had normal testosterone and DHT in their blood. If the blood levels are already normal, it isn’t clear what raising them would fix.

What does the research on hCG actually show?

The studies on hCG come from other groups of men, so they can’t tell us about PFS.

• Men coming off testosterone: a small clinic review of 28 men who switched to hCG found no serious heart or clot problems. Of those with low libido, low energy or erection problems, most said they felt better. There was no comparison group.
• Healthy men in a trial: a placebo-controlled study found low doses kept testosterone inside the testes in a normal range while the body’s own signal was switched off.
• Men with symptoms but normal testosterone: a 2022 study looked at hCG on its own. We couldn’t open the full text, so we draw nothing from it.
• hCG diet products: a review warned that products sold for weight loss “may do more harm than good”.

The UK Propecia leaflet lists “persistent difficulty having an erection after discontinuation of treatment”, along with lasting low sex drive and ejaculation problems. That is the starting point for anyone looking at treatments.

What are the risks of hCG?

hCG changes your hormones, and in PFS nobody knows how the body will respond. That uncertainty is the main risk.

Raising testosterone can also raise oestradiol, a form of oestrogen. That can lead to breast swelling or tenderness, which the Propecia leaflet already lists as a finasteride side effect. Other possible problems include headaches and mood changes. Long-term effects in PFS are unknown.

hCG bought online without a prescription may not contain what the label says. The diet-products review found exactly that problem.

Lasting symptoms may not come from hormones in the blood alone. Researchers have also looked at hormones in the brain.

In this short talk, Dr Michael Irwig, then at George Washington University, describes his 2011 study of men with lasting sexual side effects. From about 3:36 he asks whether the problem lies in hormones in the brain. It’s background on why a blood-level fix may fall short, not evidence about hCG.

Play video: Persistent sexual side effects of finasteride (Propecia) for male pattern hair loss

Our guide to PFS blood tests explains which hormones people often discuss with their doctor.

What can I do?

hCG is a prescription medicine. That’s a decision for you and a doctor who knows your history, ideally an endocrinologist. Don’t start it on your own. Our guide on how to talk to your doctor about PFS can help you prepare.

Keep a record before you start anything: your symptoms, blood results with dates, and how you feel week by week. Then you’ll know whether anything changed.

Report it: it helps everyone

A doctor’s note helps you. A report to the medicines regulator helps everyone else: it is how patterns get noticed.

• No proof needed. A suspicion is enough, even years after stopping.
• Where: the Yellow Card scheme in the UK, MedWatch in the US. Our guides cover Yellow Card and the FDA step by step.
• Use the right words. If symptoms continued after stopping, write Post 5-alpha-reductase inhibitor syndrome (MedDRA 10082430).

Our reporting guide walks you through it

What else do people ask?

Does hCG cure PFS? There is no evidence that it does. Some patients describe feeling better, others don’t, and nobody has compared it with a dummy treatment in PFS. Any change could also come from time or other things in your life.

Is hCG the same as testosterone therapy? No. Testosterone therapy adds testosterone from outside. hCG tells your own testes to make more. Both change your hormones and both need medical follow-up.

Where can I talk to others who have tried it? Our WhatsApp peer support groups let you hear what others have tried. Treat their experience as one person’s story, not advice.

If you’re weighing up hCG, take your questions and your records to a doctor first. Our PFS page is a good place to start.

Sources

1. Healy D, Bahrick A, Bak M and colleagues. Diagnostic criteria for enduring sexual dysfunction after treatment with antidepressants, finasteride and isotretinoin. Int J Risk Saf Med 2022;33(1):65-76. Proposed criteria. Section 5: finasteride can also bring cognitive problems, depression and suicidality, which can occur without sexual dysfunction.
2. Propecia 1 mg Film-coated Tablets, patient leaflet, Organon, Electronic Medicines Compendium. Section 4, frequency unknown: “persistent difficulty having an erection after discontinuation of treatment”; persistent decrease in sex drive and persistent problems with ejaculation after discontinuation; breast swelling or tenderness. Section 2: stop and contact your doctor if mood changes.
3. Basaria S, Jasuja R, Huang G and colleagues. Characteristics of men who report persistent sexual symptoms after finasteride use for hair loss. J Clin Endocrinol Metab 2016;101(12):4669-80. Testosterone and DHT did not differ from controls and were within normal ranges.
4. Rainer Q, Pai R, Zucker I, Ramasamy R, Masterson TA. The safety of human chorionic gonadotropin monotherapy among men with previous exogenous testosterone use. Cureus 2022;14(6):e25826. Retrospective chart review, single US clinic, 28 men, no control group. “No VTEs or MACEs were observed.” 15 of 21 men with erectile dysfunction, low libido or low energy reported improvement.
5. Coviello AD, Matsumoto AM, Bremner WJ and colleagues. Low-dose human chorionic gonadotropin maintains intratesticular testosterone in normal men with testosterone-induced gonadotropin suppression. J Clin Endocrinol Metab 2005;90(5):2595-602. Randomised, placebo-controlled; 29 healthy men; three weeks.
6. Efficacy and safety of human chorionic gonadotropin monotherapy for men with hypogonadal symptoms and normal testosterone. 2022. Listed in the earlier version of this article; the page could not be opened to verify its findings on 22 October 2026, so no finding is taken from it.
7. Evidence for, and associated risks with, the human chorionic gonadotropin supplemented diet. J Diet Suppl 2016;13(6):694-9. Analysed what some hCG diet preparations contain; they “may do more harm than good”.
8. GOV.UK. Report a problem with a medicine or medical device.
9. PFS Foundation, Persistent sexual side effects of finasteride (Propecia) for male pattern hair loss, August 2012. Dr Michael Irwig. Background, not evidence about hCG.