Human Menopausal Gonadotropin (HMG): The Science and its role as a Fertility Medicine

April 2013

This article is on two parts: firstly, MuscleTalk Moderator mad_cereal_lover PhD explains the science of HMG; then MuscleTalk member Liebow talks about his experiences with low sex drive and poor fertility and how HMG and good advice meant he was able to conceive again.

Part 1: The Science of HMG

By MuscleTalk moderator mad_cereal_lover PhD

To understand the use of HMG in hormone recovery, we must first understand the processes of importance that take place in physiological shutdown of male hormones following exogenous testosterone (and derivates) use. To understand more about the hypothalamus-pituitary-testicular (HPT) axis and medicines such as human chorionic gonadotropin (HCG) please the article Nolvadex, Clomid and HCG in Post Cycle Therapy (PCT)

When we administer certain hormones into our bodies, various cells and organs have the ability to sense this. Your body 'sees' this increase in testosterone or similar molecules and as a result it can sense that it is in a higher concentration than what would be normal in the blood. As a result, it will shut down its own testosterone production. There are various mechanisms involved in this, but an important one is the cessation in production of luteinizing hormone (LH) and follicle stimulating hormone (FSH), produced by the pituitary gland. These hormones are required for the testes to be stimulated to produce testosterone but also play a role in sperm production.

From a blood-testosterone aspect this all seems okay to us, sure we have shut down natural testosterone production, but we still have testosterone in us; right? Well, one of the big problems with regards to fertility is that the testes do not work like that. The Leydig cells in the testes produce testosterone when stimulated by LH. Testosterone is released from these cells which are in close proximity to the Sertoli cells. When Sertoli cells see a high concentration of testosterone, they are stimulated to produce and mature sperm by the process of spermatogenesis. A high blood concentration of testosterone will not do this job. Thus administering anabolic androgenic steroids (AAS) will shut down natural testosterone production which will in turn slow down (and eventually near turn off) the proper formation and maturation of sperm. Thus infertility is a serious issue with use of AAS.

Classically, HCG has been seen to rectify this problem in males. HCG is an LH analogue – it 'looks' like LH to the body and so it can stimulate the Leydig cells to produce testosterone and in turn, hopefully, restore fertility. In some cases this will occur, and many people have had success from HCG therapy relating to infertility. However, the response is not robust and certainly with longer shut-down periods, many often find the use of HCG (even in combination with other post cycle therapy (PCT) medicines such as clomifene (aka clomid) and tamoxifen (aka nolvadex), etc) to not be effective at restoring fertility.

Furthermore, what HCG lacks is to produce the important effects that FSH inflicts upon fertility. FSH, despite its name, is important in male fertility in two main pathways. The first thing it does is to enhance the action of LH, by increasing the amount of protein that will 'see' testosterone in the Sertoli cells. The more easily these cells can see testosterone, the more likely spermatogenesis will occur. Secondly, FSH enhances the maturation of sperm by effects on their primary division. These are two important aspects of the role of FSH in the male testes that HCG is not optimal in promoting.

HMG, or its full name Human Menopausal Gonadotropin, bears similarities to HCG in that while HCG is similar to human LH, HMG contains actual LH. Additionally (and crucially) though, HMG also contains purified FSH. The combination of these two hormones perform the effects described above: induction of natural testosterone production by Leydig cells, and subsequent formation and maturation of sperm cells. The result is improved and potentially recovered fertility for the male concerned.

Does HMG really work?
So often we hear about various different drugs and the science for them is sound, but real world evidence is lacking. There are a few studies performed on HMG over the last 25 years, and I would like to draw your attention to two of these studies, pointing out a few key details. The first goes back to 1985 by Ley & Leonard and is an important study as it looks at males who had previously encountered AAS treatment (treatment for low hormone levels including mainly testosterone). This study is available online and I encourage you to read it in more detail than the brief summary I will provide here.

They looked at 13 hypogonadotropic men all of who had undetectable levels of LH/FSH, lower than normal levels of testosterone and azoospermia, thus were unable to currently conceive. Obviously with the low hormonal levels there were issues with libido as well. Furthermore, there were instances where upon testis biopsies, Leydig cells were completely absent. Despite this, all 13 men responded to treatment with HCG with increasing testosterone levels. However, upon addition of HMG treatment, most men saw a further increase in testosterone, sometimes very large. HCG was able to increase sperm counts in most men slightly; however, only upon addition of HMG were sperm counts above 'normal' fertility levels (i.e. 20 million per ml) observed. The study indicates that the addition of HMG therapy surpasses any level that HCG treatment could achieve alone. Admittedly this is a particular subset of men who have medical conditions and abnormal hormone issues, but the results are interesting nonetheless.

The second is more recent by Buchter et al in 1998. This is even more interesting from the point of view that it looks at three times the number of cases as the previous study and in a different manner. Again, this study can be found online and I encourage you to read it. The most interesting result you could take away from this study is that in the group of men treated who suffered from hypopituitarism, all 21 treated with HCG/HMG achieved spermatogenesis and a large proportion (81%) was able to successfully achieve pregnancies. The discussion of this article is most interesting as it raises the points from its own study and the literature that many in the field believe that to achieve spermatogenesis and pregnancy in a gonadotropin-compromised individual requires combinational therapy of HCG and HMG. The important point to note is that HCG is not sufficient alone in many cases.

Given the fact that other studies point to HMG increasing endogenous testosterone further than HCG can, as those who have relatively 'normal' pituitaries but have compromised their function due to AAS use, it would be wise to consider the use of HMG. This would not only be for purposes of fertility, but to induce natural testosterone levels back to normal values when they have been suppressed. Treatment in this latest study was the use of HCG twice per week at 1000-2500IU per dose (Mon-Fri) and HMG three times per week at 75-150IU (Mon-Wed-Fri). Thus for bodybuilders seeking to regain fertility, spermatogenesis and restore natural testosterone levels but wishing to keep costs down, a weekly dose of the lower ends should be employed for at least one month.

A schedule would involve:
Monday: 1000-1500IU HCG + 75IU HMG
Wednesday: 75IU HMG
Friday: 1000-1500IU HCG + 75IU HMG

Depending on the amount of suppression this cycle may need to be lengthened for a further period. Please note this information is for hypothetical purposes and neither I nor MuscleTalk recommends the use of any prescription medicines without the consultation of a qualified physician.


References:
  • Buchter et al (1998). Pulsatile GnRH or human chorionic gonadotropin/human menopausal gonadotropin as effective treatment for men with hypogonadotropic hypogonadism: a review of 42 cases. Eur J Endo 139: 298-303.
  • Ley & Leonard (1985). Male Hypogonadotropic Hypogonadism: Factors Influencing Response to Human Chorionic Gonadotropin and Human Menopausal Gonadotropin, Including Prior Exogenous Androgens. J Clin Endo Metab 61(4); 746-752.

Part 2: HMG: The Miracle Fertility Med? A Personal Story and Lesson to Young Bodybuilders

By MuscleTalk Pro-Member Liebow

Many years ago I started off my fitness habits with boxing and of course, like most young people, I was into looking 'big and hench'. I naively used the AAS dianabol a few times at a very young age (around 15) and loved the great results I achieved, such as strength and size increases. I did not notice many side effects and would just jump back on cycle after some time off with no PCT. So there I was, messing myself up quite a bit without giving it much thought. I came away from boxing to reflect on my discipline and get on with my life – the usual life issues such as my career and marriage, etc.

I missed the weights, and in 2010 I was back in the gym lifting again, this time in a powerlifting fashion. I worked hard, ate everything and progress was steady, albeit slow. In 2011, my first child was born and I found myself slowing in the gym and not growing much more in the size/strength department, causing much frustration and annoyance. This time I now turned to legal pro-hormones as I did not have a source for AAS. Again, I achieved great results but did not run the PCT I was advised to; instead I used an OTC product. I waited two months and jumped back on to yet another cycle. By the end of 2011, I was eager to try injectable meds. This time I listened to sound advice and planned a good testosterone cycle with proper PCT and I felt I recovered fine into 2012. The whole time I was eating everything I saw, however I was not doing much cardio work but focused on lifting very heavy weights. I went back on more AAS, this time using trenbolone with again, great gains. I entered a local novice event and did well. I was on a real high here!

Then my wife approached me during the summer of 2012 wanting to move on with our family and have a second child. At this time, my usual 'post cycle blues' were in action. I had no libido, poor mood, no drive and so on. I reassured her though that in a few weeks I would have recovered and it would be fine which built her hopes up. Despite this I failed to recover after these few weeks I promised her. Another few months went by, and still nothing – I felt terrible. So I decided to throw in some proviron to see if that would help with things. It didn't so I turned to HCG. I tried a range of approaches over the space of four months: 500IU EOD, 500IU ED, 1500IU EOD, and even 2500IU EOD. I even ran clomid alongside the HCG to see if that would help with its fertility properties, but nothing seemed to work.

So, here I was, several months after the 'talk' and I am still heavily shutdown. This caused a serious strain on my relationship and my wife blamed the steroids (and rightly so!). We sought advice from the doctor and my wife was perfectly fine. However, the doctor took one look at my parts and said "Ah, I think I can see the problem". Cutting to the point and saving the embarrassing details, it seems that my sperm production was horrifically suppressed and I had only around 10,000 sperm to one ml of semen. This was further compounded by the fact I had no sex drive.

This news devastated me (and my wife) and I felt as though my relationship was now about to fall apart. All of a sudden, my muscles and hard work over the last few years seemed out of place and plain wrong. I felt that I had been so short sighted and did not once think about how my actions would affect others nor did I consider the long term. I ignored so much good advice about recovery, PCT, time on and time off. I felt like the most moronic failure to myself and to my wife.

So was determined and made a plan to try and rebuild our relationship, as a way to move forward. I decided (bear with me...) to jump back on testosterone enanthate at a low dose. If we could not have more children, we could focus again on our intimacy and each other. I felt there was no point in having no sex drive, so this made sense to me. Now as a desperate last resort, I thought I would try one more medicine to see if it would help with my fertility. I was advised to use HMG and to also come off testosterone to help improve conception chances (but you know how I feel about advice). A few weeks went by, and my libido is back to sky high and once again I am pleasant to be around, and I was starting to not feel as crap as I did previously. A fortnight had passed and the HMG was finished.

Another few weeks pass, and we happen to notice something very peculiar. The wife hadn't menstruated yet. This can occur at times, so we thought nothing of it. A few days later, I am woken up in bed at 8am by a tearful wife, holding a Clearblue Pregnancy Test. It read 'PREGNANT 2-3 WEEKS'. I grumbled at this and turned over, with the honest belief that I was still asleep. After a few firm taps of encouragement, I turned over again, and I wasn't dreaming. Somehow, we had conceived!

That concludes my story, but what can we take away from this? Anyone with half a brain and a keen ear can see the problem. And it is certainly not "go wild and then use HMG". How does a teenager start to take steroids, does not run appropriate recovery medicines, then goes for all out advanced cycles with minimal breaks in between, then wonder why he cannot conceive? And the further downside to my 'too much too soon' outlook, is that low-dose anything is now too weak for anabolism and I require doses much higher than I should need at my age/experience.

So while the clear message here is to stress the importance of taking extra precautions and taking adequate time off between cycles, I have gotten off the hook very lightly and I am able to put my life back on track. I was lucky and was able to find success behind HMG. Not everyone will be lucky like that. And for all the heartache and stress I have put my wife through (as well as myself), I am still trying to forgive myself for it. It's just not worth it.

HMG won't work for everyone, so surely its best to try and avoid getting to that point in the first place? The only way you will avoid my type of mistake is when you start to pay attention to the experienced people around you and take their advice seriously. Had I not listened to the advice when it came to HMG, who knows where I would be now? I haven't included every detail on my home life, but never have I had such a wakeup call in all my life! And to those who helped me, I am forever grateful for the support and help – especially when I look back and realised the help was there all along, and this whole scenario could have been avoided. All it required from my part was a little patience, and a little open mindedness. That's all it takes: be inspired!

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