Editing Human chorionic gonadotropin (section)

==Uses==

===Tumor marker===
Human chorionic gonadotropin can be used as a [[tumor marker]],<ref>{{cite web|title=Tumor Markers Found in Blood or Urine|url=http://www.cancer.org/treatment/understandingyourdiagnosis/examsandtestdescriptions/tumormarkers/tumor-markers-t-m-blood-urine|publisher=American Cancer Society|access-date=21 January 2014|archive-date=6 March 2014|archive-url=https://web.archive.org/web/20140306072557/http://www.cancer.org/treatment/understandingyourdiagnosis/examsandtestdescriptions/tumormarkers/tumor-markers-t-m-blood-urine|url-status=dead}}</ref> as its β subunit is secreted by some [[cancer]]s including [[seminoma]], [[choriocarcinoma]], [[teratoma]] with elements of [[choriocarcinoma]], other [[germ cell tumor]]s, [[hydatidiform mole]], and [[islet cell tumor]]. For this reason, a positive result in males can be a test for [[testicular cancer]]. The normal range for men is between 0-5 mIU/mL. Combined with [[alpha-fetoprotein]], β-HCG is an excellent tumor marker for the monitoring of [[germ cell tumor]]s.<ref>{{Cite web|date=2010-06-07|title=Tumor Markers for Testicular Cancer and Extragonadal Germ Cell Tumors in Teenage Boys and Men|url=https://www.cancer.net/research-and-advocacy/asco-care-and-treatment-recommendations-patients/tumor-markers-testicular-cancer-and-extragonadal-germ-cell-tumors-teenage-boys-and-men|access-date=2021-02-16|website=Cancer.Net|language=en|archive-date=2021-03-03|archive-url=https://web.archive.org/web/20210303091015/https://www.cancer.net/research-and-advocacy/asco-care-and-treatment-recommendations-patients/tumor-markers-testicular-cancer-and-extragonadal-germ-cell-tumors-teenage-boys-and-men|url-status=dead}}</ref> <!-- it would be helpful to have somewhere a complete list of tumors (by histology) that secrete βHCG. -->

===Fertility===
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Human chorionic gonadotropin injection is extensively used for [[final maturation induction]] in lieu of [[luteinizing hormone]]. In the presence of one or more mature ovarian follicles, ovulation can be triggered by the administration of HCG. As [[ovulation]] will happen between 38 and 40 hours after a single HCG injection,<ref>[http://www.medscape.com/viewarticle/473515 HCG Injection After Ovulation Induction With Clomiphene Citrate] at Medscape. By Peter Kovacs. Posted: 04/23/2004</ref> procedures can be scheduled to take advantage of this time sequence,<ref name=ivf.com>{{cite web | title = Ovulation Induction | url = http://www.ivf.com/ovind.html | work = IVF.com | archive-url = https://web.archive.org/web/20120226141802/http://www.ivf.com/ovind.html | archive-date=2012-02-26 | access-date = 7 March 2010 }}</ref>{{Unreliable medical source|date=December 2011}} such as [[intrauterine insemination]] or sexual intercourse. Also, patients that undergo [[IVF]], in general, receive HCG to trigger the ovulation process, but have an [[oocyte retrieval]] performed at about 34 to 36 hours after injection, a few hours before the eggs actually would be released from the ovary.{{cn|date=September 2023}}

As hCG supports the [[corpus luteum]], administration of hCG is used in certain circumstances to enhance the production of [[progesterone]].

Several vaccines against human chorionic gonadotropin (hCG) for the prevention of pregnancy are currently in clinical trials.<ref name="Talwar_2015">{{cite journal | vauthors = Talwar GP, Gupta JC, Rulli SB, Sharma RS, Nand KN, Bandivdekar AH, Atrey N, Singh P | title = Advances in development of a contraceptive vaccine against human chorionic gonadotropin | journal = Expert Opinion on Biological Therapy | volume = 15 | issue = 8 | pages = 1183–1190 | year = 2015 | pmid = 26160491 | doi = 
10.1517/14712598.2015.1049943 | hdl = 11336/76410 | s2cid = 10315692 | hdl-access = free }}</ref>

====Use in males====
In males, hCG injections are used to stimulate the [[Leydig cell]]s to synthesize [[testosterone]].<ref>{{cite journal | vauthors = Riccetti L, De Pascali F, Gilioli L, Potì F, Giva LB, Marino M, Tagliavini S, Trenti T, Fanelli F, Mezzullo M, Pagotto U, Simoni M, Casarini L | title = Human LH and hCG stimulate differently the early signalling pathways but result in equal testosterone synthesis in mouse Leydig cells in vitro | journal = Reproductive Biology and Endocrinology | volume = 15 | issue = 1 | pages = 2 | date = January 2017 | pmid = 28056997 | doi = 10.1186/s12958-016-0224-3 | pmc = 5217336 | doi-access = free }}</ref> The intratesticular testosterone is necessary for [[spermatogenesis]] from the [[sertoli cells]]. Typical medical uses for hCG in males include treating certain types of [[hypogonadism]] (either as monotherapy, or, more commonly, in combination with [[Testosterone (medication)|exogenous testosterone]]), as well as to either treat or prevent infertility, for example, during testosterone replacement therapy hCG is often used to restore or maintain fertility and prevent testicular atrophy.<ref>{{cite journal | vauthors = Kim ED, Crosnoe L, Bar-Chama N, Khera M, Lipshultz LI | title = The treatment of hypogonadism in men of reproductive age | journal = Fertility and Sterility | volume = 99 | issue = 3 | pages = 718–724 | date = March 2013 | pmid = 23219010 | doi = 10.1016/j.fertnstert.2012.10.052 | doi-access = free }}</ref><ref name="e876">{{cite journal | vauthors = Lee JA, Ramasamy R | title = Indications for the use of human chorionic gonadotropic hormone for the management of infertility in hypogonadal men | journal = Translational Andrology and Urology | volume = 7 | issue = Suppl 3 | pages = S348–S352 | date = July 2018 | pmid = 30159241 | doi = 10.21037/tau.2018.04.11 | publisher = AME Publishing Company | doi-access = free | pmc = 6087849 }}</ref>

====HCG Pubergen, Pregnyl warnings====
In the case of female patients who want to be treated with HCG Pubergen, Pregnyl:{{cn|date=August 2022}}
a) Since infertile female patients who undergo medically assisted reproduction (especially those who need [[In vitro fertilisation|in vitro fertilization]]), are known to often be suffering from<!-- !  check for tone !--> tubal abnormalities, after a treatment with this drug they might experience many more [[ectopic pregnancies]]. This is why early ultrasound confirmation at the beginning of a pregnancy (to see whether the pregnancy is intrauterine or not) is crucial. Pregnancies that have occurred after a treatment with this drug have a higher risk of [[multiple pregnancy]]. Female patients who have thrombosis, severe obesity, or thrombophilia should not be prescribed this medicine as they have a higher risk of arterial or venous thromboembolic events after or during a treatment with HCG Pubergen, Pregnyl. b)Female patients who have been treated with this medicine are usually more prone to pregnancy losses.{{cn|date=September 2023}}

In the case of male patients: A prolonged treatment with HCG Pubergen, Pregnyl is known to regularly lead to increased production of androgen. Therefore: Patients who have overt or latent cardiac failure, hypertension, renal dysfunction, migraines, or epilepsy might not be allowed to start using this medicine or may require a lower dose of HCG Pubergen, Pregnyl. This drug should be used with extreme caution in the treatment of [[prepubescent]] teenagers in order to reduce the risk of precocious sexual development or premature epiphyseal closure. This type of patients' skeletal maturation should be closely and regularly monitored.{{cn|date=September 2023}}

Both male and female patients who have the following medical conditions must not start a treatment with HCG Pubergen, Pregnyl: (1) Hypersensitivity to this drug or to any of its main ingredients. (2) Known or possible androgen-dependent tumors for example male breast carcinoma or prostatic carcinoma.

===Anabolic steroid adjunct===
HCG is included in some sports' [[Doping in sport|banned substances]] lists.

When exogenous AAS (Anabolic Androgenic Steroids) are put into the male body, natural negative-feedback loops cause the body to shut down its own production of [[testosterone]] via shutdown of the hypothalamic-pituitary-gonadal axis ([[Hypothalamic-pituitary-gonadal axis|HPGA]]). This causes testicular atrophy, among other things. HCG is commonly used during and after steroid cycles to maintain and restore testicular size as well as normal testosterone production.<ref>{{cite news | url = https://www.sfgate.com/sports/article/HCG-helps-steroid-users-restore-testosterone-3162496.php | date = May 8, 2009 | vauthors = Williams L | newspaper = San Francisco Chronicle | title=Manny Ramirez suspended; testosterone ratio exceeded limits; fertility drug reported}}</ref>

High levels of AASs, that mimic the body's natural testosterone, trigger the [[hypothalamus]] to shut down its production of [[gonadotropin-releasing hormone]] (GnRH) from the hypothalamus. Without GnRH, the [[pituitary gland]] stops releasing [[luteinizing hormone]] (LH). LH normally travels from the pituitary via the blood stream to the testes, where it triggers the production and release of testosterone. Without LH, the testes shut down their production of testosterone.<ref name="pmid12740738">{{cite journal | vauthors = van Breda E, Keizer HA, Kuipers H, Wolffenbuttel BH | title = Androgenic anabolic steroid use and severe hypothalamic-pituitary dysfunction: a case study | journal = International Journal of Sports Medicine | volume = 24 | issue = 3 | pages = 195–196 | date = April 2003 | pmid = 12740738 | doi = 10.1055/s-2003-39089 | s2cid = 260166539 }}</ref> In males, HCG helps restore and maintain testosterone production in the testes by mimicking LH and triggering the production and release of testosterone.{{cn|date=November 2024}}

Professional athletes who have tested positive for HCG have been temporarily banned from their sport, including a 50-game ban from [[MLB]] for [[Manny Ramirez]] in 2009<ref>{{cite news|url=https://www.nytimes.com/2009/05/08/sports/baseball/08ramirez.html|title=Manny Ramirez Is Banned for 50 Games|date=May 8, 2009| vauthors = Schmidt MS | newspaper=The New York Times}}</ref> and a 4-game ban from the [[NFL]] for [[Brian Cushing]] for a positive urine test for HCG.<ref name="urlCushing suspended for performance-enhancing drugs | Houston Texans Football | Chron.com - Houston Chronicle">{{cite web | url = http://www.chron.com/disp/story.mpl/sports/fb/texansfront/6995505.html | title = Cushing suspended for performance-enhancing drugs  | vauthors = McClain J | date = 2010-05-12 | work = Houston Texans Football | publisher = Houston Chronicle | access-date = 2010-10-23 }}</ref> [[Mixed Martial Arts]] fighter [[Dennis Siver]] was fined $19,800 and suspended 9 months for being tested positive after his bout at [[UFC 168]].<ref>{{cite news|url=http://www.mmamania.com/2014/4/24/5649056/dennis-siver-fined-suspended-nine-months-positive-drug-test-hcg-ufc-168-mma|title=Dennis Siver fined, suspended nine months for positive drug test following UFC 168|date=April 24, 2014| vauthors = Holland JS |newspaper=MMAMania.com}}</ref> Jurickson Profar tested positive for the substance and was suspended for 80-games on 3/31/2025.<ref>{{cite news|url=https://www.espn.com/mlb/story/_/id/44482019/braves-jurickson-profar-gets-80-game-ban-ped-violation|title=Braves' Jurickson Profar gets 80-game ban for PED violation|date=March 31, 2025| vauthors = Gonzalez A | work=espn.com | access-date=2025-03-31}}</ref>

=== HCG diet ===
British endocrinologist [[Albert T. W. Simeons]] proposed HCG as an adjunct to an ultra-low-calorie weight-loss diet (fewer than 500 calories).<ref name="isbn0-615-42755-3">{{cite book | vauthors = Simeons AT | title = Pounds & Inches: A New Approach To Obesity | publisher = Popular Publishing | year = 2010 | isbn = 978-0-615-42755-3}}</ref> Simeons, while studying pregnant women in India on a calorie-deficient diet, and obese boys with pituitary issues ([[Frölich's syndrome]]) treated with low-dose HCG, observed that both lost fat rather than lean (muscle) tissue.<ref name="isbn0-615-42755-3" /> He reasoned that HCG must be programming the [[hypothalamus]] to do this in the former cases in order to protect the developing fetus by promoting mobilization and consumption of ''abnormal'', ''excessive'' [[adipose]] deposits.  Simeons in 1954 published a book entitled ''Pounds and Inches'', designed to combat obesity. Simeons, practicing at Salvator Mundi International Hospital in Rome, Italy, recommended low-dose daily HCG injections (125&nbsp;IU) in combination with a customized ultra-low-calorie (500 cal/day, high-protein, low-carbohydrate/fat) diet, which was supposed to result in a loss of adipose tissue without loss of lean tissue.<ref name="isbn0-615-42755-3" />

Other researchers did not find the same results when attempting experiments to confirm Simeons' conclusions, and in 1976 in response to complaints the FDA required Simeons and others to include the following disclaimer on all advertisements:<ref>''In the Matter of Simeon Management Corp.'' (Fed. Trade Comm'n, 1976) 87 F.T.C. 1184; affirmed by ''Simeon Management Corp. v. FTC'' (9th Cir. 1978) 579 F.2d 1137, 49 ALR-Fed 1.</ref>

{{quotation|These weight reduction treatments include the injection of HCG, a drug which has not been approved by the Food and Drug Administration as safe and effective in the treatment of obesity or weight control. There is no substantial evidence that HCG increases weight loss beyond that resulting from caloric restriction, that it causes a more attractive or "normal" distribution of fat, or that it decreases the hunger and discomfort associated with calorie-restrictive diets.|1976 FDA-mandated disclaimer for HCG diet advertisements}}

There was a resurgence of interest in the "HCG diet" following promotion by [[Kevin Trudeau]], who was banned  from making HCG diet weight-loss claims by the U.S. [[Federal Trade Commission]] in 2008, and eventually jailed over such claims.<ref name="FTC 2008/10">{{cite web | url = http://www.ftc.gov/opa/2008/10/trudeau.shtm | title = Kevin Trudeau Banned from Infomercials For Three Years, Ordered to Pay More Than $5 Million for False Claims About Weight-Loss Book | date = 6 October 2008 | publisher = Federal Trade Commission | quote = ''FTC v. Trudeau'' (7th Cir., 2009) 579 F.3d 754 remanded (N.D.Ill., 2010) 708 F.Supp.2d 711, affirmed (7th Cir. 2011) 662 F.3d 947, certiorari denied (Oct. 9, 2012) _U.S._, 133 S.Ct. 426, 184 L.Ed.2d 257; and a ten-year prison sentence for violating a court order, ''U.S. v. Trudeau'' (N.D.Ill., Jan. 29, 2014) 2014 u.s.dist. LEXIS 10717, 2014 WL 321373. }}</ref><ref>{{cite journal | vauthors = Bell CB | title = The Curious Case of Kevin Trudeau, King Catch Me If You Can. | journal = Mississippi Law Journal | date = 2009 | volume = 79 | pages = 1043 | url = http://heinonline.org/HOL/Page?handle=hein.journals/mislj79&div=44&g_sent=1&collection=journals#1053 }}</ref>

A 1976 study in the [[American Journal of Clinical Nutrition]]<ref name="pmid786001">{{cite journal | vauthors = Stein MR, Julis RE, Peck CC, Hinshaw W, Sawicki JE, Deller JJ | title = Ineffectiveness of human chorionic gonadotropin in weight reduction: a double-blind study | journal = The American Journal of Clinical Nutrition | volume = 29 | issue = 9 | pages = 940–948 | date = September 1976 | pmid = 786001 | doi = 10.1093/ajcn/29.9.940 | doi-access = free }}</ref> concluded that HCG is not more effective as a weight-loss aid than dietary restriction alone.<ref name="urlHCG Worthless as Weight-Loss Aid">{{cite web | url = http://www.dietscam.org/reports/hcg.shtml | title = HCG Worthless as Weight-Loss Aid | vauthors = Barrett S | work = Diet Scam Watch | publisher = dietscam.org | access-date = 2009-02-03 | archive-date = 2009-01-20 | archive-url = https://web.archive.org/web/20090120183842/http://dietscam.org/reports/hcg.shtml | url-status = dead }}</ref>

A 1995 meta analysis found that studies supporting HCG for weight loss were of poor methodological quality and concluded that "there is no scientific evidence that HCG is effective in the treatment of obesity; it does not bring about weight-loss or fat-redistribution, nor does it reduce hunger or induce a feeling of well-being".<ref name="pmid8527285">{{cite journal | vauthors = Lijesen GK, Theeuwen I, Assendelft WJ, Van Der Wal G | title = The effect of human chorionic gonadotropin (HCG) in the treatment of obesity by means of the Simeons therapy: a criteria-based meta-analysis | journal = British Journal of Clinical Pharmacology | volume = 40 | issue = 3 | pages = 237–243 | date = September 1995 | pmid = 8527285 | pmc = 1365103 | doi = 10.1111/j.1365-2125.1995.tb05779.x }}</ref>

On November 15, 2016, the [[American Medical Association]] (AMA) passed policy that "The use of human chorionic gonadotropin (HCG) for weight loss is inappropriate."<ref>{{Cite news|url=https://globenewswire.com/news-release/2016/11/15/890309/10166002/en/Obesity-Medicine-Association-Applauds-American-Medical-Association-s-Decision-to-Adopt-New-Anti-HCG-Policy.html|title=Obesity Medicine Association Applauds American Medical Association's Decision to Adopt New Anti-HCG Policy|date=15 November 2016 | publisher = Obesity Medicine Association | via = GlobeNewswire News Room|language=en-US|access-date=2016-11-16}}</ref>

{{quotation|There is no scientific evidence that HCG is effective in the treatment of obesity. The meta-analysis found insufficient evidence supporting the claims that HCG is effective in altering fat-distribution, hunger reduction, or in inducing a feeling of well-being. The authors stated "…the use of HCG should be regarded as an inappropriate therapy for weight reduction…" In the authors opinion, "Pharmacists and physicians should be alert on the use of HCG for Simeons therapy. The results of this meta-analysis support a firm standpoint against this improper indication. Restraints on physicians practicing this therapy can be based on our findings."| American Society of Bariatric Physicians'<ref name="ASBP" /> commentary on Lijesen et al. (1995)<ref name="pmid8527285" />}}

According to the American Society of Bariatric Physicians, no new clinical trials have been published since the definitive 1995 meta-analysis.<ref name="ASBP">{{cite web | url = http://www.asbp.org/resources/uploads/files/HCG%20Position%20Statement.pdf | work = American Society of Bariatric Physicians | archive-url = https://web.archive.org/web/20120511014611/http://www.asbp.org/resources/uploads/files/HCG%20Position%20Statement.pdf | archive-date=2012-05-11 | title = Position statement on HCG diet }}</ref>

The scientific consensus is that any weight loss reported by individuals on an "HCG diet" may be attributed entirely to the fact that such diets prescribe calorie intake of between 500 and 1,000 calories per day, substantially below recommended levels for an adult, to the point that this may risk health effects associated with malnutrition.<ref>{{cite web | url = http://www.mayoclinic.com/health/hcg-diet/AN02091 | title = Does the HCG diet work — and is it safe? | work = [[Mayo Clinic]] }}</ref>

====Homeopathic HCG for weight control====
Controversy about, and shortages<ref name="urlBulletin">{{cite web | url = http://www.ashp.org/DrugShortages/Current/Bulletin.aspx?id=382 | title = Chorionic Gonadotropin (Human) Injection Shortage | date = 2010-10-13 | work = Bulletin | publisher = American Society of Health-System Pharmacists | access-date = 2010-10-23 | archive-date = 2011-09-19 | archive-url = https://web.archive.org/web/20110919004921/http://www.ashp.org/DrugShortages/Current/Bulletin.aspx?id=382 | url-status = dead }}</ref> of, injected HCG for weight loss have led to substantial Internet promotion of "[[homeopathy|homeopathic]] HCG" for weight control. The ingredients in these products are often obscure, but if prepared from true HCG via homeopathic dilution, they contain either no HCG at all or only trace amounts. Moreover, it is highly unlikely that oral HCG is bioavailable due to the fact that digestive protease enzymes and hepatic metabolism renders peptide-based molecules (such as insulin and human growth hormone) biologically inert. HCG can likely only enter the bloodstream through injection.{{cn|date=September 2023}}

The United States [[Food and Drug Administration]] has stated that over-the-counter products containing HCG are fraudulent and ineffective for weight loss. They are also not protected as homeopathic drugs and have been deemed illegal substances.<ref name="urlHCG weight-loss products are fraudulent, FDA says - USATODAY.com">{{cite web | url = https://www.usatoday.com/yourlife/fitness/weight-loss-challenge/2011-01-24-hcgdiet24_ST_N.htm?loc=interstitialskip | title = HCG weight-loss products are fraudulent, FDA says - USATODAY.com | vauthors = Hellmich N | date = 2011-01-23 | publisher = USA Today | access-date = 2011-02-03 }}</ref> HCG is classified as a prescription drug in the United States and it has not been approved for over-the-counter sales by the FDA as a weight loss product or for any other purposes, and therefore neither HCG in its pure form nor any preparations containing HCG may be sold legally in the country except by prescription.<ref name="MedPage20111206" /> In December 2011, FDA and FTC started to take actions to pull unapproved HCG products from the market.<ref name="MedPage20111206" /> In the aftermath, some suppliers started to switch to "hormone-free" versions of their weight loss products, where the hormone is replaced with an unproven mixture of free amino acids<ref>{{cite news|url=http://www.sfgate.com/cgi-bin/article.cgi?f=/g/a/2012/03/08/prweb9258422.DTL|title=Hormone-Free HCG Drops are Quickly Replacing Homeopathic Counterparts|newspaper=San Francisco Chronicle|date=March 9, 2012}}</ref> or where [[radionics]] is used to transfer the "energy" to the final product.{{cn|date=September 2023}}

{{As of|2011|12|6|df=US}}, the United States [[Food and Drug Administration]] has prohibited the sale of [[homeopathy|homeopathic]] and [[over-the-counter drug|over-the-counter]] hCG [[dieting|diet]] products and declared them [[fraud|fraudelent]] and banned.<ref name="MedPage20111206">{{cite news | vauthors = Gever J | date=December 6, 2011 |title=FDA Yanks HCG Weight Loss Agents from Market |url=http://www.medpagetoday.com/ProductAlert/OTC/30042?pfc=101&spc=230 |publisher=[[MedPage Today]] |access-date=December 7, 2011}}</ref><ref>{{cite web |url=https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm281333.htm |archive-url=https://web.archive.org/web/20111208151744/http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm281333.htm |url-status=dead |archive-date=December 8, 2011 |title=HCG Diet Products Are Illegal |publisher=FDA |date=December 6, 2011}}</ref><ref>{{cite press release |title=FDA, FTC act to remove 'homeopathic' HCG weight loss products from the market |publisher=FDA |date=6 December 2011 |url=https://www.ftc.gov/system/files/attachments/press-releases/ftc-charges-hcg-marketer-deceptive-advertising/fda_hcg_products_press_release_12-6-11.pdf |access-date=5 January 2021}}</ref>