epilepsy might not be allowed to start using this medicine or may require a lower dose of hcg pubergen, pregnyl. this drug should be used with extreme caution in the treatment of prepubescent teenagers in order to reduce the risk of precocious sexual development or premature epiphyseal closure. this type of patients' skeletal maturation should be closely and regularly monitored. both male and female patients who have the following medical conditions must not start a treatment with hcg pubergen, pregnyl: (1) hypersensitivity to this drug or to any of its main ingredients. (2) known or possible androgen-dependent tumors for example male breast carcinoma or prostatic carcinoma. anabolic steroid adjunct in the world of performance-enhancing drugs, hcg is increasingly used in combination with various anabolic-androgenic steroid (aas) cycles. as a result, hcg is included in some sports' illegal drug lists. when exogenous aas are put into the male body, natural negative-feedback loops cause the body to shut down its own production of testosterone via shutdown of the hypothalamic-pituitary-gonadal axis (hpga). this causes testicular atrophy, among other things. hcg is commonly used during and after steroid cycles to maintain and restore testicular size as well as normal testosterone production. high levels of aass, that mimic the body's natural testosterone, trigger the hypothalamus to shut down its production of gonadotropin-releasing hormone (gnrh) from the hypothalamus. without gnrh, the pituitary gland stops releasing luteinizing hormone (lh). lh normally travels from the pituitary via the blood stream to the testes, where it triggers the production and release of testosterone. without lh, the testes shut down their production of testosterone. in males, hcg helps restore and maintain testosterone production in the testes by mimicking lh and triggering the production and release of testosterone. if hcg is used for too long and in too high a dose, the resulting rise in natural testosterone and estrogen would eventually inhibit endogenous production of luteinizing hormone via negative feedback on the hypothalamus and pituitary gland. professional athletes who have tested positive for hcg have been temporarily banned from their sport, including a 50-game ban from mlb for manny ramirez in 2009 and a 4-game ban from the nfl for brian cushing for a positive urine test for hcg. mixed martial arts fighter dennis siver was fined $19,800 and suspended 9 months for being tested positive after his bout at ufc 168. hcg diet british endocrinologist albert t. w. simeons proposed hcg as an adjunct to an ultra-low-calorie weight-loss diet (fewer than 500 calories). simeons, while studying pregnant women in india on a calorie-deficient diet, and "fat boys" with pituitary problems (frölich's syndrome) treated with low-dose hcg, observed that both lost fat rather than lean (muscle) tissue. he reasoned that hcg must be programming the hypothalamus to do this in the former cases in order to protect the developing fetus by promoting mobilization and consumption of abnormal, excessive adipose deposits. simeons in 1954 published a book entitled pounds and inches, designed to combat obesity. simeons, practicing at salvator mundi international hospital in rome, italy, recommended low-dose daily hcg injections (125 iu) in combination with a customized ultra-low-calorie (500 cal/day, high-protein, low-carbohydrate/fat) diet, which was supposed to result in a loss of adipose tissue without loss of lean tissue. other researchers did not find the same results when attempting experiments to confirm simeons' conclusions, and in 1976 in response to complaints the fda required simeons and others to include the following disclaimer on all advertisements: these weight reduction treatments include the injection of hcg, a drug which has not been approved by the food and drug administration as safe and effective in the treatment of obesity or weight control. there is no substantial evidence that hcg increases weight loss beyond that resulting from caloric restriction, that it causes a more attractive or "normal" distribution of fat, or that it decreases the hunger and discomfort associated with calorie-restrictive diets.— 1976 fda-mandated disclaimer for hcg diet advertisements there was a resurgence of interest in the "hcg diet" following promotion by kevin trudeau, who was banned from making hcg diet weight-loss claims by the u.s. federal trade commission in 2008, and eventually jailed over such claims. a 1976 study in the american journal of clinical nutrition concluded that hcg is not more effective as a weight-loss aid than dietary restriction alone. a 1995 meta analysis found that studies supporting hcg for weight loss were of poor methodological quality and concluded that "there is no scientific evidence that hcg is effective in the treatment of obesity; it does not bring about weight-loss or fat-redistribution, nor does it reduce hunger or induce a feeling of well-being". on november 15, 2016, the american medical association (ama) passed policy that "the use of human chorionic gonadotropin (hcg) for weight loss is inappropriate." there is no scientific evidence that hcg is effective in the treatment of obesity. the meta-analysis found insufficient evidence supporting the claims that hcg is effective in altering fat-distribution, hunger reduction, or in inducing a feeling of well-being. the authors stated "…the use of hcg should be regarded as an inappropriate therapy for weight reduction…" in the authors opinion, "pharmacists and physicians should be alert on the use of hcg for simeons therapy. the results of this meta-analysis support a firm standpoint against this improper indication. restraints on physicians practicing this therapy can be based on our findings."— american society of bariatric physicians' commentary on lijesen et al. (1995) according to the american society of bariatric physicians, no new clinical trials have been published since the definitive 1995 meta-analysis. the scientific consensus is that any weight loss reported by individuals on an "hcg diet" may be attributed entirely to the fact that such diets prescribe calorie intake of between 500 and 1,000 calories per day, substantially below recommended levels for an adult, to the point that this may risk health effects associated with malnutrition. homeopathic hcg for weight control controversy about, and shortages of, injected hcg for weight loss have led to substantial internet promotion of "homeopathic hcg" for weight control. the ingredients in these products are often obscure, but if prepared from true hcg via homeopathic dilution, they contain either no hcg at all or only trace amounts. moreover, it is highly unlikely that oral hcg is bioavailable due to the fact that digestive protease enzymes and hepatic metabolism renders peptide-based molecules (such as insulin and human growth hormone) biologically inert. hcg can likely only enter the bloodstream through injection. the united states food and drug administration has stated that over-the-counter products containing hcg are fraudulent and ineffective for weight loss. they are also not protected as homeopathic drugs and have been deemed illegal substances. hcg is classified as a prescription drug in the united states and it has not been approved for over-the-counter sales by the fda as a weight loss product or for any other purposes, and therefore neither hcg in its pure form nor any preparations containing hcg may be sold legally in the country except by prescription. in december 2011, fda and ftc started to take actions to pull unapproved hcg products from the market. in the aftermath, some suppliers started to switch to "hormone-free" versions of their weight loss products, where the hormone is replaced with an unproven mixture of free amino acids or where radionics is used to transfer the "energy" to the final product. tetanus vaccine conspiracy theory catholic bishops in kenya are among those who have spread a conspiracy theory asserting that hcg forms part of a covert sterilization program, forcing denials from the kenyan government. in order to induce a stronger immune response, some versions of human chorionic gonadotropin-based anti-fertility vaccines were designed as conjugates of the β subunit of hcg covalently linked to tetanus toxoid. it was alleged that a non-conjugated tetanus vaccine used in developing countries was laced with a human chorionic gonadotropin-based anti-fertility drug and was distributed as a means of mass sterilization. this charge has been vigorously denied by the world health organization (who) and unicef. others have argued that a hcg-laced vaccine could not possibly be used for sterilization, since the effects of the anti-fertility vaccines are reversible (requiring booster doses to maintain infertility) and a non-conjugated vaccine is likely to be ineffective. finally, independent testing of the tetanus vaccine by kenya's health authorities revealed no traces of the human chorionic gonadotropin hormone.