HCG & Gonadorelin Pricing: April 2026

HCG (human chorionic gonadotropin) and gonadorelin are the two most common add-ons to testosterone replacement therapy (TRT). Testosterone taken as a drug shuts down the body's own brain-to-testes signaling chain, called the HPG axis, so the testes can shrink and fertility can drop. Both drugs are prescribed to prevent that.

How they differ: HCG works downstream: it mimics luteinizing hormone (LH) and binds LH receptors on the Leydig cells of the testes. That drives testosterone and sperm production even when the pituitary is shut down. Gonadorelin works upstream: it is a synthetic copy of GnRH, a 10-amino-acid peptide, and it prompts the pituitary gland to release LH and FSH, which then signal the testes. That comes closer to the body's natural pulsed hormone rhythm.

HCG status (April 2026): HCG became a biologic under the BPCIA transition on March 23, 2020, and biologics cannot be made by 503A or 503B compounding pharmacies. A 503A pharmacy compounds patient-specific prescriptions, while a 503B facility compounds in bulk. So HCG is legally sold only as the FDA-approved brands Novarel and Pregnyl. Supply has been spotty since 2020, with shortages reported through 2026, because only a handful of 503B facilities keep access to the approved brand supply. In the latest survey, about 5 of 81 FDA-approved 503B pharmacies offered HCG.

Gonadorelin status: Gonadorelin is on the FDA's 503A Category 1 bulk drug substances list, which means pharmacies can compound it with a valid prescription. Its original approved brands, Factrel and LutrePulse, were discontinued, but 503A and 503B compounders can legally prepare it. Since HCG compounding ended, gonadorelin has become the dominant TRT add-on in the US.

Typical dosing: HCG is 250-500 IU under the skin 2-3 times a week as a TRT add-on, and fertility protocols go as high as 1,500-3,000 IU twice a week. Gonadorelin is 100-200 mcg under the skin 2-3 times a week in the common TRT protocol, though some protocols use tiny doses twice a day to mimic natural pulsing.

Insurance: Rarely covers either drug as a TRT or hypogonadism add-on. HCG has FDA-approved uses for female infertility and for undescended testes in boys (prepubertal cryptorchidism), so coverage is more likely for those conditions. Most TRT patients pay out of pocket. Both need a prescription and neither is sold over the counter, but both are HSA/FSA eligible with that prescription.