Hormonal contraception for men: Limitations

Hormonal contraception for men: Limitations

Eberhard Nieschlag

Institute of Reproductive Medicine of the University of

Münster, (WHO Collaboration Centre for Research in Male Reproduction), Münster,


As opinion polls show, men are ready for hormonal male

contraception and would use an effective preparation if it became generally

available. However, they would prefer a pill over any other mode of application.

Notwithstanding, modalities for male contraception currently under investigation

favour testosterone and gestagen injections or implants of a combination of both

as they provide the constant serum levels required for suppression of

gonadotropins and spermatogenesis. This implies that the contraceptive will not

be self administered, but will rather require medical assistance for initiation

and possibly also for termination. The contraceptive protection provided by a

hormonal male method will have a relatively slow onset as, on average, three

months are required to achieve the necessary azoospermia or at least severe

oligozoospermia. Therefore, use of hormonal male contraception will require

careful planning and will be used preferentially by couples in stable

relationships. Similarly, recovery of spermatogenesis after cessation of

hormonal male contraception is relatively slow requiring 3-6 months to regain

full fertility. Since most clinical trials so far did not exceed one year, it is

unclear whether longer use may result in prolonged recovery phases. Non-

uniformity of suppression of spermatogenesis under a given regimen remains an

important limitation. There are ethnic differences (East Asian men respond

better than Caucasians), but also differences within a population which could

not yet be explained by a mechanism that would allow a rational approach to

counteract it. Until this goal is reached it may be necessary to investigate

whether a volunteer has achieved azoospermia or not, i.e. semen analysis would

be required before contraceptive protection can be guaranteed. These

investigations would complicate the use of a male hormonal contraceptive, but

would be similar to the requirements after vasectomy.

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