HMG (human menopausal gonadotropin)

What HMG is

The name explains the origin. Human menopausal gonadotropin is obtained from the urine of women after menopause. After menopause, the feedback from the ovaries ceases. The pituitary gland responds with a very high release of FSH and LH, the two hormones that control the ovaries and testes. Part of this is excreted, and the product is prepared from it.

The method is old. The extraction method dates from 1949, and HMG entered clinical use in 1961. This makes it one of the oldest hormone products still in use today. The common products contain 75 units of FSH and 75 units of LH activity; the LH activity comes predominantly from HCG, which according to the summary of product characteristics is added as needed from the urine of pregnant women. This composition is the whole point of the substance.

The difference from HCG

HCG resembles LH. It tells the testis: produce testosterone. What it does not tell it is the second signal — FSH, which is responsible for sperm production. HMG provides both from one source; recombinant FSH and LH are also available individually or as a fixed combination. That is why it is used in fertility medicine where LH activity alone is not enough: in women, to let egg follicles mature, and in men with hormone deficiency, to stimulate sperm production. Anyone who treats HMG and HCG as interchangeable has not understood the difference that matters.

What medical use actually looks like

The indications are real and sensible. What matters, however, are the circumstances under which this happens medically: daily injection for about 10 days, under close monitoring, with ongoing adjustment of dose and duration. This is not a phrase from a package leaflet that you can skip over. It is the core of the treatment.

The reason for the close supervision is the opposite risk: the ovaries can overreact. Ovarian hyperstimulation syndrome is the dreaded complication of fertility treatment, in severe cases with fluid in the abdomen, thromboses and hospitalization. That is why ultrasound and blood values are used during treatment to check how many follicles are developing. You do not dose according to a scheme; you dose according to what you see. With this substance, a fixed protocol is not the simple version of the treatment but a different thing altogether.

Why HMG turns up after a steroid cycle

In the scene it is used by men after a cycle. The logic behind this is understandable. Anyone who supplies testosterone or nandrolone from outside switches off their own axis. The testes shrink, and sperm production comes to a standstill. HCG brings back the testosterone signal, but not the sperm signal. HMG brings both.

Pharmacologically, this reasoning is correct, and that needs to be said explicitly, because it rarely happens with gray-market substances. In andrology, combinations of HCG and FSH-containing products are indeed used to restore fertility. That is established. The question is not whether the approach makes sense, but under what conditions it is carried out.

What the studies show

Six decades of clinical use

HMG has been used clinically since 1961; the extraction method dates from 1949. Treatment in fertility medicine involves daily injection for about 10 days, under ultrasound and blood value monitoring and with ongoing adjustment of dose and duration. Products with 75 units of FSH and 75 units of LH activity are the standard. This base of experience is the actual evidence for the substance — it comes from clinical care, not from a single study.

Combination of HCG and FSH-containing products in andrology

To restore fertility after the body’s own axis has been switched off, such combinations are used in andrology. This is accompanied by semen analysis, hormone levels and follow-up monitoring over months. In men with gonadotropin deficiency, a meta-analysis of 41 studies with 1,673 patients found sperm again in 78 % after a median of 18 months, with HCG plus FSH doing better than HCG alone (Muir 2025). After a steroid cycle, there is a case report with HCG and HMG (Menon 2003) and a retrospective cohort on post-cycle treatment (İbis 2026), but no controlled study on HMG.

Transmission risk due to urinary origin

Because the product is obtained from urine, the transmission of pathogens has been discussed theoretically. Nothing has ever been demonstrated; the products are highly purified. The topic remains a footnote and is not an argument against the substance.

Where the data stop

The first gap is supervision. In andrology, use runs with laboratory values over months; on the gray market, without medical supervision, and the goods are uncertain: in seized post-cycle products, the declared active ingredient was missing in 34.9 %. What is done there shares the active ingredient with the established treatment, but not the procedure. The second gap is expectation: restoring the body’s own axis is neither guaranteed nor fast. After androgen abuse, recovery usually takes 6 to 18 months, and sperm production needs a little over 14 months on average; no specific evidence for nandrolone alone was found. Anyone who thinks they can reliably get this back with a few weeks of HMG has a certainty that the data do not provide.

Status, approval and legal

In Germany, HMG is an approved, prescription-only medicine with clearly defined indications in reproductive medicine. Use after a steroid cycle is not covered by these and accordingly takes place outside the approved scope — either under medical supervision or, much more often, via the gray market. The substance is thus available through two very different routes, with very different safeguards behind them. Anyone competing in organized sport must also observe the anti-doping rules that apply there; they apply independently of medicines law. Substances with LH or HCG activity are prohibited at all times in men under the WADA list.

Safety

The best-known complication of treatment is ovarian hyperstimulation syndrome, with fluid in the abdomen, thromboses and, in severe cases, hospitalization. It is the reason for the close monitoring and at the same time the reason why an approach without monitoring is not the same treatment. The theoretically discussed transmission of pathogens via the urinary origin has never been demonstrated and remains a footnote. The real safety question outside clinical care is quality: HMG is a biological extract and not a single molecule that can simply be replicated. With a multi-component mixture, testing is considerably more difficult. Whether an ampoule really delivers 75 units of FSH activity is an entirely different measurement from the question of whether a particular peptide is present in the stated amount.

Sources

• Extraction method for human menopausal gonadotropin, first described in 1949 (Donini and Montezemolo, Serono); cited in Front Endocrinol 2025 (PMID 40255498)
• Clinical introduction of HMG in fertility treatment, 1961 — Lunenfeld, Reprod Med Biol 2011
• Summary of product characteristics for HMG products with 75 units of FSH and 75 units of LH activity
• Guideline of the American Society for Reproductive Medicine (Fertility and Sterility 2016) — ovarian hyperstimulation syndrome as a complication of gonadotropin treatment
• Muir et al., Clinical Endocrinology 2025 — meta-analysis of gonadotropin therapy with HCG and FSH-containing products in andrology
• Shankara-Narayana et al., J Clin Endocrinol Metab 2020 — recovery after androgen abuse: mostly 6–18 months, sperm production 14.1 months on average
• İbis et al., BJU International 2026 — post-cycle treatment after a short steroid cycle, retrospective cohort of 79 men
• Menon, Fertility and Sterility 2003 — case report: azoospermia after steroids, treated with HCG and HMG
• Front Chem 2025 — seized post-cycle products, the declared active ingredient was missing in 34.9 %
• WADA Prohibited List 2026, S2.2.1 — substances with LH and HCG activity in men