An unfortunate resurgence of human chorionic gonadotropin use for weight loss

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Some 55 years ago, English physician ATW Simeons1 proposed to treat obesity by administering human chorionic gonadotropin (hCG). Simeons’ protocol involves a combination of up to 6 weeks of a daily low-dose hCG injection and a very-low-calorie-diet (500 kcal per day). Early hCG clinical trials showed mixed results for weight loss; however, in recent decades several randomized controlled trials demonstrated that hCG was no better than placebo, and experts concluded that hCG has no merit for weight loss.2 Thus, the use of hCG for weight loss is discouraged by legitimate clinicians who treat obese patients.3

However, since the publication of a 2007 popular book,4 and most recently the promotion of hCG for weight loss on the Dr Oz television show, some conventional and many alternative medicine clinics have been offering hCG weight loss programs because it is a lucrative business for a prevalent health issue, obesity. Anecdotal stories indicate that many patients are satisfied with these programs because of the success of weight loss, although any weight loss that occurs is very likely due to the hypocaloric diet rather than any effect of hCG per se and as there is usually no weight loss maintenance program provided, weight is quickly regained after the end of the program.

In addition to its lack of efficacy, it is concerning that the hCG dosage administered to obese patients is sufficiently high to cause certain physiological responses, and the quality of hCG used by many ‘obesity clinics’ is unknown. A typical dosage used for weight loss programs is the daily dosage of 150 IU for six times per week or weekly dosage of 1000 IU. In a clinical trial of oocyte production, a daily dose of 200 IU has been successfully used for maintaining late follicular phase as a gonadotropin-releasing hormone antagonist.5 The likelihood that hCG administered for weight loss is having reproductive effects is further suggested by the finding of luteinizing hormone/hCG receptors on various tissues.6, 7 Preliminary studies showed that hCG facilitated decidualization of stromal cells of human endometrium,8 which raises concern of possible leiomyoma formation and exacerbation of endometriosis. For males, animal prostate cells expressed HCG receptor gene upon stimulation, and the authors concluded that luteinizing hormone/hCG receptors are linked to the development of prostatic hyperplasia and prostate carcinomas.9 Carlson et al.10 report that luteinizing hormone/hCG receptor mRNA was found from autopsy archival samples of benign gynecomastia and male breast carcinoma, and suggested that luteinizing hormone and hCG might have a role in the pathogenesis of male breast disorders. At sufficiently high dosage, hCG functions as a growth hormone which modulates the anthropomorphic indicators of older men with partial age-related androgen deficiency.11

Given that hCG has no demonstrated weight loss effects and has potential safety concerns, it is incumbent upon the scientific and clinical community in the obesity field to educate their patients about the lack of efficacy and potential risks of off-label hCG use and to speak out strongly against its use.

References

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    Hamilton M, Greenway F . Evaluating commercial weight loss programmes: an evolution in outcomes research. Obes Rev 2004; 5: 217–232.

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    Trudeau K . The Weight Loss Cure ‘They’ Don’t want you to Know About. Alliance Publishing Group, Inc.: Elk Grove Village, IL, 2007.

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    Blockeel C, De Vos M, Verpoest W, Stoop D, Haentjens P, Devroey P . Can 200 IU of hCG replace recombinant FSH in the late follicular phase in a GnRH-antagonist cycle? A pilot study. Hum Reprod 2009; 24: 2910–2916.

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    Rao CV . Human adrenal LH/hCG receptors and what they could mean for adrenal physiology and pathology. Mol Cell Endocrinol 2010; 329: 33–36.

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    Rao CV . Physiological and pathological relevance of human uterine LH/hCG receptors. J Soc Gynecol Investig 2006; 13: 77–78.

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    Tao YX, Bao S, Ackermann DM, Lei ZM, Rao CV . Expression of luteinizing hormone/human chorionic gonadotropin receptor gene in benign prostatic hyperplasia and in prostate carcinoma in humans. Biol Reprod 1997; 56: 67–72.

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    Carlson HE, Kane P, Lei ZM, Li X, Rao CV . Presence of luteinizing hormone/human chorionic gonadotropin receptors in male breast tissues. J Clin Endocrinol Metab 2004; 89: 4119–4123.

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    Liu PY, Wishart SM, Handelsman DJ . A double-blind, placebo-controlled, randomized clinical trial of recombinant human chorionic gonadotropin on muscle strength and physical function and activity in older men with partial age-related androgen deficiency. J Clin Endocrinol Metab 2002; 87: 3125–3135.

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Correspondence to J C Lovejoy.

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The authors declare no conflict of interest.

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Lovejoy, J., Sasagawa, M. An unfortunate resurgence of human chorionic gonadotropin use for weight loss. Int J Obes 36, 385–386 (2012) doi:10.1038/ijo.2011.188

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