Why isn’t HCG mandatory for TRT. Doesn’t it effect Penile sensitivity by stimulating the HPTA? Also why would you prescribe a 5AR blocker? That can lead to permanent to semi permanent penile and mental dysfunctions? 5AR is also responsible for like 6-7 other metabolites not just DHT

AlphaMD's Answer

Why would any doctor prescribe warfarin? It’s rat poison and can kill you. Or prednisone, knowing it causes osteoporosis? Or vancomycin to cure sepsis knowing it can cause renal failure?

Practicing medicine is about weighing risks vs. benefits. There are risks of hCG as much as any medicine. It aromatizes at a much higher rate than testosterone, so patients taking it are more likely to suffer side effects. Just do a search here on Reddit and you will hear many cases where men had to quit hCG.

Also, prolonged hCG use causes tachyphylaxis. Prolonged use lowers LH receptor sensitivity, which mean higher doses are needed over time in order to have the same effectiveness (similar to opiates/heroin).

Also, there is no study proving hCG improves penile sensitivity. In fact, the only study on hCG where penile sensitivity was an end point found that any increased sensitivity was due to increased testosterone levels.

Regarding 5AR inhibitors, again, it is a discussion had with patients. The long term risk of sexual dysfunction with Finasteride is 1.4% compared to 0.9% placebo.

Long term (>7 years) use of Finasteride was studied in over 18,882 men. Incidence of sexual dysfunction increased on average only 3 points (on a 0-100 scale), which is equivalent to placebo (due to decreased sexual function associated with aging over 7 years).

For some men having hair or being able to urinate normally is worth the potential 1.4% risk of sexual dysfunction.