Human Chorionic Gonadotropin

Scientific Name(s): Human chorionic gonadotropin

Common Name(s): hCG , Simeons diet , Simeons therapy

Uses

Existing evidence does not support the use of human chorionic gonadotropin (hCG) in weight reduction, and the use of hCG for this purpose is not supported by the American Medical Association (AMA) or the American Society of Bariatric Physicians. Homeopathic preparations of hCG do not contain significant amount of the active ingredient, and clinical trials have not been conducted to provide evidence for effect.

Dosing

Recommendations for dosing for indications other than those approved for hCG cannot be made because evidence to support efficacy is lacking.

Contraindications

Precocious puberty, prostatic carcinoma or other androgen-dependent neoplasia, prior allergic reaction to chorionic gonadotropin, and pregnancy.

Pregnancy/Lactation

hCG is contraindicated in pregnant women. Avoid use in lactation.

Interactions

None well documented.

Adverse Reactions

Arterial thromboembolism, headache, irritability and other CNS symptoms, genitourinary effects, and hypersensitivity have been reported.

Toxicology

Defects of forelimbs and the CNS, as well as alterations in sex ratio, have been reported in mice on combined gonadotropin and hCG regimens. No mutagenic effect has been clearly established in humans.

hCG is prepared from the urine of pregnant women. It can also be produced via recombinant DNA/genetic modification techniques. 1

History

In the 1950s, the endocrinologist Dr. Albert Simeons promoted the use of hCG together with an ultra-low calorie diet (500 calories per day) as a weight loss strategy in which the body would preferentially burn stored fat from the stomach, hips, and thighs without causing undesirable loss of muscle tissue, hunger, or irritability.

Following the publication of trials refuting its efficacy and including adverse events, the use of hCG fell out of favor. In 1995 the US Food and Drug Administration required labeling and advertising of hCG to state that there was no evidence of efficacy in weight reduction. Homeopathic drops and lozenges containing the “energetic imprint” of hCG have been promoted via the Internet. 2 , 3

Chemistry

hCG is a water soluble glycoprotein hormone derived from the urine of pregnant women. It is produced by the developing embryo after conception and later by the placenta. 1

Uses and Pharmacology

The action of hCG is virtually identical to that of pituitary luteinizing hormone, although hCG appears to have a small degree of follicle-stimulating hormone activity as well. It stimulates production of gonadal steroid hormones by stimulating the testis to produce androgens and the corpus luteum of the ovary to produce progesterone. 1 Approved indications for the use of hCG are prepubertal cryptorchidism, hypogonadism, and ovulation induction.

Obesity/weight loss

hCG has not been demonstrated to be effective adjunctive therapy in the treatment of obesity, and it is the position of the American Society of Bariatric Physicians that hCG cannot be recommended for weight loss. 4

Animal data

Animal studies are lacking for the use of hCG in obesity, and based on evidence from clinical trials, would now be redundant.

Clinical data

A meta-analysis of clinical trials conducted up to 1995 found no evidence of effect for hCG in weight loss, redistribution of fat, or sense of hunger or well-being, beyond that resulting from caloric restriction. 5 There have been no published quality clinical trials since the meta-analysis, and no clinical trials have been published using either homeopathic drops or lozenges. 3

Dosage

Recommendations for dosing for indications other than those approved for HhCG cannot be made as evidence to support efficacy is lacking. Trials used 125 units of hCG daily for 6 days out of 7 over a 6-week period for weight reduction. 5 , 6

Homeopathic forms of hCG do not contain sufficient quantities of the active ingredient, and the efficacy of the “energetic imprint” has not been substantiated. 4

Bioavailability of the injection is greater with intravenous delivery than with subcutaneous delivery. 7

Pregnancy/Lactation

Category X . hCG is contraindicated in pregnant women. 1

It is not known whether chorionic gonadotropin is excreted in human milk. 1

Interactions

hCG can crossreact in the radioimmunoassay of gonadotropins. 1

Adverse Reactions

Known adverse reactions include arterial thromboembolism, CNS symptoms (eg, headache, irritability, restlessness, depression, fatigue, aggressive behavior), and genitourinary and hypersensitivity effects, as well as local effects from the injection (eg, pain, edema). 1

The transmission of hepatitis that was historically associated with the use of jet injectors in clinics was resolved by use of single-use disposable syringes. 8 , 9

Toxicology

Defects of forelimbs and the CNS, as well as alterations in sex ratio, have been reported in mice on combined gonadotropin and hCG regimens. The dose of gonadotropins used was intended to induce superovulation. No mutagenic effect has been clearly established in humans. 1

Bibliography

1. Human Chorionic Gonadotrophin. Drug Facts & Comparisons . Facts & Comparisons [database online]. St. Louis, MO: Wolters Kluwer Health Inc; 2005.
2. Robb-Nicholson C. By the way, doctor. I've been trying to lose weight for a long time and nothing seems to work. What do you know about the HCG diet? Harv Womens Health Watch . 2010;17(9):8.
3. Hamilton M, Greenway F. Evaluating commercial weight loss programmes: an evolution in outcomes research. Obes Rev . 2004;5(4):217-232.
4. American College of Bariatric Physicians. Position Statement: Use of HCG in the Treatment of Obesity. http://www.asbp.org/resources/uploads/files/HCG%20Position%20Statement.pdf . Approved December 2009. Accessed May 11, 2011.
5. Lijesen GK, Theeuwen I, Assendelft WJ, Van Der Wal G. The effect of human chorionic gonadotrophin (HCG) in the treatment of obesity by means of the Simeons therapy: a criteria-based meta-analysis. Br J Clin Pharmacol . 1995;40(3):237-243.
6. Young RL, Fuchs RJ, Woltjen MJ. Chorionic gonadotrophin in weight control. A double-blind crossover study. JAMA . 1976;236(22):2495-2497.
7. Chan CC, Ng EH, Chan MM, et al. Bioavailability of hCG after intramuscular or subcutaneous injection in obese and non-obese women. Hum Reprod . 2003;18(11):2294-2297.
8. Canter J, Mackey K, Good LS, et al. An outbreak of hepatitis B associated with jet injections in a weight reduction clinic. Arch Intern Med . 1990;150(9):1923-1927.
9. Leads from the MMWR. Hepatitis B associated with jet gun injection—California. JAMA . 1986;256(4):446-447.

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