What is the role of human chorionic gonadotropin (hCG) in the treatment of cryptorchidism?

Updated: Dec 17, 2020
  • Author: Joel M Sumfest, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

The action of hCG is virtually identical to that of pituitary LH, although hCG also appears to have a small degree of follicle-stimulating hormone (FSH) activity. It stimulates production of gonadal steroid hormones by stimulating the Leydig cells to produce androgens. The exact mechanism of action of the increased androgens in testicular descent is not known but may involve effects on the testicular cord or cremaster muscle. hCG is administered via intramuscular injection.

Multiple series on the efficacy of hCG have been published; however, because of differences in patient age, treatment schedules, and possible inclusion of retractile testes, very divergent results have been reported. A  meta-analysis of hCG treatment of cryptorchidism concluded that hCG treatment is no more effective than placebo. [52]   American Urological Association guidelines recommend against the use of hormonal therapy to induce testicular descent, due to low response rates and lack of evidence for long-term efficacy. [1]

Many dosage schedules have been reported, ranging from 3-15 doses. However, hCG appears to be as effective in 3 or 4 doses as with 9 or 10 doses. One of the most common schedules is 250 IU/dose in young infants, 500 IU/dose in children 6 years or younger, and 1000 IU/dose in individuals older than 6 years given twice a week for 5 weeks (as per the International Health Foundation). [53]

Success rates for descent into the scrotum are 25-55% in uncontrolled studies but only 6-21% in randomized blinded studies. Distally located testes in older boys are more likely to descend in response to hormonal treatment than abdominal testes. Repeated courses have offered little advantage.

Adverse effects of hCG treatment include increased scrotal rugae, pigmentation, pubic hair, and penile growth, which regress after treatment cessation. A total dose of more than 15,000 IU may induce epiphyseal plate fusion and retard future somatic growth.


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