Gonadorelin

The hCG alternative that works from one level higher. Instead of mimicking LH from below, gonadorelin tells the pituitary to produce its own LH and FSH, which keeps the testicular machinery more physiologically engaged. In medicine it is the GnRH stimulation test and, via pulsatile pump, a treatment for congenital hypogonadism. In TRT and cycle support it is prescribed to keep the axis awake while exogenous testosterone is running.

Kisspeptin sits one step above gonadorelin in the cascade, the upstream trigger. HMG sits below, delivering FSH and LH activity directly. Gonadorelin is the middle layer, and it requires a working pituitary to do anything useful.

Good data in congenital hypogonadism with pump delivery. Limited data for the intermittent subcutaneous protocol the community actually runs:

TRT clinics typically prescribe 100 mcg subcutaneous two to three times a week, often timed to injection days for simplicity. Some push to daily dosing. The clinical gold standard is a pulsatile pump delivering 5 to 20 mcg every 60 to 120 minutes, but that is not practical outside a research setting. The intermittent subcutaneous protocol is a pragmatic compromise: enough signal to keep the pituitary responding, not enough to mimic the physiologic pulse pattern.

If you cannot commit to injections multiple times a week, hCG is simpler, better studied, and works with less frequent dosing. If fertility is the actual mission and intermittent subcutaneous gonadorelin is not cutting it, the next step is adding HMG for direct FSH and LH delivery. If you want to stimulate from further upstream, kisspeptin fires the hypothalamus above gonadorelin, though the data for that approach is thinner still.

Generally well tolerated at community doses. The pump protocol carries more exposure: