Men's Health · Gonadotropin · Compounded 503A
HMG: FSH + LH activity for male fertility.
Human menopausal gonadotropin (HMG) — also called menotropin — is a purified gonadotropin preparation containing both FSH and LH activity. In male fertility medicine it is used alongside HCG to stimulate full spermatogenesis when HCG alone is insufficient — the FSH component is what drives Sertoli-cell-mediated sperm production.
What HMG is
HMG is a purified gonadotropin extract from the urine of postmenopausal women, containing approximately equal FSH and LH activity per ampule. It is the original gonadotropin preparation, in clinical use since the 1950s.
Recombinant FSH (Gonal-F, Follistim) and recombinant LH (Luveris) are also available and offer higher purity, but HMG remains widely used because of cost and the natural FSH:LH ratio it provides.
In men's-health fertility practice, HMG is added to HCG when HCG monotherapy fails to produce adequate sperm counts — typically in men with profound or longstanding hypogonadotropic hypogonadism.
How it works
The LH component of HMG binds Leydig-cell LH receptors and stimulates testosterone production — the same action as HCG.
The FSH component binds Sertoli-cell FSH receptors and supports the cellular machinery of spermatogenesis — converting spermatogonia through to mature spermatozoa over the ~74-day spermatogenic cycle.
In hypogonadotropic men, HCG alone restores intratesticular testosterone and may produce some sperm in time. Adding HMG provides the missing FSH signal, accelerating and more reliably restoring spermatogenesis.
What patients use it for
Direct FSH replacement
Provides the FSH signal that is missing in hypogonadotropic men — HCG alone cannot replicate this.
Accelerated sperm recovery
When added to HCG, restores sperm counts faster and more reliably than HCG monotherapy in men with severe GnRH-axis suppression.
Natural FSH:LH ratio
Approximately 1:1 FSH:LH activity matches the physiologic gonadotropin balance — useful when both activities are wanted.
Established efficacy
Decades of clinical experience in male fertility induction and ART (assisted reproductive technology) cycles.
Evidence summary
Liu PY et al. (Lancet, 2006) systematic review of gonadotropin therapy in hypogonadotropic hypogonadism — HCG + FSH (HMG or recombinant FSH) reliably induces spermatogenesis in 70–95% of men.
Warne DW et al. (Fertil Steril, 2009) — multicenter study of HMG and recombinant FSH in hypogonadotropic male fertility induction.
Esteves SC et al. (Andrology, 2020) reviewed current gonadotropin protocols for male hypogonadotropic hypogonadism.
Dosing and clinical context
General clinical context only. Kindr Health physicians determine the appropriate dose and protocol for each patient based on history and labs. This is not a prescription or dosing recommendation.
Subcutaneous or IM injection, typically 2–3x weekly.
Almost always added to HCG (HCG alone first; HMG added at 3–6 months if sperm has not appeared or counts remain inadequate).
Treatment courses are long — full spermatogenic recovery often takes 6–24 months.
Safety and contraindications
Generally well tolerated. Possible: injection-site reactions, mild gynecomastia (estradiol rise from testicular aromatization), mood changes.
Rare: hypersensitivity reactions (HMG contains urinary protein impurities — recombinant FSH preferred in patients with prior allergic reactions).
Periodic semen analysis and hormone labs (testosterone, estradiol, FSH, LH) guide titration.
Compounded HMG is available through licensed 503A pharmacies; branded preparations (Menopur) are FDA-approved for female infertility and used off-label in men.
Who it's typically considered for
- Men with hypogonadotropic hypogonadism attempting fertility induction
- Men on HCG monotherapy with inadequate sperm response after 6 months
- Men with congenital GnRH deficiency (Kallmann syndrome) building fertility
- Post-TRT 'restart' patients with persistent azoospermia
Frequently asked questions
HMG vs HCG?
HCG provides LH activity (Leydig cell / testosterone). HMG provides both FSH and LH activity (Sertoli + Leydig / sperm + testosterone). Most fertility protocols start with HCG; HMG is added if needed.
HMG vs recombinant FSH?
Both work. Recombinant FSH is purer (no urinary protein), more expensive, and more consistent dose-to-dose. HMG is cheaper and provides natural FSH:LH ratio.
How long until I have sperm?
Spermatogenesis takes ~74 days. In hypogonadotropic men starting from azoospermia, sperm typically appears in semen by 6–12 months with combined HCG + HMG.
Do I need HMG if my LH and FSH are normal?
No. HMG is for men with low gonadotropins (hypogonadotropic hypogonadism). Men with primary testicular failure (high LH/FSH, low T) cannot be helped by HMG.
Can HMG help if HCG alone is working?
If HCG monotherapy has restored adequate sperm counts, HMG is not needed. Adding it doesn't usually improve already-adequate response.
Is HMG FDA-approved for men?
FDA-approved labeling is for female infertility. Use in male fertility is off-label but well-supported by literature and standard endocrine practice.
Sources
- Liu PY et al. Induction of spermatogenesis during gonadotropin treatment of gonadotropin-deficient infertile men. Lancet (2006). — pubmed.ncbi.nlm.nih.gov/16753485
- Warne DW et al. A combined analysis of data to identify predictive factors for spermatogenesis in men with hypogonadotropic hypogonadism. Fertil Steril (2009). — pubmed.ncbi.nlm.nih.gov/18554591
- Esteves SC et al. Reproductive outcomes of testicular versus ejaculated sperm for ICSI. Andrology (2020). — pubmed.ncbi.nlm.nih.gov/31692249
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Medically reviewed by Dr. Ana Lisa Carr, MD, MBA
Board-Certified Family Medicine Physician · Lead Provider / Medical Reviewer
NPI 1689841744 · Last reviewed: May 10, 2026
Last reviewed May 10, 2026. Compounded medications are prepared by FDA-registered 503A pharmacies and are not FDA-approved drug products. Prescriptions require a clinical evaluation; a Kindr Health physician determines eligibility. Not for use in pregnancy. This page provides educational information and is not medical advice.