Taking Over the Pituitary

November 27th, 2011 § 19 comments

Bob recently asked about using hCG (human chorionic gonadotropin) rather than clomiphene to increase testosterone.  As I explained in How Clomid Works in Men, clomiphene stimulates the pituitary to make luteinizing hormone (LH), which then acts on the Leydig cells in the testis to make testosterone.  So why not use LH directly?

One way to take over the pituitary’s production of its reproductive hormones is to use human chorionic gonadotropin (hCG), which looks like LH to the body.  It effectively stimulates the Leydig cells to make testosterone.  But it’s expensive and must be injected.  So if the pituitary is working, clomiphene may be a better choice to start.  If the pituitary isn’t working, hCG can be tried.  But if the man’s LH is already very high, neither clomiphene or LH will help all that much, as the man’s body is already trying that strategy by itself.

The pituitary also makes follicle stimulating hormone (FSH), which acts on the Sertoli cells around the developing sperm cells.  To help stimulate the making of sperm in the testis, recombinant FSH (rFSH) or human menopausal gonadotropin (hMG) may be used.  Like hCG, these drugs are expensive and must be injected.

Thanks for the question, Bob!

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§ 19 Responses to Taking Over the Pituitary"

  • Kelly says:

    Are there any long term solutions to increasing a man’s low testosterone without decreasing their future fertility? I understand that Clomid is not considered a long term solution.

    • maledoc says:

      Hi Kelly, wander around the other posts on this blog, and you’ll find that while clomiphene is off-label for use in the male, that doesn’t mean that under a doctor’s supervision it can’t be considered to be used long-term.

    • noni says:

      What is your opinion on using both Clomid and hCG at the same time
      for male infertility. And do you have a contact email for my urologist
      to contact you?

  • patientmom says:

    Am I clear in understanding the pituitary must be fully functioning in order for Clomid to raise testosterone levels? What lab tests indicate whether or not the pituitary is working?

    • maledoc says:

      Not necessarily fully functioning, but functioning to some degree. Read through the other posts on this blog to learn about how pituitary hormones are assessed.

  • Bahraimi says:

    Thanks a lot Doc for your clarification 🙂 Awesome Blog

  • Chris Jarvis says:

    Thank you for this blog. It is welcome after sifting through the many questionable HRT sites found through google. As someone on testosterone therapy under medical supervision I would like to offer my two cents worth on a popular subject here – why Dr. Niederberger doesn’t offer free, anonymous, unethical (and illegal) medical advise to individuals. As I am writer on religion rather than science I will use an analogy – in the Asian tradition with which I am most familiar there are three foundations: scriptures, temples and teachers (to me these are roughly comparable to drugs, procedures and doctors). Of these, the teacher is paramount because solo experimentation can be dangerous to oneself and others. I am enjoying learning many things from ‘Male Health’, but, no disrespect intended, ultimately Dr. Niederberger’s recommendations are general and I prefer to listen to the counsel of the two doctors who are very familiar with me personally, whom I pay fees and I have an ongoing client relationship with. I would add that even my having a urologist in Bangkok and an endocrinologist in Vancouver has its downsides.: There will always be differences of opinion. I ask that readers extend the courtesy of not asking the author of this blog to do what he cannot, may not and will not do. It will save reading the repeated “I am sorry I cannot advise”. This is being done for our benefit.

  • Nonlibidoist says:

    This is a useful blog but I notice that you don’t mention libido anywhere, or it just doesn’t show in the tag cloud.

    Have you thought about an post about the effects of testosterone levels on libido and what other factors can affect it? I know they certainly aren’t directly correlated.

    • maledoc says:

      That’s a great point. Libido is so complex, and testosterone is only one part of it. Libido, after all, involves much more than one hormone.

  • Carl says:

    Hi doctor. I heard that hcg has a short half life
    And needs to be injected often,which doesn’t sound very convenient. I also heard if the dosage is to high it can cause the leydig cells to become desensitized. What is a typical
    Dosage for a patient and how often do they need to inject it?

  • Carl says:

    Thanks doctor, I will ask my endo. Another
    Question. When you inject hcg does your body slow down its own LH production?

    • maledoc says:

      A man should always use prescription medications under a doctor’s care. It sounds like you have an endocrinologist, which is great. Part of your doctor’s job is to explain how medications he or she prescribes work.

  • KG says:


    Is there any evidence that a small/diminutive pituitary gland can cause lower testosterone levels ?

    • maledoc says:

      The only way a man would know about his brain anatomy would be if a doctor ordered a test such as an MRI to look at it. In that case, he’d best ask his doctor about why the test was ordered and how hormones may be involved.

  • maledoc says:

    It’s been many years, and I’ve finally turned off comments for this WordPress blog. Why? Although it’s the first question in the FAQ, I still get comments (a bunch a day!) asking personal medical questions that I can’t answer. That’s sad and frustrating for me, because as a doctor, I really like to help patients. But this WordPress site was never meant to deliver personal medical care, and the University lawyers tell me that doing so would run afoul of State and Federal laws.

    If you have specific questions about your own personal care, I urge you as outlined in the FAQ to use the American Urological Association’s Society for the Study of Male Reproduction’s search engine

    I also urge you to read through all of Maledoc.com and especially the comments. For the five or so years that it was active, A lot of excellent questions were asked, including by other healthcare providers. Chances are, if you have a general question, it’s been answered here and more than once.