BuserelinvsGonadorelin (GnRH)

Molecular Formula

C₆₀H₈₆N₁₆O₁₃

Molecular Weight

1239.4 g/mol

Half-Life

2-4 hours (subcutaneous), 30-60 minutes (intranasal); longer for depot formulation (28-40 days)

Bioavailability

~1% (oral); ~10-15% (intranasal); ~95% (subcutaneous)

CAS Number

57773-65-6

Molecular Formula

C₅₅H₇₅N₁₇O₁₃

Molecular Weight

1182.3

Half-Life

2-4 minutes

Bioavailability

Varies by route: ~5-20% (intranasal), 100% (IV/IM injections)

CAS Number

34973-08-5

Common

• Mild headache
• Local injection site reactions (redness, swelling)
• Temporary hot flashes
• Mood changes or emotional sensitivity
• Nausea or mild stomach upset
• Allergic skin reactions
• Dizziness or lightheadedness
• Temporary changes in vision
• Joint or muscle aches
• Insomnia or sleep disturbances
• Severe allergic reactions (difficulty breathing, swelling)
• Severe hormonal imbalance symptoms
• Ovarian hyperstimulation syndrome (OHSS)
• Signs of blood clots (chest pain, leg swelling)
• Severe mood changes or depression

Serious

• Severe allergic reaction

Evidence Level

Strong human trials (Phase 3 or FDA approved)

FDA Status

FDA approved for other use

Safety Overview

Buserelin is an FDA-approved GnRH agonist with safety data from Phase 3 trials and decades of clinical use, but carries well-documented risks from intentional testosterone/estrogen suppression. The initial testosterone flare (first 2-3 weeks) can worsen prostate cancer symptoms and cause tumor flare pain in 10-20% of patients. Long-term use causes bone density loss of 2-3% annually, with vertebral fractures in 10-20% of long-term users. Cardiovascular risks include increased MI and stroke in men over 65. Hot flashes affect 40-80%, erectile dysfunction is nearly universal, and liver enzyme elevations occur in 5%. Nasal spray formulation causes local irritation in 20-30% of users.

Contraindications

• xPregnancy or breastfeeding
• xHypersensitivity to GnRH agonists
• xCertain bone diseases when long-term use is planned

Evidence Level

Moderate human trials (Phase 1-2)

FDA Status

FDA approved for this use

Safety Overview

Gonadorelin is native GnRH and carries the safety profile established over 40+ years of clinical use in reproductive endocrinology. As the body's natural hormone, it produces minimal local side effects when dosed appropriately. The critical safety concern with gonadorelin is the initial flare effect within 24-48 hours of first dose—temporary elevation in FSH and LH—which can paradoxically suppress sex hormones before the desired stimulation occurs. This flare makes gonadorelin unsuitable for some conditions and explains why synthetic analogs (agonists, antagonists) are preferred in many modern fertility protocols.

Contraindications

• xPregnancy or breastfeeding
• xHormone-sensitive cancers (breast, prostate, ovarian)
• xSevere pituitary or hypothalamic disease
• xUndiagnosed abnormal vaginal bleeding
• xKnown hypersensitivity to GnRH