There are options for increasing serum testosterone levels in a manner that will not cause testicular atrophy and should maintain sperm production. These options are utilized by some anti-aging centers and are banned by the World Anti-Doping Agency (WADA), the agency that governs sports doping for the Olympics and other groups.14,15

    These options include using agents known to increase testosterone output either by increasing the stimulatory signal to the testicles or reducing the negative feedback at the hypothalamus and pituitary glands. The origins of these drugs stem primarily from fertility medicine, chemotherapy for certain female cancers or prostate enlargement.

    There are three basic groups of drugs that increase testosterone production: gonadotropins, anti-estrogens and 5-a reductase inhibitors. While there is a limit to the overall increase in testosterone, the effect is significant enough to promote muscular development and provide an athletic advantage.15

    Gonadotropins are drugs that mimic the signal produced by the pituitary gland to stimulate the testicles to produce testosterone. This class is represented by human chorionic gonadotropin (hCG). hCG is familiar to many bodybuilders as it is commonly used to accelerate testicular function recovery post-cycle.16 However, the stimulatory effect of hCG not only affects suppressed testicles; it also increases production in normally functioning testicles, resulting in elevated or even supraphysiologic testosterone concentrations. hCG has been documented to increase testosterone in normal men by 10 – 30 nmol and it is possible that slightly greater increases may be possible.17-19 This would result in high-normal to mildly supraphysiologic testosterone levels, roughly equivalent to 200 mg/week of testosterone enanthate. While this is not an exaggerated increase, it is sufficient to provide an anabolic effect. Because this effect is dependent upon having at least one functioning testicle, these drugs are only banned in men. In fact, it is not even tested for in women because the presence of hCG is the basis for pregnancy testing. WADA and other groups believe that a female athlete’s right to privacy would be violated by testing and that such testing is unnecessary as there is no evidence of obtaining a performance advantage in the absence of having testicles.15 Interestingly, hCG is produced in minute amounts in men and women naturally, and in higher levels by certain tumors.