(192) Evaluating Effect of hCG and hCG+rFSH Therapy on Ejaculation Disorders in Middle-Aged Men: A Case Study
Authors: Kobayashi H , Uetani M , Nakajima K , Nagao K , Islam N M 
Published: March 2024

Abstract

Introduction
The prevalence of various ejaculation disorders affecting middle-aged and older men has gained increasing attention due to their significant impact on quality of life. One of them, Late-Onset Hypogonadism (LOH) syndrome, can result in a decline in overall well-being. Testosterone replacement therapy (TRT) is commonly used to address LOH; however, it presents challenges such as diminishing endogenous testosterone secretion and incomplete symptom relief.

Objective
This study aimed to investigate the effects of human chorionic gonadotropin (hCG) or hCG plus recombinant follicle-stimulating hormone (rFSH) therapy in patients experiencing ejaculation disorders characterized by low semen volume and decreased pleasure during ejaculation.

Methods
Four male patients, aged 55 to 59 years, complaining of decreased ejaculatory pleasure and low semen volume, were enrolled in the study. One patient received hCG+rFSH therapy, while three patients received hCG alone. The initial dose of hCG was 5,000 units administered twice a week, and if deemed insufficient, it was increased to three times a week. rFSH was administered at a dosage of 150 units three times a week. Levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and estradiol (E2) were measured monthly. Anastrozole (1 mg) was added for patients exhibiting elevated E2 levels.

Results
Case 1: A 58-year-old male. Prior to treatment, testosterone and E2 levels were 4.84 ng/mL and 34.2 pg/mL, respectively. hCG+rFSH therapy resulted in increased testosterone levels (10.2 ng/mL) and elevated E2 levels (109.0 pg/mL) after three months of treatment. Addition of anastrozole resulted in testosterone levels of 10.90 ng/mL and E2 levels of 57.9 pg/mL in the following month. The patient experienced improved sexual desire, increased semen volume, and hair loss as a side effect. Treatment was discontinued after six months. Case 2: A 57-year-old male with diabetes mellitus. Pre-treatment testosterone and E2 levels were 2.19 ng-mL and 21.9 pg/mL, respectively. After changing the hCG dosage to 5,000 units three times a week, testosterone levels reached 5.33 ng/mL and E2 levels increased to 72.8 pg/mL after two months. With the addition of anastrozole four months into treatment, E2 levels were 44.4 pg/mL after five months. The patient reported improved morning erections, increased libido, increased semen volume, and improved glycemic control (HbA1c decreased from 9.0 to 7.0). Case 3: A 55-year-old male. Pre-treatment testosterone and E2 levels were 4.99 ng/mL and 32.3 pg/mL, respectively. In the first month of hCG therapy, testosterone levels increased to 13.6 ng/mL, while E2 levels rose to 75.5 pg/mL. Then, despite testosterone remaining in the 9.0–10.0 ng/mL range, E2 levels increased to 100 pg/mL. With the addition of anastrozole in the fifth month, the patient reported increased semen volume thereafter. Case 4: A 59-year-old male with a history of bipolar disorder. Prior to treatment, testosterone and E2 levels were 2.45 ng/mL and 23.0 pg/mL, respectively. hCG therapy resulted in testosterone levels of 6.71 ng/ml and E2 levels of 51.0 pg/mL after two months.

Conclusions
This case study highlights the outcomes of hCG or hCG+rFSH therapy in middle-aged men experiencing ejaculation disorders.

Disclosure
No.