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Steroid hormones for contraception in men.
David A Grimes1, Laureen M Lopez, Maria F Gallo
1Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA. david_grimes@med.unc.edu.
The Cochrane Database of Systematic Reviews
|March 16, 2012
Summary
Male hormonal contraception using sex steroids shows promise but is not yet clinically ready. Randomized controlled trials indicate varying effectiveness, with some combinations showing better results for achieving azoospermia (no sperm).
Area of Science:
- Reproductive Endocrinology
- Clinical Pharmacology
- Men's Health
Background:
- Male hormonal contraception aims to suppress sperm production via sex steroids.
- Testosterone suppression necessitates 'add-back' therapy to maintain normal levels.
- Developing effective and safe male hormonal contraceptives remains a significant challenge.
Purpose of the Study:
- To systematically review all randomized controlled trials (RCTs) evaluating male hormonal contraceptives.
- To assess the efficacy of various steroid hormone combinations in achieving azoospermia.
Main Methods:
- Comprehensive search of multiple databases (CENTRAL, MEDLINE, POPLINE, LILACS, EMBASE) and clinical trial registries.
- Inclusion of RCTs comparing steroid hormones with other contraceptives, including placebo and active controls.
- Primary outcome measure was azoospermia; data on pregnancy rates and side effects were insufficient.
Main Results:
- 33 RCTs met inclusion criteria, demonstrating wide variability in azoospermia rates.
- Specific combinations like levonorgestrel implants with injectable testosterone enanthate showed higher efficacy.
- Different dosages and formulations of testosterone (TE, TU) and progestins (levonorgestrel, desogestrel) yielded varying success rates in achieving azoospermia.
Conclusions:
- Currently, no male hormonal contraceptive is ready for widespread clinical application.
- Most studies were small, exploratory, and lacked the power to yield precise results.
- Future research requires robust RCTs with adequate statistical power and standardized azoospermia assessment.
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