The FDA-approved fertility gonadotropin (Menopur, Ferring) used in IVF stimulation, male hypogonadotropic hypogonadism, and off-label after TRT cessation. Combination of FSH and LH-like activity — with a real pharmacology nuance: per the FDA label, that LH-like activity is largely hCG, not LH itself.
Human Menopausal Gonadotropin (HMG), generic name menotropins, is a urine-derived gonadotropin extracted from postmenopausal women’s urine and processed to deliver roughly equal FSH and LH activity. The current US standard is Menopur (Ferring Pharmaceuticals, NDA 21-663, FDA-approved October 29, 2004), supplied as 75 IU FSH + 75 IU LH activity per vial. Older formulations included Pergonal and Repronex.
Important pharmacology nuance. Per Menopur FDA label Section 11: “Human Chorionic Gonadotropin (hCG) is detected in Menopur.” Approximately 95% of the LH-receptor signaling in HMG comes from co-isolated hCG (which the donor pool naturally contains because of pregnant donors), not LH itself. This isn’t a quality issue — the receptor activity is real and the same — but it explains why HMG and pure-hCG share so much pharmacology in male-fertility contexts.
FDA-approved (Menopur, NDA 21-663). Prescription-only; in practice usually requires fertility-specialist or endocrinologist oversight. Not WADA-listed by name, but gonadotropins fall under WADA S2.3 (Growth Factors and Growth Factor Modulators) and HMG-class agents are not permitted for athletes in or out of competition.
The current Menopur label (since 2014) approves HMG for controlled ovarian stimulation in IVF/ART in ovulatory women, after pituitary suppression with a GnRH agonist. Anovulatory ovulation induction was dropped from the modern US Menopur label (still indicated on some EU labels and historically on US menotropins). The label’s “Initial U.S. Approval: 1975” refers to the menotropins drug class (Pergonal era), not Menopur specifically.
Approved IVF dosing per Menopur Section 2:
Male hypogonadotropic hypogonadism (HH) is not on the Menopur US label but is a recognized off-label use supported by reproductive endocrinology guidelines. HMG (with hCG) is used to induce spermatogenesis in HH patients who want fertility — the classic protocol is hCG to drive intratesticular testosterone, then add HMG once hCG alone fails to induce sperm production.
Drives granulosa-cell proliferation and follicle maturation in ovaries; supports Sertoli cells and spermatogenesis in testes. Half-life ~11–13 hours per Menopur Section 12.3, so once-daily dosing builds steady levels over 3–5 days.
Drives theca-cell androgen synthesis and luteinization in ovaries; drives Leydig-cell intratesticular testosterone in men. The hCG-rich nature of HMG’s LH activity is why the LH-receptor signaling is more sustained than recombinant LH (the long hCG half-life carries over).
Pure recombinant FSH (Gonal-F, Follistim) lacks LH activity. For patients with low endogenous LH (older women in IVF, men with HH), the combined FSH+LH signaling matters. Cochrane meta-analyses (van Wely 2011, PMID 21328276; Coomarasamy 2008, PMID 18056719) show HMG produces a modest live-birth advantage over rFSH in IVF (RR ~1.18), though the effect size is debated.
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Start Tracking FreeHMG isn’t labeled for male use in the US, but the reproductive-endocrinology literature on it is real and the protocols have been used clinically for decades. Two distinct contexts:
Men with HH (Kallmann, post-pituitary surgery, etc.) start with hCG monotherapy 1500–3000 IU 2–3×/wk SC for ~3–6 months. If sperm fail to appear, HMG 75–150 IU 3×/wk SC is added. Most men eventually develop sperm in the ejaculate; pregnancies are achievable. Liu 2009 (PMID 19066302) is the prospective predictor study.
Exogenous testosterone suppresses HPT-axis signaling. After cessation, recovery can take months to years; some men don’t recover spontaneously. Off-label protocols use hCG (with or without HMG, with or without a SERM like clomiphene or tamoxifen) to drive intratesticular testosterone and sperm production. Wenker 2015 retrospective and the Endocrine Society 2018 testosterone guideline (PMID 29562364) discuss this. Effect sizes are population-dependent.
Prescribe a TRT-restart or PCT protocol. Off-label use with HMG involves cycle planning, lab monitoring (FSH/LH/T/E2/sperm count), GnRH agonist coordination, and individualized dosing — in real clinical practice this is done with a reproductive endocrinologist or men’s-health urologist. We describe what the literature class shows; we don’t replace that visit.
What HMG does NOT do: raise testosterone meaningfully in eugonadal men with intact HPT axes. The vendor-side “natural T-boost” framing for HMG is overreach. HMG works when pituitary signaling is the bottleneck; if your pituitary is intact and pumping, exogenous gonadotropins don’t add much.
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| Agent | FSH | LH-like | Best for |
|---|---|---|---|
| HMG (Menopur) | Yes (75 IU/vial) | Yes — mostly hCG (75 IU/vial) | IVF in ovulatory women; male HH (with hCG); post-TRT fertility |
| hCG (Pregnyl, Novarel) | No | Yes (long half-life) | Trigger shot; male HH first-line; TRT-on hCG to preserve testicular volume |
| Recombinant FSH (Gonal-F, Follistim) | Yes (pure) | No | IVF in women with intact LH; cleaner FSH-only signal |
| Recombinant LH (Luveris) | No | Yes (pure LH) | Combined with rFSH when LH supplementation is needed without hCG |
Menopur is supplied as a lyophilized powder + provided sterile-saline diluent. Reconstitute per the included instructions; do not substitute bacteriostatic water for the supplied diluent unless explicitly directed.
Compounded HMG from 503A pharmacies has different reconstitution / BUD specs — follow the compounder’s label, not Menopur’s.
HMG (Human Menopausal Gonadotropin) is a prescription medication. StackTrax does not sell, prescribe, or facilitate purchase of prescription drugs.
Find a clinician who can order baseline lab work, screen for contraindications, monitor your response, and adjust dosing over time. Options to consider:
Before starting, you’ll typically want:
Avoid sources that offer prescription medications without labs, medical history, or licensed-provider oversight. If a telehealth service promises a prescription after a 5-minute questionnaire, that’s a red flag.
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