Follicle Stimulating Hormone
FSH (or folllicle stimulating hormone) is the hormonal message from the brain that tells the testicles to make sperm. Although used much more commonly in female fertility treatments, the use of exogenous FSH medications can be useful in men who's own pituitary glands are not producing adequate amounts (see the "FSH Abnormalities" section for more information).
[Note: in terms of hormones, the word "exogenous" indicates that FSH is being given to a person in the form of a medication or supplement (such as testosterone gels or FSH injections). In contrast, the word "endogenous" which means that the body is stimulated to produce more of the hormone itself].
Exogenous FSH comes in two commercially available forms. Human menopausal gonadotropins (HMG) is FSH that has been extracted from the urine of postmenopausal women. It comes in two types: menotropins (such as Repronex and Menopur), which contain both FSH and HCG, and urofollitropins (such as Bravelle and Fertinex), which contain just purified FSH. The other form is recombinant FSH (rFSH), which contains purified FSH that has been produced in the lab from genetically modified cells. Commercially available forms include Follistim and Gonal-F.
All FSH is given by subcutaneous (SQ) or intramuscular (IM) injection. HMG comes in vials and is drawn up in syringes for use, and Gonal-F is available in this form as well. Follistim and Gonal-F are also available in ready-to-use injectable pens that can be dialed to the selected dose. There have not been any data reliably showing that one form is safer or more effective than the other for male fertility treatment.
Dosing of FSH
The typical starting dose of FSH is 75 IU SQ three times per week, and this dosage is adequate in most men. In some circumstances, FSH dosages can be increased to 150 IU or even 225 IU SQ three times per week, although this can get very expensive. Note that blood FSH levels often do not increase in men taking FSH, as the exogenous hormone does not display much cross-reactivity with most commercial laboratory assays.
Exogenous FSH FSH replacement in men is generally associated with minimal side effects other than mild pain or bleeding at the injection site. A possible exception is "acute bank account pain" associated with the cost of the medications if they are not covered by insurance (see below).
If you do happen to experience any FSH-related side effects, it is recommended to stop the medication and contact your medical care provider.
Costs of FSH
Exogenous FSH is quite expensive, especially when it is necessary to use for relatively long periods of time, which is often the case in male fertility problems. If insurance does not cover the FSH medications, the "Fertility Medications Cost" section of this website reviews the pricing from several regional and national fertility pharmacies.