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Azevedo RA, Gualano B, Teixeira TA, Nascimento BCG, Hallak J. Abusive use of anabolic androgenic steroids, male sexual dysfunction and infertility: an updated review. FRONTIERS IN TOXICOLOGY 2024; 6:1379272. [PMID: 38711907 PMCID: PMC11070513 DOI: 10.3389/ftox.2024.1379272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/09/2024] [Indexed: 05/08/2024] Open
Abstract
The evolving prevalence of anabolic androgenic steroids (AAS) abuse among nonathletes is alarming because of the known harm to an individual's health. Among the adverse effects of AAS abuse, male infertility and sexual dysfunction have been often reported in the literature, but little is known regarding its actual prevalence, possible underpinning mechanisms, and potential treatments either during or post-AAS usage. Thus, the current narrative review summarizes the state-of-art regarding the effects of AAS on male fertility and sexual function. Evidence was gathered from the latest reviews and recent original studies, specifically from prospective cohorts and clinical trials, ultimately resulting in five main topics of discussion. First, AAS usage is briefly characterized by its historical background, main physiological mechanisms, and the most frequently used AAS substances. Second, data on the prevalence of AAS-induced male infertility and sexual dysfunction are described. Third, some new insights on possible underpinning mechanisms of AAS-induced male infertility and sexual dysfunction are thoroughly discussed, with particular attention to histological data derived from animal models and the latest insights from prospective cohorts in humans. Fourth, the potential treatments during and after the AAS usage are presented, highlighting the odds of resolving male infertility and sexual dysfunction. Fifth, future directions on this topic are discussed, focusing on the methodological robustness of scientific studies.
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Affiliation(s)
- Rafael de Almeida Azevedo
- Applied Physiology and Nutrition Research Group, Center of Lifestyle Medicine, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, Center of Lifestyle Medicine, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Thiago Afonso Teixeira
- Division of Urology, Department of Surgery, University Hospital, School of Medicine and Drug Research Laboratory, Federal University of Amapa, Macapá, Brazil
- Men’s Health Study Group, Institute for Advanced Studies, University of Sao Paulo, São Paulo, Brazil
- Androscience Institute for Science, Education and Advanced Projects in Male Health, São Paulo, Brazil
| | | | - Jorge Hallak
- Men’s Health Study Group, Institute for Advanced Studies, University of Sao Paulo, São Paulo, Brazil
- Androscience Institute for Science, Education and Advanced Projects in Male Health, São Paulo, Brazil
- Division of Urology, Department of Surgery, University of Sao Paulo, São Paulo, Brazil
- Androscience—Science and Innovation Center and High Complexity Clinical and Research Andrology Laboratory, São Paulo, Brazil
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Louwagie EJ, Quinn GFL, Pond KL, Hansen KA. Male contraception: narrative review of ongoing research. Basic Clin Androl 2023; 33:30. [PMID: 37940863 PMCID: PMC10634021 DOI: 10.1186/s12610-023-00204-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/26/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Since the release of the combined oral contraceptive pill in 1960, women have shouldered the burden of contraception and family planning. Over 60 years later, this is still the case as the only practical, effective contraceptive options available to men are condoms and vasectomy. However, there are now a variety of promising hormonal and non-hormonal male contraceptive options being studied. The purpose of this narrative review is to provide clinicians and laypeople with focused, up-to-date descriptions of novel strategies and targets for male contraception. We include a cautiously optimistic discussion of benefits and potential drawbacks, highlighting several methods in preclinical and clinical stages of development. RESULTS As of June 2023, two hormonal male contraceptive methods are undergoing phase II clinical trials for safety and efficacy. A large-scale, international phase IIb trial investigating efficacy of transdermal segesterone acetate (Nestorone) plus testosterone gel has enrolled over 460 couples with completion estimated for late 2024. A second hormonal method, dimethandrolone undecanoate, is in two clinical trials focusing on safety, pharmacodynamics, suppression of spermatogenesis and hormones; the first of these two is estimated for completion in December 2024. There are also several non-hormonal methods with strong potential in preclinical stages of development. CONCLUSIONS There exist several hurdles to novel male contraception. Therapeutic development takes decades of time, meticulous work, and financial investment, but with so many strong candidates it is our hope that there will soon be several safe, effective, and reversible contraceptive options available to male patients.
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Affiliation(s)
- Eli J Louwagie
- University of South Dakota Sanford School of Medicine, 1400 W 22nd St, Sioux Falls, SD, 57105, USA.
| | - Garrett F L Quinn
- University of South Dakota Sanford School of Medicine, 1400 W 22nd St, Sioux Falls, SD, 57105, USA
| | - Kristi L Pond
- University of South Dakota Sanford School of Medicine, 1400 W 22nd St, Sioux Falls, SD, 57105, USA
| | - Keith A Hansen
- Chair and Professor, Dept. of Obstetrics and Gynecology, University of South Dakota Sanford School of Medicine; Reproductive Endocrinologist, Sanford Fertility and Reproductive Medicine, 1500 W 22nd St Suite 102, Sioux Falls, SD, 57105, USA
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3
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Amory JK. Male Contraception. Semin Reprod Med 2023; 41:279-286. [PMID: 38113922 DOI: 10.1055/s-0043-1777757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Approximately 40 to 50% of pregnancies are unintended. Contraceptive use significantly reduces the risk of unintended pregnancy. Approximately 70% of couples' contraceptive use is female and 30% is male, attributable to the reliance on condoms and vasectomies. Unfortunately, many women cannot use currently available contraceptives due to medical contraindications or side effects. At the same time, men want additional safe and effective contraceptive methods. Because of this, work to develop novel, safe, and effective male contraceptives is underway. This review will briefly discuss the pros and cons of condoms and vasectomies, and then describe research into the development of novel methods of male contraception, by the mechanism of action of the contraceptive. First, we will discuss male contraceptives that block sperm transmission. Next, we will discuss male contraceptives that impair sperm production. Lastly, we will discuss male contraceptives that impair sperm function.
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Affiliation(s)
- John K Amory
- Department of Medicine, The Center for Research in Reproduction and Contraception, University of Washington, Seattle, Washington
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Rizzuti A, Alvarenga C, Stocker G, Fraga L, Santos HO. Early Pharmacologic Approaches to Avert Anabolic Steroid-induced Male Infertility: A Narrative Review. Clin Ther 2023; 45:e234-e241. [PMID: 37806813 DOI: 10.1016/j.clinthera.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/23/2023] [Accepted: 09/03/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE To review the impact of testosterone and other androgenic-anabolic steroids (AASs) on male fertility, exploring potential drugs that can be used to preserve or restore male fertility upon AAS use or prior contact. METHODS A review was performed to provide a unifying clinical link between drugs used to preserve or restore male fertility (ie, clomiphene citrate, human chorionic gonadotropin, selective estrogen receptor modulators, recombinant luteinizing and follicle-stimulating hormones, and human menopausal gonadotrophin) in the context of AAS-induced infertility and related aspects. FINDINGS Human chorionic gonadotropin (125-500 IU every other day), clomiphene citrate (12.5-50 mg/d), recombinant luteinizing hormone (125-500 IU every other day), recombinant follicle-stimulating hormone (75-150 IU 1-3×/wk), and human menopausal gonadotrophin (75-150 IU 1-3×/wk) are promising early pharmacologic approaches to avert AAS-induced male infertility. Additionally, a full partner assessment is crucial to the success of a couple planning to have children. The partner's age and gynecopathies must be considered. Egg or sperm cryopreservation can also be alternatives for future fertility. Reinforcing AAS cessation is imperative to achieving better success in misusers. IMPLICATIONS The exponential increase in AAS misuse raises concerns about the impact on male fertility. This review suggests that gonadotropin analogs and selective androgen receptor modulators (clomiphene citrate) are viable approaches to early preserve or restore fertility in men on AAS use or with previous contact. However, proper standardization of doses and combinations is required and hence physicians should also be aware of patients' and partners' fertility.
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Affiliation(s)
- André Rizzuti
- School of Medicine, Estácio de Sá University (UNESA), Rio de Janeiro, RJ, Brazil
| | - Conrado Alvarenga
- School of Medicine, Department of Urology, University of Sao Paulo (USP), Sao Paulo, Brazil
| | - Gustavo Stocker
- School of Medicine, University Center Assis Gurgacz Foundation (FAG), Cascavel, PR, Brazil
| | - Lucas Fraga
- School of medicine, Santa Casa da misericordia de Vitorica (EMESCAM), Vitória, ES, Brazil
| | - Heitor O Santos
- School of Medicine, Federal University of Uberlandia (UFU), Uberlandia, MG, Brazil.
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Wang C, Meriggiola MC, Amory JK, Barratt CLR, Behre HM, Bremner WJ, Ferlin A, Honig S, Kopa Z, Lo K, Nieschlag E, Page ST, Sandlow J, Sitruk-Ware R, Swerdloff RS, Wu FCW, Goulis DG. Practice and development of male contraception: European Academy of Andrology and American Society of Andrology guidelines. Andrology 2023. [PMID: 37727884 DOI: 10.1111/andr.13525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUNDS Despite a wide spectrum of contraceptive methods for women, the unintended pregnancy rate remains high (45% in the US), with 50% resulting in abortion. Currently, 20% of global contraceptive use is male-directed, with a wide variation among countries due to limited availability and lack of efficacy. Worldwide studies indicate that >50% of men would opt to use a reversible method, and 90% of women would rely on their partner to use a contraceptive. Additional reasons for novel male contraceptive methods to be available include the increased life expectancy, sharing the reproductive risks among partners, social issues, the lack of pharma industry involvement and the lack of opinion makers advocating for male contraception. AIM The present guidelines aim to review the status regarding male contraception, the current state of the art to support the clinical practice, recommend minimal requirements for new male contraceptive development and provide and grade updated, evidence-based recommendations from the European Society of Andrology (EAA) and the American Society of Andrology (ASA). METHODS An expert panel of academicians appointed by the EAA and the ASA generated a consensus guideline according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system. RESULTS Sixty evidence-based and graded recommendations were produced on couple-centered communication, behaviors, barrier methods, semen analysis and contraceptive efficacy, physical agents, surgical methods, actions before initiating male contraception, hormonal methods, non-hormonal methods, vaccines, and social and ethical considerations. CONCLUSION As gender roles transform and gender equity is established in relationships, the male contribution to family planning must be facilitated. Efficient and safe male-directed methods must be evaluated and introduced into clinical practice, preferably reversible, either hormonal or non-hormonal. From a future perspective, identifying new hormonal combinations, suitable testicular targets, and emerging vas occlusion methods will produce novel molecules and products for male contraception.
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Affiliation(s)
- Christina Wang
- Division of Endocrinology, Department of Medicine and Clinical and Translational Science Institute, The Lundquist Insitute and Harbor-UCLA Medical Center, Torrance, California, USA
| | - Maria Cristina Meriggiola
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - John K Amory
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Christopher L R Barratt
- Division of Systems and Cellular Medicine, Medical School, Ninewells Hospital, University of Dundee, Dundee, Scotland
| | - Hermann M Behre
- Center for Reproductive Medicine and Andrology, University Medicine Halle, Halle, Germany
| | - William J Bremner
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Alberto Ferlin
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Stanton Honig
- Division of Reproductive and Sexual Medicine, Department of Urology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Zsolt Kopa
- Department of Urology, Andrology Centre, Semmelweis University, Budapest, Hungary
| | - Kirk Lo
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Eberhard Nieschlag
- Center of Reproductive Medicine and Andrology, University Hospital, Münster, Germany
| | - Stephanie T Page
- Division of Metabolism, Endocrinology and Nutrition, UW Medicine Diabetes Institute, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jay Sandlow
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Regine Sitruk-Ware
- Center for Biomedical Research, Population Council, New York, New York, USA
| | - Ronald S Swerdloff
- Division of Endocrinology, Department of Medicine, The Lundquist Institute and Harbor-UCLA Medical Center, Torrance, California, USA
| | - Frederick C W Wu
- Division of Endocrinology, Diabetes and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Dimitrios G Goulis
- First Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Amory JK, Blithe DL, Sitruk-Ware R, Swerdloff RS, Bremner WJ, Dart C, Liu PY, Thirumalai A, Nguyen BT, Anawalt BD, Lee MS, Page ST, Wang C. Design of an international male contraceptive efficacy trial using a self-administered daily transdermal gel containing testosterone and segesterone acetate (Nestorone). Contraception 2023; 124:110064. [PMID: 37210024 DOI: 10.1016/j.contraception.2023.110064] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 05/22/2023]
Abstract
Injectable male hormonal contraceptives are effective for preventing pregnancy in clinical trials; however, users may prefer to avoid medical appointments and injections. A self-administered transdermal contraceptive gel may be more acceptable for long-term contraception. Transdermal testosterone gels are widely used to treat hypogonadism and transdermal administration may have utility for male contraception; however, no efficacy data from transdermal male hormonal contraceptive gel are available. We designed and are currently conducting an international, multicenter, open-label study of self-administration of a daily combined testosterone and segesterone acetate (Nestorone) gel for male contraception. The transdermal approach to male contraception raises novel considerations regarding adherence with the daily gel, as well as concern about the potential transfer of the gel and the contraceptive hormones to the female partner. Enrolled couples are in committed relationships. Male partners have baseline normal spermatogenesis and are in good health; female partners are regularly menstruating and at risk for unintended pregnancy. The study's primary outcome is the rate of pregnancy in couples during the study's 52-week efficacy phase. Secondary endpoints include the proportion of male participants suppressing sperm production and entering the efficacy phase, side effects, hormone concentrations in male participants and their female partners, sexual function, and regimen acceptability. Enrollment concluded on November 1, 2022, with 462 couples and enrollment is now closed. This report outlines the strategy and design of the first study to examine the contraceptive efficacy of a self-administered male hormonal contraceptive gel. The results will be presented in future reports. IMPLICATIONS: The development of a safe, effective, reversible male contraceptive would improve contraceptive options and may decrease rates of unintended pregnancy. This manuscript outlines the study design and analysis plan for an ongoing large international trial of a novel transdermal hormone gel for male contraception. Successful completion of this and future studies of this formulation may lead to the approval of a male contraceptive.
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Affiliation(s)
- John K Amory
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States.
| | - Diana L Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, United States
| | - Regine Sitruk-Ware
- Population Council, Center for Biomedical Research, New York, NY, United States
| | - Ronald S Swerdloff
- The Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, United States
| | - William J Bremner
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Clint Dart
- Premier Research, Morrisville, NC, United States
| | - Peter Y Liu
- The Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, United States
| | - Arthi Thirumalai
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Brian T Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Bradley D Anawalt
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Min S Lee
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, United States
| | - Stephanie T Page
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Christina Wang
- The Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, United States
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White J, Ghomeshi A, Deebel NA, Miller DT, Rahman F, Venigalla G, Sandler M, Tomlinson A, Ramasamy R. Factors Associated With Restarting Androgenic Anabolic Steroids After Cessation in Men With Infertility: A Retrospective Analysis. Cureus 2023; 15:e41134. [PMID: 37519603 PMCID: PMC10386875 DOI: 10.7759/cureus.41134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction The use of androgenic anabolic steroids (AAS) negatively affects male fertility by disrupting hormone release and reducing testosterone levels. Despite this, many men using steroids are unaware of fertility-related consequences. We aimed to determine the factors associated with AAS resumption during fertility treatment, specifically focusing on the duration, age, and dosage of AAS use prior to treatment. Our study, the first of its kind, investigated risk factors for resuming AAS following fertility assessment. Methods We conducted a retrospective review of adult men diagnosed with infertility due to chronic AAS use between 2012 and 2022 at the University of Miami. The study included men with azoospermia or severe oligospermia who were instructed to stop using AAS. Excluded were those who underwent orchiectomy for benign or malignant conditions. We collected data on demographic characteristics, AAS route details, fertility treatments, and AAS resumption. We hypothesized that risk factors for restarting AAS would include duration of AAS use, type of AAS, pre-treatment testosterone levels, and increased age. Results We identified 94 men with infertility caused by AAS use. Among them, 31 (33.0%) resumed AAS therapy within eight months after cessation. The median age of men who restarted AAS was 40 years. Those who resumed AAS had used it for a longer duration prior to fertility assessment compared to those who did not (60 months vs. 17 months, respectively). However, we found no statistically significant differences in age, duration of AAS use, AAS administration details, or serum testosterone levels at the time of initial assessment. Conclusion In conclusion, most men seeking fertility assessment due to AAS abuse did not resume testosterone therapy. However, those who did restart AAS had a longer history of AAS use. Future high-quality prospective studies are needed to better understand the risk factors associated with resuming AAS in male infertility caused by anabolic steroids.
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Affiliation(s)
- Josh White
- Urology, University of Miami, Miami, USA
| | - Armin Ghomeshi
- Urology, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
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Balbach M, Rossetti T, Ferreira J, Ghanem L, Ritagliati C, Myers RW, Huggins DJ, Steegborn C, Miranda IC, Meinke PT, Buck J, Levin LR. On-demand male contraception via acute inhibition of soluble adenylyl cyclase. Nat Commun 2023; 14:637. [PMID: 36788210 PMCID: PMC9929232 DOI: 10.1038/s41467-023-36119-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/17/2023] [Indexed: 02/16/2023] Open
Abstract
Nearly half of all pregnancies are unintended; thus, existing family planning options are inadequate. For men, the only choices are condoms and vasectomy, and most current efforts to develop new contraceptives for men impact sperm development, meaning that contraception requires months of continuous pretreatment. Here, we provide proof-of-concept for an innovative strategy for on-demand contraception, where a man would take a birth control pill shortly before sex, only as needed. Soluble adenylyl cyclase (sAC) is essential for sperm motility and maturation. We show a single dose of a safe, acutely-acting sAC inhibitor with long residence time renders male mice temporarily infertile. Mice exhibit normal mating behavior, and full fertility returns the next day. These studies define sAC inhibitors as leads for on-demand contraceptives for men, and they provide in vivo proof-of-concept for previously untested paradigms in contraception; on-demand contraception after just a single dose and pharmacological contraception for men.
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Affiliation(s)
- Melanie Balbach
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA
| | - Thomas Rossetti
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA
| | - Jacob Ferreira
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA
| | - Lubna Ghanem
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA
| | - Carla Ritagliati
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA
| | - Robert W Myers
- Tri-Institutional Therapeutics Discovery Institute, New York, NY, USA
| | - David J Huggins
- Tri-Institutional Therapeutics Discovery Institute, New York, NY, USA.,Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
| | - Clemens Steegborn
- Department of Biochemistry, University of Bayreuth, Bayreuth, Germany
| | - Ileana C Miranda
- Laboratory of Comparative Pathology, Weill Cornell Medicine, Memorial Sloan Kettering Cancer Center, and The Rockefeller University, New York, NY, USA
| | - Peter T Meinke
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA.,Tri-Institutional Therapeutics Discovery Institute, New York, NY, USA
| | - Jochen Buck
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA.
| | - Lonny R Levin
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA
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Lue Y, Swerdloff R, Pak Y, Nguyen BT, Yuen F, Liu PY, Blithe DL, Wang C. Male contraception development: monitoring effective spermatogenesis suppression utilizing a user-controlled sperm concentration test compared with standard semen analysis. Fertil Steril 2023; 119:208-217. [PMID: 36347310 PMCID: PMC9898087 DOI: 10.1016/j.fertnstert.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine whether a user-controlled sperm concentration test compared with standard semen analysis can effectively monitor spermatogenesis suppression for male contraception. DESIGN Single center, prospective sub study of the ongoing clinical trial: "Study of daily application of Nestorone and testosterone combination gel for male contraception." SETTING Research institute at an academic medical center. PARTICIPANT(S) Couples participating in the male contraceptive clinical trial. INTERVENTIONS None. MAIN OUTCOME MEASURE(S) The ability by participants to monitor sperm suppression to a threshold compatible with contraceptive efficacy utilizing a user-controlled test verified by sperm concentration determined by standard laboratory methods. RESULT(S) Thirty-eight men participating in a hormonal male contraceptive clinical trial provided multiple samples during spermatogenesis suppression for this substudy. Participants, employing a user-controlled test, correctly identified the absence of sperm (a negative test) in 100% of their laboratory-confirmed azoospermic samples (n = 122). Participants also identified 100% of samples (n = 73) with sperm >0.2 million/mL as positive. Sperm counts between 0.01 and 0.2 million/mL were identified as negative in 96% of samples. Trial participants noted the overall ease of using the test with respect to sample preparation, test timing, and result interpretation, and that they could accurately use this test at home without difficulty. CONCLUSION(S) Participants undergoing spermatogenesis suppression in a hormonal male contraceptive trial performed user-controlled test to determine whether their semen sperm concentration was ≤ or >0.2 million/mL. Compared with standard semen analyses, participants correctly identified 100% of samples with sperm counts >0.2 million/mL as positive (Sensitivity 100%). A positive result when the couple is using a male contraceptive method triggers the need for semen analysis by a laboratory while the couple uses another method of contraception. Participants correctly diagnosed samples ≤0.2 million sperm/mL as negative in 99% of samples (specificity 99%). A negative result indicates a sperm concentration ≤0.2 million/mL, well below the threshold of ≤1 million/mL offering contraceptive efficacy demonstrated by prior studies. At-home sperm concentration test would minimize the need for users to return to the clinic to monitor suppression of spermatogenesis, decreasing cost and burden of male contraception trials and increasing practicality of the method. CLINICAL TRIAL REGISTRATION NUMBER NCT: 03452111.
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Affiliation(s)
- Yanhe Lue
- Division of Endocrinology, Department of Medicine, THarbor-UCLA Medical Center, Medical Center, West Carson, California
| | - Ronald Swerdloff
- Division of Endocrinology, Department of Medicine, THarbor-UCLA Medical Center, Medical Center, West Carson, California
| | - Youngju Pak
- Division of Endocrinology, Department of Medicine, THarbor-UCLA Medical Center, Medical Center, West Carson, California; Clinical and Translational Science Institute, The Lundquist Institute at Harbor-University of California, Los Angeles, Medical Center, West Carson, California
| | - Brian T Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Fiona Yuen
- Division of Endocrinology, Department of Medicine, THarbor-UCLA Medical Center, Medical Center, West Carson, California
| | - Peter Y Liu
- Division of Endocrinology, Department of Medicine, THarbor-UCLA Medical Center, Medical Center, West Carson, California
| | - Diana L Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Christina Wang
- Division of Endocrinology, Department of Medicine, THarbor-UCLA Medical Center, Medical Center, West Carson, California; Clinical and Translational Science Institute, The Lundquist Institute at Harbor-University of California, Los Angeles, Medical Center, West Carson, California.
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10
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Thirumalai A, Anawalt BD. Relationships between endogenous and exogenous testosterone and cardiovascular disease in men. Rev Endocr Metab Disord 2022; 23:1305-1322. [PMID: 36219323 DOI: 10.1007/s11154-022-09752-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 01/11/2023]
Abstract
In this narrative review, we discuss the evidence about the controversy about the cardiovascular effects of endogenous and exogenous testosterone in men. Prospective cohort studies with follow-up of ~5-15 years generally indicate no association or a possible inverse relationship between serum endogenous testosterone concentrations and composite major cardiovascular events, cardiovascular deaths and overall mortality. Pharmacoepidemiological studies of large databases generally show no association between testosterone therapy and incident major cardiovascular events, and some pharmacoepidemiological studies demonstrate an association with decreased overall mortality. Randomized, placebo-controlled trials indicate that there is no increased incidence of overall major cardiovascular events with 1-3 years of testosterone therapy. These placebo-controlled trials have major limitations including small numbers of participants, short duration of testosterone therapy and follow-up, and lack of systematic adjudication of cardiovascular events. Overall, the evidence indicates that endogenous testosterone concentrations and testosterone therapy at physiological dosages confer no or minimal effects on the incidence of cardiovascular outcomes. There is insufficient evidence to make conclusions about testosterone therapy for patients at high risk of cardiovascular events (e.g., men with recent myocardial infarctions or stroke and men with recurrent idiopathic deep venous thromboses). In general, clinicians should avoid prescribing supraphysiological testosterone therapy to hypogonadal men or men with slightly low to low-normal serum testosterone concentrations and no identified disorder of the hypothalamus-pituitary-testicular axis because of the uncertain cardiovascular risks and the lack of proven health benefits. For most men with bona fide hypogonadism, benefits of testosterone therapy exceed the potential risk of adverse cardiovascular effects.
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Affiliation(s)
- Arthi Thirumalai
- Department of Medicine, University of Washington School of Medicine, Box 356420 Department of Medicine, 1959 NE Pacific Avenue, Seattle, WA, 98195, USA
| | - Bradley D Anawalt
- Department of Medicine, University of Washington School of Medicine, Box 356420 Department of Medicine, 1959 NE Pacific Avenue, Seattle, WA, 98195, USA.
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11
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Thirumalai A, Anawalt BD. Androgenic Steroids Use and Abuse. Urol Clin North Am 2022; 49:645-663. [DOI: 10.1016/j.ucl.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Abstract
Rates of unplanned pregnancies are high globally, burdening women and families. Efforts to develop male contraceptive agents have been thwarted by unacceptable failure rates, side effects and a dearth of pharmaceutical industry involvement. Hormonal male contraception consists of exogenous androgens which exert negative feedback on the hypothalamic-pituitary-gonadal axis and suppress gonadotropin production. This in turn suppresses testicular testosterone production and sperm maturation. Addition of a progestin suppresses spermatogenesis more effectively in men. Contraceptive efficacy studies in couples have shown male hormonal methods are effective and reversible, but also may come with side effects related to sexual desire, acne and serum cholesterol and inconvenient methods of dosing and delivery. Recently, novel androgens as potential contraceptive agents are being evaluated in early clinical trials and look to overcome these drawbacks. Here we summarize landmark studies of prototype male hormonal contraceptives, showcasing recent advances and future prospects in this important area of public health.
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Affiliation(s)
- Arthi Thirumalai
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA.
| | - Stephanie T Page
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA.
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13
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Page ST, Blithe D, Wang C. Hormonal Male Contraception: Getting to Market. Front Endocrinol (Lausanne) 2022; 13:891589. [PMID: 35721718 PMCID: PMC9203677 DOI: 10.3389/fendo.2022.891589] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022] Open
Abstract
Rates of unplanned pregnancies are high and stagnant globally, burdening women, families and the environment. Local limitations placed upon contraceptive access and abortion services exacerbate global disparities for women. Despite survey data suggesting men and their partners are eager for expanded male contraceptive options, efforts to develop such agents have been stymied by a paucity of monetary investment. Modern male hormonal contraception, like female hormonal methods, relies upon exogenous progestins to suppress the hypothalamic-pituitary-gonadal axis, in turn suppressing testicular testosterone production and sperm maturation. Addition of an androgen augments gonadotropin suppression, more effectively suppressing spermatogenesis in men, and provides androgenic support for male physiology. Previous contraceptive efficacy studies in couples have shown that hormonal male methods are effective and reversible. Recent efforts have been directed at addressing potential user and regulatory concerns by utilizing novel steroids and varied routes of hormone delivery. Provision of effective contraceptive options for men and women is an urgent public health need. Recognizing and addressing the gaps in our contraceptive options and engaging men in family planning will help reduce rates of unplanned pregnancies in the coming decades.
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Affiliation(s)
- Stephanie T. Page
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, United States
- *Correspondence: Stephanie T. Page,
| | - Diana Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Christina Wang
- Clinical and Translational Science Institute at the Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
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14
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Nguyen BT, Yuen F, Farrant M, Thirumalai A, Fernando F, Amory JK, Swerdloff RS, Anawalt BD, Blithe DL, Long JE, Liu PY, Page ST, Wang C. Acceptability of the oral hormonal male contraceptive prototype, 11β-methyl-19-nortestosterone dodecylcarbonate (11β-MNTDC), in a 28-day placebo-controlled trial. Contraception 2021; 104:531-537. [PMID: 34153318 PMCID: PMC8995005 DOI: 10.1016/j.contraception.2021.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/24/2021] [Accepted: 06/11/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine men's satisfaction with and the potential acceptability of 11β-methyl-19-nortestosterone dodecylcarbonate (11β-MNTDC) when used for 28 days as an experimental, once-daily, oral hormonal male contraceptive (HMC). STUDY DESIGN We surveyed participants from a double-blind, randomized, placebo-controlled, phase 1 clinical trial, examining their experience with and willingness to use daily oral 11β-MNTDC for male contraception. RESULTS Of 42 trial participants, 40 (30 11β-MNTDC, 10 placebo) completed baseline and end-of-treatment surveys. Based on a 28-day experience, few cited any baseline concerns about safety and drug adherence. Following treatment, nearly three-quarters (72.5%) of participants reported satisfaction with the study drug and nearly all (92.5%) would recommend the method to others. More than half of participants would be willing to pay for the study drug (62.5%) and indicated that the method exceeded initial expectations (53.9%). Nearly 90% reported that taking the pill was easy to remember and did not interfere with their daily routines. Approximately one-third of participants reported bothersome side effects (37% 11β-MNTDC vs. 20% placebo, p = 0.45). Given the option, 42% of participants would prefer a daily HMC pill over injectable regimens or a daily topical gel. CONCLUSION A majority of participants in this short-term trial of daily oral 11β-MNTDC reported satisfaction with the regimen, would recommend it to others, and would pay to use the drug as HMC despite some bothersome side effects. IMPLICATIONS Oral 11β-MNTDC would be an acceptable and preferable method among men desiring reversible hormonal male contraception (HMC). These data support further trials of novel oral HMCs such as 11β-MNTDC.
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Affiliation(s)
- Brian T Nguyen
- Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; Division of Endocrinology, Department of Medicine, The Lundquist Institute and Harbor UCLA Medical Center, Torrance, CA, United States.
| | - Fiona Yuen
- Division of Endocrinology, Department of Medicine, The Lundquist Institute and Harbor UCLA Medical Center, Torrance, CA, United States
| | - Maritza Farrant
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Arthi Thirumalai
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Frances Fernando
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - John K Amory
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Ronald S Swerdloff
- Division of Endocrinology, Department of Medicine, The Lundquist Institute and Harbor UCLA Medical Center, Torrance, CA, United States
| | - Bradley D Anawalt
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Diana L Blithe
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Jill E Long
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Peter Y Liu
- Division of Endocrinology, Department of Medicine, The Lundquist Institute and Harbor UCLA Medical Center, Torrance, CA, United States
| | - Stephanie T Page
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Christina Wang
- Division of Endocrinology, Department of Medicine, The Lundquist Institute and Harbor UCLA Medical Center, Torrance, CA, United States
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15
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Shrestha B, Schaefer A, Zhu Y, Saada J, Jacobs TM, Chavez EC, Omsted SS, Cruz-Teran CA, Vaca GB, Vincent K, Moench TR, Lai SK. Engineering sperm-binding IgG antibodies for the development of an effective nonhormonal female contraception. Sci Transl Med 2021; 13:13/606/eabd5219. [PMID: 34380769 DOI: 10.1126/scitranslmed.abd5219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 03/08/2021] [Accepted: 07/23/2021] [Indexed: 12/25/2022]
Abstract
Many women risk unintended pregnancy because of medical contraindications or dissatisfaction with contraceptive methods, including real and perceived side effects associated with the use of exogenous hormones. We pursued direct vaginal delivery of sperm-binding monoclonal antibodies (mAbs) that can limit progressive sperm motility in the female reproductive tract as a strategy for effective nonhormonal contraception. Here, motivated by the greater agglutination potencies of polyvalent immunoglobulins but the bioprocessing ease and stability of immunoglobulin G (IgG), we engineered a panel of sperm-binding IgGs with 6 to 10 antigen-binding fragments (Fabs), isolated from a healthy immune-infertile woman against a unique surface antigen universally present on human sperm. These highly multivalent IgGs (HM-IgGs) were at least 10- to 16-fold more potent and faster at agglutinating sperm than the parent IgG while preserving the crystallizable fragment (Fc) of IgG that mediates trapping of individual spermatozoa in mucus. The increased potencies translated into effective (>99.9%) reduction of progressively motile sperm in the sheep vagina using as little as 33 μg of the 10-Fab HM-IgG. HM-IgGs were produced at comparable yields and had identical thermal stability to the parent IgG, with greater homogeneity. HM-IgGs represent not only promising biologics for nonhormonal contraception but also a promising platform for engineering potent multivalent mAbs for other biomedical applications.
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Affiliation(s)
- Bhawana Shrestha
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Alison Schaefer
- UNC/NCSU Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Yong Zhu
- Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Jamal Saada
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Timothy M Jacobs
- Division of Pharmacoengineering and Molecular Pharmaceutics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Dualogics LLC, Durham, NC 27713, USA
| | - Elizabeth C Chavez
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Stuart S Omsted
- Department of Biophysics, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Carlos A Cruz-Teran
- Division of Pharmacoengineering and Molecular Pharmaceutics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Gabriela Baldeon Vaca
- Divisions of Infectious Disease and Obstetrics & Gynecology, Boston University School of Medicine, Boston, MA 02118, USA
| | - Kathleen Vincent
- Division of Gynecology, Department of Obstetrics and Gynecology, Center for Biomedical Engineering, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Thomas R Moench
- Department of Biophysics, Johns Hopkins University, Baltimore, MD 21218, USA.,Mucommune LLC, Durham, NC 27709, USA.,Mapp Biopharmaceutical Inc., San Diego, CA 92121, USA
| | - Samuel K Lai
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. .,UNC/NCSU Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Division of Pharmacoengineering and Molecular Pharmaceutics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,Mucommune LLC, Durham, NC 27709, USA
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16
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Long JE, Lee MS, Blithe DL. Update on Novel Hormonal and Nonhormonal Male Contraceptive Development. J Clin Endocrinol Metab 2021; 106:e2381-e2392. [PMID: 33481994 PMCID: PMC8344836 DOI: 10.1210/clinem/dgab034] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The advent of new methods of male contraception would increase contraceptive options for men and women and advance male contraceptive agency. Pharmaceutical R&D for male contraception has been dormant since the 1990s. The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) has supported a contraceptive development program since 1969 and supports most ongoing hormonal male contraceptive development. Nonhormonal methods are in earlier stages of development. CONTENT Several hormonal male contraceptive agents have entered clinical trials. Novel single agent products being evaluated include dimethandrolone undecanoate, 11β-methyl-nortestosterone dodecylcarbonate, and 7α-methyl-19-nortestosterone. A contraceptive efficacy trial of Nestorone®/testosterone gel is underway. Potential nonhormonal methods are at preclinical stages of development. Many nonhormonal male contraceptive targets that affect sperm production, sperm function, or sperm transport have been identified. SUMMARY NICHD supports development of reversible male contraceptive agents. Other organizations such as the World Health Organization, the Population Council, and the Male Contraception Initiative are pursuing male contraceptive development, but industry involvement remains limited.
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Affiliation(s)
- Jill E Long
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
- Correspondence: Dr. Jill Long, 6710B Rockledge Drive, Room 3243, Bethesda, MD 20892, USA.
| | - Min S Lee
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Diana L Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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17
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Yuen F, Thirumalai A, Fernando FA, Swerdloff RS, Liu PY, Pak Y, Hull L, Bross R, Blithe DL, Long JE, Page ST, Wang C. Comparison of metabolic effects of the progestational androgens dimethandrolone undecanoate and 11β-MNTDC in healthy men. Andrology 2021; 9:1526-1539. [PMID: 33908182 DOI: 10.1111/andr.13025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/19/2021] [Accepted: 04/19/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Dimethandrolone (DMA) and 11β-methyl-19-nortestosterone (11β-MNT) are two novel compounds with both androgenic and progestational activity that are under investigation as potential male hormonal contraceptives. Their metabolic effects have never been compared in men. OBJECTIVE Assess for changes in insulin sensitivity and adiponectin and compare the metabolic effects of these two novel androgens. MATERIALS/METHODS In two clinical trials of DMA undecanoate (DMAU) and 11β-MNT dodecylcarbonate (11β-MNTDC), oral prodrugs of DMA and 11β-MNT, healthy men received drug, or placebo for 28 days. Insulin and adiponectin assays were performed on stored samples. Mixed model analyses were performed to compare the effects of the two drugs. Student's t test, or the non-parametric Kruskal-Wallis test as appropriate, was used to evaluate for an effect of active drug versus placebo. RESULTS Class effects were seen, with decrease in HDL-C and SHBG, and increase in weight and hematocrit, with no statistically significant differences between the two compounds. No changes in fasting glucose, fasting insulin, or HOMA-IR were seen with either compound. There was a slight decrease in adiponectin with DMAU that was not seen with 11β-MNTDC. An increase in LDL-C was seen with 11β-MNTDC but not with DMAU. DISCUSSION There were no significant changes in insulin resistance after 28 days of oral administration of these novel androgens despite a mild increase in weight. There may be subtle differences in their metabolic impacts that should be explored in future studies. CONCLUSION Changes in metabolic parameters should be carefully monitored when investigating androgenic compounds.
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Affiliation(s)
- Fiona Yuen
- Department of Medicine, Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Arthi Thirumalai
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Frances A Fernando
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Ronald S Swerdloff
- Department of Medicine, Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Peter Y Liu
- Department of Medicine, Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Youngju Pak
- Department of Medicine, Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Laura Hull
- Department of Medicine, Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Rachelle Bross
- Department of Medicine, Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Diana L Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Jill E Long
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Stephanie T Page
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Christina Wang
- Department of Medicine, Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
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18
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Thirumalai A, Amory JK. Emerging approaches to male contraception. Fertil Steril 2021; 115:1369-1376. [PMID: 33931201 DOI: 10.1016/j.fertnstert.2021.03.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/29/2021] [Indexed: 01/12/2023]
Abstract
Despite significant interests in contraception by men, effective methods of male contraception are limited to vasectomy and condoms. Recently, there have been several promising advances in male contraceptive research. This review will update readers on recent research in both hormonal and nonhormonal approaches to male contraception. Hormonal approaches to male contraception have been stymied by adverse effects, formulations requiring injections or implants, a 5% to10% nonresponse rate, as well as poor understanding of user acceptability. In the last several years, research has focused on novel, orally bioavailable androgens such as dimethandrolone undecanoate and 11β-methyl-19-nor-testosterone. Additionally, combinations of a topical testosterone gel combined with a gel containing segesterone acetate, a potent progestin, have shown promise in clinical trials recently. Simultaneously, significant preclinical progress has been made in several approaches to nonhormonal male contraceptives, including compounds that inhibit sperm motility such as eppin, compounds that inhibit retinoic acid binding or biosynthesis, and reversible approaches to obstruction of the vas deferens. It is imperative for these areas of research to continue making strides so that there is a gamut of contraceptive options for couples to choose from. Some of these approaches will hopefully reach clinical utility soon, greatly improving contraceptive choice for couples.
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Affiliation(s)
- Arthi Thirumalai
- Center for Research in Reproduction and Contraception, Department of Medicine, University of Washington, Seattle, Washington
| | - John K Amory
- Center for Research in Reproduction and Contraception, Department of Medicine, University of Washington, Seattle, Washington.
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19
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Kharaba ZJ, Buabeid MA, Alfoteih YA. Effectiveness of testosterone therapy in hypogonadal patients and its controversial adverse impact on the cardiovascular system. Crit Rev Toxicol 2020; 50:491-512. [PMID: 32689855 DOI: 10.1080/10408444.2020.1789944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Testosterone is the major male hormone produced by testicles which are directly associated with man's appearance and secondary sexual developments. Androgen deficiency starts when the male hormonal level falls from its normal range though, in youngsters, the deficiency occurs due to disruption of the normal functioning of pituitary, hypothalamus glands, and testes. Thus, testosterone replacement therapy was already known for the treatment of androgen deficiency with lesser risks of producing cardiovascular problems. Since from previous years, the treatment threshold in the form of testosterone replacement therapy has effectively increased to that extent that it was prescribed for those conditions which it was considered as inappropriate. However, there are some research studies and clinical trials available that proposed the higher risk of inducing cardiovascular disease with the use of testosterone replacement therapy. Thus under the light of these results, the FDA has published the report of the increased risk of cardiovascular disease with the increased use of testosterone replacement therapy. Nevertheless, there is not a single trial available or designed that could evaluate the risk of cardiovascular events with the use of testosterone replacement therapy. As a result, the use of testosterone still questioned the cardiovascular safety of this replacement therapy. Thus, this literature outlines the distribution pattern of disease by investigating the data and link between serum testosterone level and the cardiovascular disease, also the prescription data of testosterone replacement therapy patients and their tendency of inducing cardiovascular disease, meta-analysis and the trials regarding testosterone replacement therapy and its connection with the risks of causing cardiovascular disease and lastly, the possible effects of testosterone replacement therapy on the cardiovascular system. This study aims to evaluate the available evidence regarding the use of testosterone replacement therapy when choosing it as a treatment plan for their patients.
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Affiliation(s)
- Zelal Jaber Kharaba
- Department of Clinical Sciences, College of Pharmacy, Al-Ain University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Manal Ali Buabeid
- Department of Clinical Sciences, Ajman University, Ajman, United Arab Emirates
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20
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Yuen F, Nguyen BT, Swerdloff RS, Wang C. Continuing the search for a hormonal male contraceptive. Best Pract Res Clin Obstet Gynaecol 2020; 66:83-94. [PMID: 32197832 PMCID: PMC7375909 DOI: 10.1016/j.bpobgyn.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/28/2020] [Accepted: 02/09/2020] [Indexed: 11/28/2022]
Abstract
This chapter discusses the mechanisms of action of hormonal male contraception, which suppresses the hypothalamic-pituitary-testis axis. When the intratesticular concentration of testosterone is subsequently suppressed to adequately low concentrations, spermatogenesis is arrested. Androgens are a necessary hormonal male contraceptive component because they not only suppress the hypothalamic-pituitary-testis axis, but also provide the male hormone necessary to maintain peripheral androgen functions. Past studies using testosterone alone and testosterone combined with progestins demonstrated contraceptive efficacy in the female partner at rates similar to combined hormonal female methods. Newer hormonal male contraceptive formulations and the alternative routes of administration are discussed, along with potential barriers, challenges, and opportunities for hormonal male contraceptive development. Novel methods that are safe, effective, reversible, user-friendly, and coitus-independent are intrinsic to equitably meet the various needs and limitations of an increasingly diverse population.
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Affiliation(s)
- Fiona Yuen
- Division of Endocrinology, Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, 90509, USA.
| | - Brian T Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90007, USA.
| | - Ronald S Swerdloff
- Division of Endocrinology, Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, 90509, USA
| | - Christina Wang
- Division of Endocrinology, Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, 90509, USA.
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21
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Amory JK. Development of Novel Male Contraceptives. Clin Transl Sci 2020; 13:228-237. [PMID: 31618525 PMCID: PMC7070810 DOI: 10.1111/cts.12708] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 09/03/2019] [Indexed: 12/16/2022] Open
Abstract
Unintended pregnancy is surprisingly common, accounting for 40-50% of pregnancies worldwide. Contraception is the most effective means of preventing unintended pregnancy. Seventy percent of all contraceptives are used by women; however, some women are unable to use contraceptives due to health conditions or side effects. Many men wish to take a more active role family planning, but currently have only two effective male contraceptive options, condoms and vasectomy. Therefore, work to develop novel male contraceptives analogous to popular female methods, such as daily pills or long-acting shots and implants, is underway. This paper will briefly discuss the pros and cons of condoms and vasectomies, and then review the research into novel methods of male contraception.
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Affiliation(s)
- John K. Amory
- Department of MedicineCenter for Research in Reproduction and ContraceptionUniversity of WashingtonSeattleWashingtonUSA
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22
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Abstract
The economic and public health burdens of unplanned pregnancies are evident globally. Since the introduction of the condom >300 years ago, assumptions about male willingness to participate in contraception, as well as concerns about failure rates and side effects, have stagnated the development of additional reversible male contraceptives. However, changing attitudes and recent research advances have generated renewed interest in developing reversible male contraceptives. To achieve effective and reversible suppression of spermatogenesis, male hormonal contraception relies on suppression of testicular testosterone and sperm production using an androgen-progestin combination. While these may be associated with side effects—changes in libido, weight, hematocrit, and cholesterol—recently, novel androgens and progestins have shown promise for a “male pill” with reduced side effects. Here we summarize landmark studies in male contraceptive development, showcase the most recent advances, and look into the future of this field, which has the potential to greatly impact global public health.
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Affiliation(s)
- Arthi Thirumalai
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, Washington 98195, USA
| | - Stephanie T. Page
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, Washington 98195, USA
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23
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Abstract
Testosterone is the main male sex hormone and is essential for the maintenance of male secondary sexual characteristics and fertility. Androgen deficiency in young men owing to organic disease of the hypothalamus, pituitary gland or testes has been treated with testosterone replacement for decades without reports of increased cardiovascular events. In the past decade, the number of testosterone prescriptions issued for middle-aged or older men with either age-related or obesity-related decline in serum testosterone levels has increased exponentially even though these conditions are not approved indications for testosterone therapy. Some retrospective studies and randomized trials have suggested that testosterone replacement therapy increases the risk of cardiovascular disease, which has led the FDA to release a warning statement about the potential cardiovascular risks of testosterone replacement therapy. However, no trials of testosterone replacement therapy published to date were designed or adequately powered to assess cardiovascular events; therefore, the cardiovascular safety of this therapy remains unclear. In this Review, we provide an overview of epidemiological data on the association between serum levels of endogenous testosterone and cardiovascular disease, prescription database studies on the risk of cardiovascular disease in men receiving testosterone therapy, randomized trials and meta-analyses evaluating testosterone replacement therapy and its association with cardiovascular events and mechanistic studies on the effects of testosterone on the cardiovascular system. Our aim is to help clinicians to make informed decisions when considering testosterone replacement therapy in their patients.
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24
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Sharma RS, Mathur AK, Singh R, Das HC, Singh GJ, Toor DPS, Guha SK. Safety & efficacy of an intravasal, one-time injectable & non-hormonal male contraceptive (RISUG): A clinical experience. Indian J Med Res 2019; 150:81-86. [PMID: 31571633 PMCID: PMC6798614 DOI: 10.4103/ijmr.ijmr_635_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background & objectives: For improved male contraception, a new polymeric drug molecule – Reversible Inhibition of Sperm under Guidance (RISUG) has been synthesized and has been found to be effective, safe and reversible in various animal species. Phase-I and phase-II clinical trials have confirmed its safety and contraceptive efficacy. The present study was undertaken as a multicentric-limited phase-III clinical trial to test the efficacy and safety of RISUG in human volunteers. Methods: One hundred and thirty nine young males each having at least two children and living with wife were given 120 μl of RISUG as bilateral vas intraluminal injection. After the single-dose administration, the individuals were followed in respect of general health and semen parameters. Their wives were also followed particularly to determine onset of pregnancy. Results: During the six month follow up, the health of male volunteers and their wives was normal with no significant adverse effects. Temporary scrotal enlargement and mild scrotal and inguinal region pain were manifested in most individuals and resolved within one month without any routine activity impairment. In six individuals, there was injection procedure failure and azoospermia was not achieved. The other 133 individuals had either severe oligozoospermia or azoospermia at the first semen examination one month following RISUG injection; 82.7 per cent individuals had continued azoospermia in the month following first semen examination onwards and the rest 17.3 per cent manifested azoospermia within three to six months. Interpretation & conclusions: RISUG intravasal injection appears to be a safe clinical procedure with no significant adverse effects and has high sustained contraceptive efficacy. The localized intervention and continued contraceptive action on single-dose administration were significant features of the RISUG technology.
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Affiliation(s)
- Radhey Shyam Sharma
- Division of Reproductive Biology, Maternal Health and Child Health, Indian Council of Medical Research, New Delhi, India
| | - Ajit Kumar Mathur
- Division of Reproductive Biology, Maternal Health and Child Health, Indian Council of Medical Research, New Delhi, India
| | - Rajeev Singh
- Division of Reproductive Biology, Maternal Health and Child Health, Indian Council of Medical Research, New Delhi, India
| | - Hem Chandra Das
- Male Family Planning Clinic, Lok Nayak Jai Parkash Narayan Hospital, Delhi, India
| | | | | | - Sujoy Kumar Guha
- School of Medical Science & Technology, Indian Institute of Technology, Kharagpur, India
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Abstract
Unplanned pregnancies are an ongoing global burden, posing health and economic risks for women, children, and families. Advances in male contraception have been historically stymied by concerning failure rates, problematic side effects, and perceived market limitations. However, increased interest in reliable and reversible options for male contraception have resulted in resurgent efforts to introduce novel contraceptives for men. Hormonal male contraception relies on exogenous androgens and progestogens that suppress gonadotropin production, thereby suppressing testicular testosterone and sperm production. In many men, effective suppression of spermatogenesis can be achieved by androgen-progestin combination therapy. Small-scale contraceptive efficacy studies in couples have demonstrated effectiveness and reversibility with male hormonal methods, but side effects related to mood, sexual desire and cholesterol remain concerning. A number of novel androgens have reached clinical testing as potential contraceptive agents; many of these have both androgenic and progestogenic action in a single, modified steroid, thereby holding promise as single-agent contraceptives. Currently, these novel steroids hold promise as both a "male pill" and long-acting injections. Among non-hormonal methods, studies of reversible vaso-occlusive methods (polymers that block transport of sperm through the vas deferens) are ongoing, but reliable reversibility and long-term safety in men have not been established. Proteins involved in sperm maturation and motility are attractive targets, but to date both specificity and biologic redundancy have been challenges for drug development. In this review, we aim to summarize landmark studies on male contraception, highlight the most recent advances and future development in this important field of public health and medicine.
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Reynolds-Wright JJ, Anderson R. Male contraception: where are we going and where have we been? BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:bmjsrh-2019-200395. [PMID: 31537614 PMCID: PMC6892591 DOI: 10.1136/bmjsrh-2019-200395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/13/2019] [Accepted: 08/30/2019] [Indexed: 05/22/2023]
Abstract
Progress in developing new reversible male contraception has been slow. While the hormonal approach has been clearly shown to be capable of providing effective and reversible contraception, there remains no product available. Currently, trials of a self-administered gel combination of testosterone and the progestogen Nestorone® are under way, complementing the largely injectable methods previously investigated. Novel long-acting steroids with both androgenic and progestogenic activity are also in early clinical trials. The non-hormonal approach offers potential advantages, with potential sites of action on spermatogenesis, and sperm maturation in the epididymis or at the vas, but remains in preclinical testing. Surveys indicate the willingness of men, and their partners, to use a new male method, but they continue to lack that opportunity.
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Affiliation(s)
- John Joseph Reynolds-Wright
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Richard Anderson
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
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Anawalt BD, Roth MY, Ceponis J, Surampudi V, Amory JK, Swerdloff RS, Liu PY, Dart C, Bremner WJ, Sitruk-Ware R, Kumar N, Blithe DL, Page ST, Wang C. Combined nestorone-testosterone gel suppresses serum gonadotropins to concentrations associated with effective hormonal contraception in men. Andrology 2019; 7:878-887. [PMID: 30969032 DOI: 10.1111/andr.12603] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Novel male-based contraceptives are needed to broaden family planning choices. A progestin, Nestorone® (Nes) gel, plus a testosterone (T) gel suppresses sperm concentrations to levels associated with effective contraception in normal men. However, administration of two gels on different parts of the body daily is impractical. OBJECTIVE Compare the effectiveness of daily application of a single, combined 8.3 mg Nes-62.5 mg T gel (Nes-T) vs. 62.7 mg T gel to suppress serum FSH and LH concentrations to ≤1.0 IU/L (a threshold associated with suppression of sperm concentrations to ≤1 million and effective contraception) and to compare the pharmacokinetics of serum Nes and T concentrations between the gel groups. DESIGN We conducted a 28-day, double-blind, controlled trial of 44 healthy men randomized to daily Nes-T or T gel with measurement of hormones at baseline, treatment, and recovery and during 24-h pharmacokinetic studies on days 1 and 28 of treatment. RESULTS Of the subjects who met pre-defined inclusion criteria, 84% of the Nes-T group suppressed serum gonadotropin concentrations to ≤1.0 IU/L at days 21-28 vs. 16.7% in the T group (p < 0.001). On day 1, Nes concentrations rose significantly above baseline by 2 h and continued to rise up to 24 h after Nes-T gel application. Nes concentrations were not detectable in the T group. Serum total T concentrations rose and were significantly higher in the T gel group compared to the Nes-T group at 24 h on day 1 and days 11, 14, and 21 (p < 0.01). There were no serious adverse events in either group. About 80% of the subjects reported satisfaction with both gels. CONCLUSION Daily Nes-T gel effectively and safely suppresses serum gonadotropins and is acceptable to most men. It should be studied further in efficacy trials of hormonal male contraception.
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Affiliation(s)
- B D Anawalt
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - M Y Roth
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - J Ceponis
- Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Department of Medicine, Division of Endocrinology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - V Surampudi
- Department of Medicine, Division of Endocrinology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - J K Amory
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - R S Swerdloff
- Department of Medicine, Division of Endocrinology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - P Y Liu
- Department of Medicine, Division of Endocrinology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - C Dart
- Health Decisions, Durham, NC, USA
| | - W J Bremner
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - R Sitruk-Ware
- Center for Biomedical Research, Population Council, New York, NY, USA
| | - N Kumar
- Center for Biomedical Research, Population Council, New York, NY, USA
| | - D L Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - S T Page
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - C Wang
- Department of Medicine, Division of Endocrinology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
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Research update and opportunity of non-hormonal male contraception: Histone demethylase KDM5B-based targeting. Pharmacol Res 2019; 141:1-20. [DOI: 10.1016/j.phrs.2018.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 11/29/2018] [Accepted: 12/09/2018] [Indexed: 12/28/2022]
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Gava G, Meriggiola MC. Update on male hormonal contraception. Ther Adv Endocrinol Metab 2019; 10:2042018819834846. [PMID: 30899448 PMCID: PMC6419257 DOI: 10.1177/2042018819834846] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/08/2019] [Indexed: 11/25/2022] Open
Abstract
Despite increases in female contraceptive options, 40-45% of pregnancies across the world are still unplanned. While several effective female contraceptive methods have been developed, contraceptive choices for men are still limited to the male condom with its high failure rates and to vasectomies, which are invasive and not reliably reversible. Several studies have demonstrated a great interest among men and women for effective, reversible, and safe male contraceptive methods. Over the years, numerous studies have been performed to develop male hormonal and nonhormonal safe and effective contraceptives. A variety of new molecules are under development as oral or transdermal hormonal contraceptives for men demonstrating few side effects. In our overpopulated world, the development and commercialization of a male contraceptive method that will allow both men and women to take an active role in family planning is mandatory and further research on this topic is required.
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Affiliation(s)
- Giulia Gava
- Gynecology and Physiopathology of Human Reproduction, S. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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30
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Affiliation(s)
- Stephanie T Page
- Center for Research in Reproduction and Contraception, University of Washington, Department of Medicine, Seattle, WA, USA
| | - John K Amory
- Center for Research in Reproduction and Contraception, University of Washington, Department of Medicine, Seattle, WA, USA.
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31
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Khourdaji I, Zillioux J, Eisenfrats K, Foley D, Smith R. The future of male contraception: a fertile ground. Transl Androl Urol 2018; 7:S220-S235. [PMID: 29928620 PMCID: PMC5989114 DOI: 10.21037/tau.2018.03.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The continued and rapid expansion of the Earth’s population mandates the need for safe and effective measures of contraception. While a plethora of options exist for women, methods of contraception for the male partner are limited to condoms and vasectomy. The sequela of this discrepancy has led to the family planning burden falling disproportionately on the female partner. For the past several decades, extensive research has been undertaken exploring the feasibility of hormonal male contraception. This proposed method of contraception has focused on suppressing spermatogenesis by exploiting the hypothalamic-pituitary-gonadal (HPG) axis. Beginning with proof of concept studies in the early nineties, administration of testosterone in healthy male subjects has been shown to be an efficacious method of inducing sterility. Owing to ethnic differences in spermatogenesis suppression and the comparatively low rate of azoospermia in Caucasian men with androgen-only regimens, investigators have explored the addition of progestins to further enhance the efficacy of hormonal contraception. Though studies have revealed promise with androgen-progestin regimens, the lack of long-term studies has precluded the development of a marketable product. Recently, more research has been directed towards identifying non-hormonal alternatives to male contraception. These non-hormonal options have ranged from the development of devices facilitating reversible occlusion of the vas deferens lumen to medications disrupting various pathways in the process of spermatogenesis. Underlying the development of hormonal and non-hormonal strategies is the shared enthusiasm men and women have towards these male directed methods. The willingness of couples to pursue these alternatives combined with the global need to reduce the psychological and socioeconomic implications of unintended pregnancy ensures that research will continue to bring this goal to fruition.
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Affiliation(s)
- Iyad Khourdaji
- Department of Urology, University of Virginia Healthcare System, Charlottesville, VA, USA
| | - Jacqueline Zillioux
- Department of Urology, University of Virginia Healthcare System, Charlottesville, VA, USA
| | | | - Daniel Foley
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ryan Smith
- Department of Urology, University of Virginia Healthcare System, Charlottesville, VA, USA.,Contraline, Inc., Charlottesville, VA, USA.,University of Virginia School of Medicine, Charlottesville, VA, USA
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32
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Dorman E, Perry B, Polis CB, Campo-Engelstein L, Shattuck D, Hamlin A, Aiken A, Trussell J, Sokal D. Modeling the impact of novel male contraceptive methods on reductions in unintended pregnancies in Nigeria, South Africa, and the United States. Contraception 2018; 97:62-69. [PMID: 28887053 PMCID: PMC5732079 DOI: 10.1016/j.contraception.2017.08.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/25/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We modeled the potential impact of novel male contraceptive methods on averting unintended pregnancies in the United States, South Africa, and Nigeria. STUDY DESIGN We used an established methodology for calculating the number of couple-years of protection provided by a given contraceptive method mix. We compared a "current scenario" (reflecting current use of existing methods in each country) against "future scenarios," (reflecting whether a male oral pill or a reversible vas occlusion was introduced) in order to estimate the impact on unintended pregnancies averted. Where possible, we based our assumptions on acceptability data from studies on uptake of novel male contraceptive methods. RESULTS Assuming that only 10% of interested men would take up a novel male method and that users would comprise both switchers (from existing methods) and brand-new users of contraception, the model estimated that introducing the male pill or reversible vas occlusion would decrease unintended pregnancies by 3.5% to 5.2% in the United States, by 3.2% to 5% in South Africa, and by 30.4% to 38% in Nigeria. Alternative model scenarios are presented assuming uptake as high as 15% and as low as 5% in each location. Model results were sensitive to assumptions regarding novel method uptake and proportion of switchers vs. new users. CONCLUSION Even under conservative assumptions, the introduction of a male pill or temporary vas occlusion could meaningfully contribute to averting unintended pregnancies in a variety of contexts, especially in settings where current use of contraception is low. IMPLICATIONS Novel male contraceptives could play a meaningful role in averting unintended pregnancies in a variety of contexts. The potential impact is especially great in settings where current use of contraception is low and if novel methods can attract new contraceptive users.
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Affiliation(s)
- Emily Dorman
- Modeling and Simulation, Evidera Inc., Bethesda, MD, USA; Male Contraception Initiative, Durham, NC, USA
| | - Brian Perry
- Department of Population Health Science, Duke University, Durham, NC, USA.
| | - Chelsea B Polis
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Guttmacher Institute, New York, NY, USA
| | - Lisa Campo-Engelstein
- Alden March Bioethics Institute and Department of Obstetrics and Gynecology, Albany Medical College, Albany, NY, USA
| | - Dominick Shattuck
- Institute for Reproductive Health, Georgetown University, Washington, DC, USA
| | | | - Abigail Aiken
- LBJ School of Public Affairs, University of Texas at Austin, Austin, TX, USA
| | - James Trussell
- Office of Population Research, Princeton University, Princeton, NJ, USA; University of Edinburgh, Edinburgh, Scotland
| | - David Sokal
- Male Contraception Initiative, Durham, NC, USA; Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Zhang XW, Zhang C, Zhang W, Yang D, Meng S, Wang P, Guo J, Liu DH. Suppression of spermatogenesis by testosterone undecanoate-loaded injectable in situ-forming implants in adult male rats. Asian J Androl 2017; 18:791-7. [PMID: 26459781 PMCID: PMC5000806 DOI: 10.4103/1008-682x.160886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We have investigated the feasibility of administration of testosterone undecanoate (TU)-loaded injectable in situ-forming implant (ISFI) for contraception in adult male Sprague–Dawley rats. Male rats were treated with vehicle, TU-loaded ISFIs (540, 270 and 135 mg TU kg−1) or TU injections (45 mg TU kg−1 every 30 days) for 120 days. Fertility tests served for determining infertility or restoration of fertility in treated rats. Serum testosterone concentration, epididymal sperm count, motility, morphology, and histology of the testis were monitored. The TU-loaded ISFIs increased serum testosterone levels in rats steadily without fluctuation over 3 months. One month after TU administration, the epididymal sperm count decreased significantly in all experimental groups. After 3 months, the animals treated with 270 and 135 mg kg−1 TU-loaded ISFIs were 100% infertile, and no implantation sites were produced in the mated females. However, some of males treated with 540 mg kg−1 ISFI or TU injections were still fertile but numbers of implantation sites were also significantly lower than control values. TU-loaded ISFI at an appropriate dose has potential as a long-acting male contraceptive drug that suppresses spermatogenesis consistently over a period of 3 months.
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Affiliation(s)
- Xiao-Wei Zhang
- Drug Research Laboratory, Liaoning Research Institute of Family Planning, Huanggu District, Shenyang, China
| | - Chong Zhang
- Drug Research Laboratory, Liaoning Research Institute of Family Planning, Huanggu District, Shenyang, China
| | - Wei Zhang
- Drug Research Laboratory, Liaoning Research Institute of Family Planning, Huanggu District, Shenyang, China
| | - Dan Yang
- Drug Research Laboratory, Liaoning Research Institute of Family Planning, Huanggu District, Shenyang, China
| | - Shu Meng
- Drug Research Laboratory, Liaoning Research Institute of Family Planning, Huanggu District, Shenyang, China
| | - Ping Wang
- Drug Research Laboratory, Liaoning Research Institute of Family Planning, Huanggu District, Shenyang, China
| | - Jing Guo
- Drug Research Laboratory, Liaoning Research Institute of Family Planning, Huanggu District, Shenyang, China
| | - Dan-Hua Liu
- Drug Research Laboratory, Liaoning Research Institute of Family Planning, Huanggu District, Shenyang, China
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34
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Piotrowska K, Wang C, Swerdloff RS, Liu PY. Male hormonal contraception: hope and promise. Lancet Diabetes Endocrinol 2017; 5:214-223. [PMID: 26915313 PMCID: PMC4993687 DOI: 10.1016/s2213-8587(16)00034-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/05/2016] [Accepted: 01/12/2016] [Indexed: 02/01/2023]
Abstract
Family planning is a shared responsibility, but available male-directed contraceptive methods are either not easily reversible (vasectomy) or not sufficiently effective (condom). However, roughly 20% of couples using a contraceptive method worldwide, and up to 80% in some countries, still choose a male-directed method. Male hormonal contraception is highly effective, with perfect use failure rates of 0·6% (95% CI 0·3-1·1) if sperm concentrations of less than 1 million per mL are maintained. After cessation of male hormonal contraception, sperm output fully recovers in a predictable manner, resulting in pregnancies and livebirths. Spontaneous miscarriage and fetal malformation rates after recovery of sperm output overlap those in the general population. Short-term adverse events-acne, night sweats, increased weight, and altered mood and libido-are recognised, but are generally mild. Further optimisation of specific androgen-progestin regimens and phase 3 studies of lead combinations are still needed to successfully develop an approved male hormonal contraceptive and to identify long-term side-effects.
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Affiliation(s)
- Katarzyna Piotrowska
- Division of Endocrinology, Department of Medicine, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute (LA BioMed) Torrance, CA, USA
| | - Christina Wang
- Division of Endocrinology, Department of Medicine, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute (LA BioMed) Torrance, CA, USA
| | - Ronald S Swerdloff
- Division of Endocrinology, Department of Medicine, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute (LA BioMed) Torrance, CA, USA
| | - Peter Y Liu
- Division of Endocrinology, Department of Medicine, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute (LA BioMed) Torrance, CA, USA.
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35
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Soufir JC. Hormonal, chemical and thermal inhibition of spermatogenesis: contribution of French teams to international data with the aim of developing male contraception in France. Basic Clin Androl 2017; 27:3. [PMID: 28101363 PMCID: PMC5237323 DOI: 10.1186/s12610-016-0047-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 12/20/2016] [Indexed: 11/13/2022] Open
Abstract
Since the 1970s, international research on male contraception has been actively pursued. Hormonal and non-hormonal methods (thermal, chemical) have been tested, leading to clinical trials of interest to thousands of men and couples. The results showed that it was possible to develop methods of male contraception that inhibited spermatogenesis with good contraceptive efficacy. However, their side effects (mainly loss of libido), poorly accepted modes of administration, and the high frequency of poor responders prevented their widespread use. Based on earlier initiatives, new avenues were explored and significant progress was achieved, allowing the reasoned use of male contraception. For 40 years, several French teams have played an important role in this research. The aim of this paper is to outline the history and the progress of the experimental and clinical works of these teams who addressed hormonal, chemical and thermal approaches to male contraception. These approaches have led to a better comprehension of spermatogenesis that could be useful in fields other than male contraception: effects of toxic compounds, fertility preservation.
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Affiliation(s)
- Jean-Claude Soufir
- Biologie de la Reproduction, Centre Hospitalier Universitaire Cochin, 123 Bd de Port Royal, 75014 Paris, France
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36
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Affiliation(s)
- C Wang
- Los Angeles Biomedical Research Institute and Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | - D Serfaty
- Francophone Society of Contraception, Paris, France
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Zhao J, Liu GL, Wei Y, Jiang LH, Bao PL, Yang QY. Low-dose testosterone alleviates vascular damage caused by castration in male rats in puberty via modulation of the PI3K/AKT signaling pathway. Mol Med Rep 2016; 14:2518-26. [PMID: 27485938 PMCID: PMC4991766 DOI: 10.3892/mmr.2016.5562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 02/02/2016] [Indexed: 12/26/2022] Open
Abstract
The aim of the present study was to investigate the effect of testosterone on glucolipid metabolism and vascular injury in male rats, and examine the underlying molecular mechanisms. A total of 40 male Sprague-Dawley rats were divided into a control group (n=10), high-fat-diet + castration group (n=10), high-fat-diet + castration + low dose testosterone group (n=10), and high-fat-diet + castration + high dose testosterone group (n=10). Hematoxylin and eosin staining was performed to evaluate the morphology of the thoracic aortic tissues. Immunohistochemical staining was used to detect biomarkers of the phosphoinositide 3-kinase (PI3K) signaling pathway. The mRNA and protein expression levels of PI3K, AKT, insulin receptor substrate-1 (IRS-1), glucose transporter type 4 (GLUT-4), nuclear factor (NF)-κB and tumor necrosis factor (TNF)-α in the aortas were determined using quantitative polymerase chain reaction and Western blot analyses, respectively. Apoptosis in the aortic tissues was detected using a TUNEL assay. Castration induced apoptosis in the animals fed a high-fat-diet, whereas low dose testosterone replacement ameliorated the apoptosis in the aorta. However, the levels of apoptosis was more severe following high-dose testosterone treatment. Low-dose testosterone induced upregulation in the levels of IRS-1, AKT, GLUT-4 protein, NF-κB, TNF-α and PI3K, compared with those in the animals fed a high-fat diet following castration. A high dose of testosterone resulted in a significant decrease in the levels of IRS-1, AKT, GLUT-4, NF-κB, TNF-α and PI3K. Compared with the rats in the high-fat diet + castration group, a low dose of testosterone induced upregulation in the mRNA levels of IRS-1, AKT and GLUT-4, and downregulation of the mRNA levels of NF-κB, TNF-α and PI3K. A high dose of testosterone resulted in a significant decrease in the levels of IRS-1, AKT and GLUT-4, and marked increases in the mRNA levels of NF-κB, TNF-α and PI3K, compared with the low dose group. Castration induced marked disorders of glucolipid metabolism and vascular injuries in the pubescent male rats. Low-dose testosterone treatment was found to ameliorate the vascular damage caused by castration via the PI3K/AKT signaling pathway.
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Affiliation(s)
- Jing Zhao
- Department of Paediatrics, General Hospital of Tianjin Medical University, Tianjin 300052, P.R. China
| | - Ge-Li Liu
- Department of Paediatrics, General Hospital of Tianjin Medical University, Tianjin 300052, P.R. China
| | - Ying Wei
- Department of Paediatrics, General Hospital of Tianjin Medical University, Tianjin 300052, P.R. China
| | - Li-Hong Jiang
- Department of Paediatrics, General Hospital of Tianjin Medical University, Tianjin 300052, P.R. China
| | - Peng-Li Bao
- Department of Paediatrics, General Hospital of Tianjin Medical University, Tianjin 300052, P.R. China
| | - Qing-Yan Yang
- Department of Paediatrics, General Hospital of Tianjin Medical University, Tianjin 300052, P.R. China
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Abstract
World population continues to grow at an unprecedented rate, doubling in a mere 50years to surpass the 7-billion milestone in 2011. This steep population growth exerts enormous pressure on the global environment. Despite the availability of numerous contraceptive choices for women, approximately half of all pregnancies are unintended and at least half of those are unwanted. Such statistics suggest that there is still a gap in contraceptive options for couples, particularly effective reversible contraceptives for men, who have few contraceptive choices. Male hormonal contraception has been an active area of research for almost 50years. The fundamental concept involves the use of exogenous hormones to suppress endogenous production of gonadotropins, testosterone, and downstream spermatogenesis. Testosterone-alone regimens are effective in many men but high dosing requirements and sub-optimal gonadotropin suppression in 10-30% of men limit their use. A number of novel combinations of testosterone and progestins have been shown to be more efficacious but still require further refinement in delivery systems and a clearer understanding of the potential short- and long-term side effects. Recently, synthetic androgens with both androgenic and progestogenic activity have been developed. These agents have the potential to be single-agent male hormonal contraceptives. Early studies of these compounds are encouraging and there is reason for optimism that these may provide safe, reversible, and reliable contraception for men in the near future.
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Affiliation(s)
- Jing H Chao
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA
| | - Stephanie T Page
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA.
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Abstract
Hormonal male contraception clinical trials began in the 1970s. The method is based on the use of exogenous testosterone alone or in combination with a progestin to suppress the endogenous production of testosterone and spermatogenesis. Studies using testosterone alone showed that the method was very effective with few adverse effects. Addition of a progestin increases the rate and extent of suppression of spermatogenesis. Common adverse effects include acne, injection site pain, mood change including depression, and changes in libido that are usually mild and rarely lead to discontinuation. Current development includes long-acting injectables and transdermal gels and novel androgens that may have both androgenic and progestational activities. Surveys showed that over 50 % of men will accept a new male method and female partners will trust their partner to take oral “male pills.” Partnership between government, nongovernment agencies, academia, and industry may generate adequate interest and collaboration to develop and market the first male hormonal contraception.
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40
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Roth MY, Page ST, Bremner WJ. Male hormonal contraception: looking back and moving forward. Andrology 2015; 4:4-12. [PMID: 26453296 DOI: 10.1111/andr.12110] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/11/2015] [Accepted: 08/26/2015] [Indexed: 11/26/2022]
Abstract
Despite numerous contraceptive options available to women, approximately half of all pregnancies in the United States and worldwide are unplanned. Women and men support the development of reversible male contraception strategies, but none have been brought to market. Herein we review the physiologic basis for male hormonal contraception, the history of male hormonal contraception development, currents agents in development as well as the potential risks and benefits of male hormonal contraception for men.
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Affiliation(s)
- M Y Roth
- Department of Medicine and Center for Research in Reproduction and Contraception, University of Washington, Seattle, WA, USA
| | - S T Page
- Department of Medicine and Center for Research in Reproduction and Contraception, University of Washington, Seattle, WA, USA
| | - W J Bremner
- Department of Medicine and Center for Research in Reproduction and Contraception, University of Washington, Seattle, WA, USA
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Li HJ. More attention should be paid to the treatment of male infertility with drugs--testosterone: to use it or not? Asian J Androl 2014; 16:270-3. [PMID: 24435051 PMCID: PMC3955339 DOI: 10.4103/1008-682x.122343] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Testosterone replacement is strictly contraindicated for the treatment of male infertility’ was the advanced view from the ‘2013 European Association of Urology (EAU) guidelines on male infertility’, and this view brings extensive concern and questions. Although sufficient numbers of well-performed and controlled clinical trials that provide evidence supporting drug treatment of male infertility are not available at present, the opportunity to prove that these drugs are effective should not be prevented, and rigorous examination of drug therapy should be encouraged and strengthened. Therefore, I believe the above conclusion in the EAU guidelines is poorly conceived.
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Affiliation(s)
- Hong-Jun Li
- Urological Department of the Peking Union Medical College Hospital (PUMCH), Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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42
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Male contraception. Best Pract Res Clin Obstet Gynaecol 2014; 28:845-57. [PMID: 24947599 DOI: 10.1016/j.bpobgyn.2014.05.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 03/13/2014] [Accepted: 05/26/2014] [Indexed: 12/21/2022]
Abstract
Clear evidence shows that many men and women would welcome new male methods of contraception, but none have become available. The hormonal approach is based on suppression of gonadotropins and thus of testicular function and spermatogenesis, and has been investigated for several decades. This approach can achieve sufficient suppression of spermatogenesis for effective contraception in most men, but not all; the basis for these men responding insufficiently is unclear. Alternatively, the non-hormonal approach is based on identifying specific processes in sperm development, maturation and function. A range of targets has been identified in animal models, and targeted effectively. This approach, however, remains in the pre-clinical domain at present. There are, therefore, grounds for considering that safe, effective and reversible methods of contraception for men can be developed.
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Surampudi P, Page ST, Swerdloff RS, Nya-Ngatchou JJ, Liu PY, Amory JK, Leung A, Hull L, Blithe DL, Woo J, Bremner WJ, Wang C. Single, escalating dose pharmacokinetics, safety and food effects of a new oral androgen dimethandrolone undecanoate in man: a prototype oral male hormonal contraceptive. Andrology 2014; 2:579-587. [PMID: 24789057 DOI: 10.1111/j.2047-2927.2014.00216.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 03/10/2014] [Accepted: 03/19/2014] [Indexed: 12/18/2022]
Abstract
The novel androgen, dimethandrolone (DMA) has both androgenic and progestational activities, properties that may maximize gonadotropin suppression. We assessed the pharmacokinetics of dimethandrolone undecanoate (DMAU), an orally bioavailable, longer acting ester of DMA, for male contraceptive development. Our objective was to examine the safety and pharmacokinetics of single, escalating doses of DMAU (powder in capsule formulation) administered orally with or without food in healthy men. We conducted a randomized, double-blind Phase 1 study. For each dose of DMAU (25-800 mg), 10 male volunteers received DMAU and two received placebo at two academic medical centres. DMAU was administered both fasting and after a high-fat meal (200-800 mg doses). Serial serum samples were collected over 24 h following each dose. DMAU was well tolerated without significant effects on vital signs, safety laboratory tests or electrocardiograms. When administered while fasting, serum DMA (active compound) was detectable in only 4/10 participants after the 800 mg dose. When administered with a 50% fat meal, serum DMA was detectable in all participants given 200 mg DMAU and showed a dose-incremental increase up to 800 mg, with peak levels 4-8 h after taking the dose. Serum gonadotropins and sex hormone concentrations were significantly suppressed 12 h after DMAU administration with food at doses above 200 mg. This first-in-man study demonstrated that a single, oral dose of DMAU up to 800 mg is safe. A high-fat meal markedly improved DMAU/DMA pharmacokinetics.
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Affiliation(s)
- Prasanth Surampudi
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - Stephanie T Page
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - Ronald S Swerdloff
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - Jean Jacques Nya-Ngatchou
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - Peter Y Liu
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - John K Amory
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - Andrew Leung
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - Laura Hull
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - Diana L Blithe
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - Jason Woo
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - William J Bremner
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
| | - Christina Wang
- Division of Endocrinology, Department of Medicine, Harbor UCLA Medical center and Los Angeles Biomedical Research Institute, Torrance, CA 90501 (PS, RSS, PYL, AL, LH, CW); Division of Endocrinology, Department of Medicine, University of Washington, Seattle WA 98004 (STP, JJN, JKA, WJB); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510 (DLB, JW)
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Oduwole OO, Vydra N, Wood NEM, Samanta L, Owen L, Keevil B, Donaldson M, Naresh K, Huhtaniemi IT. Overlapping dose responses of spermatogenic and extragonadal testosterone actions jeopardize the principle of hormonal male contraception. FASEB J 2014; 28:2566-76. [PMID: 24599970 PMCID: PMC4376501 DOI: 10.1096/fj.13-249219] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Testosterone (T), alone or in combination with progestin, provides a promising approach to hormonal male contraception. Its principle relies on enhanced negative feedback of exogenous T to suppress gonadotropins, thereby blocking the testicular T production needed for spermatogenesis, while simultaneously maintaining the extragonadal androgen actions, such as potency and libido, to avoid hypogonadism. A serious drawback of the treatment is that a significant proportion of men do not reach azoospermia or severe oligozoospermia, commensurate with contraceptive efficacy. We tested here, using hypogonadal luteinizing hormone/choriongonadotropin receptor (LHCGR) knockout (LHR−/−) mice, the basic principle of the T-based male contraceptive method, that a specific T dose could maintain extragonadal androgen actions without simultaneously activating spermatogenesis. LHR−/− mice were treated with increasing T doses, and the responses of their spermatogenesis and extragonadal androgen actions (including gonadotropin suppression and sexual behavior) were assessed. Conspicuously, all dose responses to T were practically superimposable, and no dose of T could be defined that would maintain sexual function and suppress gonadotropins without simultaneously activating spermatogenesis. This finding, never addressed in clinical contraceptive trials, is not unexpected in light of the same androgen receptor mediating androgen actions in all organs. When extrapolated to humans, our findings may jeopardize the current approach to hormonal male contraception and call for more effective means of inhibiting intratesticular T production or action, to achieve consistent spermatogenic suppression.—Oduwole, O. O., Vydra, N., Wood, N. E. M., Samanta, L., Owen, L., Keevil, B., Donaldson, M., Naresh, K., Huhtaniemi, I. T. Overlapping dose responses of spermatogenic and extragonadal testosterone actions jeopardize the principle of hormonal male contraception.
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Affiliation(s)
- Olayiwola O Oduwole
- Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, and
| | - Natalia Vydra
- Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, and Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Nicholas E M Wood
- Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, and
| | - Luna Samanta
- Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, and Biochemistry Laboratory, Department of Zoology, School of Life Sciences, Ravenshaw University, Cuttack, India
| | - Laura Owen
- Biochemistry Department, University Hospital of South Manchester, Manchester, UK; and
| | - Brian Keevil
- Biochemistry Department, University Hospital of South Manchester, Manchester, UK; and
| | - Mandy Donaldson
- Department of Clinical Biochemistry, Imperial College Healthcare National Health Service Trust, Charing Cross Hospital, London, UK
| | - Kikkeri Naresh
- Department of Histopathology, Imperial College Healthcare National Health Service Trust, Imperial College London, Hammersmith Campus, London, UK
| | - Ilpo T Huhtaniemi
- Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, and
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Roth MY, Ilani N, Wang C, Page ST, Bremner WJ, Swerdloff RS, Dart C, Sitruk-Ware R, Kumar N, Blithe D, Amory JK. Characteristics associated with suppression of spermatogenesis in a male hormonal contraceptive trial using testosterone and Nestorone(®) gels. Andrology 2013; 1:899-905. [PMID: 24123845 DOI: 10.1111/j.2047-2927.2013.00135.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 08/28/2013] [Accepted: 08/29/2013] [Indexed: 11/30/2022]
Abstract
Development of a male hormonal contraceptive has been challenging ascribable to the failure to adequately suppress spermatogenesis in 5-10% of men. Methods to identify incomplete suppressors early in treatment might identify men most responsive to male hormonal contraceptives. We hypothesized that serum hormone and gonadotropin concentrations after 4 weeks of transdermal treatment with testosterone and Nestorone in a contraceptive trial would be associated with suppression of sperm concentrations to <1 million/mL after 24 weeks. Indeed, luteinizing hormone or follicle-stimulating hormone concentrations greater than 1 IU/L after 4 weeks of transdermal testosterone/nestorone treatment were 97% sensitive for predicting failure to suppress spermatogenesis after 24 weeks of treatment. Serum nestorone concentrations were significantly associated with suppression, but serum testosterone concentrations were not. Early suppression of gonadotropins is associated with, but does not ensure, adequate suppression of spermatogenesis. This information may allow for rapid identification of non-responders in male hormonal contraceptive trials.
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Affiliation(s)
- M Y Roth
- Department of Internal Medicine, University of Washington, Seattle, WA, USA
| | - N Ilani
- Division of Endocrinology, Department of Medicine, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - C Wang
- Division of Endocrinology, Department of Medicine, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - S T Page
- Department of Internal Medicine, University of Washington, Seattle, WA, USA
| | - W J Bremner
- Department of Internal Medicine, University of Washington, Seattle, WA, USA
| | - R S Swerdloff
- Division of Endocrinology, Department of Medicine, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - C Dart
- Health Decisions, Durham, NC, USA
| | - R Sitruk-Ware
- Center for Biomedical Research, Population Council, New York, NY, USA
| | - N Kumar
- Center for Biomedical Research, Population Council, New York, NY, USA
| | - D Blithe
- Contraception and Reproductive Health Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - J K Amory
- Department of Internal Medicine, University of Washington, Seattle, WA, USA
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46
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Nieschlag E. Hormonal male contraception: end of a dream or start of a new era? Endocrine 2013; 43:535-8. [PMID: 23161201 DOI: 10.1007/s12020-012-9832-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 11/01/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Eberhard Nieschlag
- Centre for Reproductive Medicine and Andrology, University of Münster, Münster, Germany.
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47
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Abstract
The biological basis for male contraception was established decades ago, but despite promising breakthroughs and the financial burden men increasingly bear due to better enforcement of child support policies, no viable alternative to the condom has been brought to market. Men who wish to control their fertility must rely on female compliance with contraceptives, barrier methods, vasectomy or abstinence. Over the last 10 years, the pharmaceutical industry has abandoned most of its investment in the field, leaving only nonprofit organisations and public entities pursuing male contraception. Leading explanations are uncertain forecasts of market demand pitted against the need for critical investments to demonstrate the safety of existing candidate products. This paper explores the developments and challenges in male contraception research. We produce preliminary estimates of potential market size for a safe and effective male contraceptive based on available data to estimate the potential market for a novel male method.
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Affiliation(s)
- Emily Dorman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Suite E4622, Baltimore, MD 21205, USA
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48
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Nieschlag E, Kumar N, Sitruk-Ware R. 7α-Methyl-19-nortestosterone (MENTR): the Population Council's contribution to research on male contraception and treatment of hypogonadism. Contraception 2013; 87:288-95. [DOI: 10.1016/j.contraception.2012.08.036] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 08/25/2012] [Indexed: 11/17/2022]
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49
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Gui YL, He CH, Amory JK, Bremner WJ, Zheng EX, Yang J, Yang PJ, Gao ES. Male Hormonal Contraception: Suppression of Spermatogenesis by Injectable Testosterone Undecanoate Alone or With Levonorgestrel Implants in Chinese Men. ACTA ACUST UNITED AC 2013; 25:720-7. [PMID: 15292101 DOI: 10.1002/j.1939-4640.2004.tb02846.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Monthly injections of testosterone undecanoate (TU) act as a male contraceptive by reversibly suppressing spermatogenesis to azoospermia or severe oligoazoospermia in 95% of Chinese men. In 5% of Chinese men, however, monthly TU administered alone fails to suppress spermatogenesis into contraceptive ranges, or sperm "rebound," leading to occurrences of pregnancy during treatment. Since combinations of progestins and androgens are associated with greater degrees of sperm suppression in white men, we hypothesized that the combination of TU and the progestin levonorgestrel (LNG) would result in improved spermatogenic suppression in Chinese men. Sixty-two healthy Chinese men were randomly assigned to one of the following 3 regimens: group I (n = 21) received 4 LNG rods (75 mg each), which were followed 4 weeks later by 500 mg of TU by intra-muscular (IM) injection every 8 weeks for 24 weeks; group II (n = 20) received 4 LNG implants, which were followed 4 weeks later by 1000 mg of TU by IM injection every 8 weeks for 24 weeks; and group III (n = 21) received TU 1000 mg by IM injection every 8 weeks for 24 weeks. Sperm counts, serum testosterone (T), luteinizing hormone, follicle-stimulating hormone, and LNG were measured every 2 weeks before, during, and after treatment. During treatment, group II demonstrated a trend toward a greater attainment of azoospermia than groups I and III (90% vs 62% [group I] vs 67% [group III]; P =.09). Attainments of either azoospermia or oligozoospermia (sperm density, <3 x 10(6)/mL) were 95%, 100%, and 86% for groups I, II, and III, respectively (P >.05 for comparisons between groups). Spermatogenesis in all subjects returned to the normal range after the implants were removed. No serious adverse events and no significant changes in serum chemistry occurred during the study. These results demonstrate that the combination of IM injections of high-dose TU every 2 months and LNG implants is associated with marked suppression of spermatogenesis in Chinese men. The combination of high-dose TU every 2 months and LNG implants is a promising candidate for future large-scale efficacy studies of hormonal male contraception in Chinese men.
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Affiliation(s)
- You-Lun Gui
- Shanghai Institute of Planned Parenthood Research, 2140 Xie Tu Rd, Shanghai 200032, China
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50
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Abstract
Contraception is an accepted route for the control of population explosion in the world. Traditionally hormonal contraceptive methods have focused on women. Male contraception by means of hormonal and non hormonal methods is an attractive alternative. Hormonal methods of contraception using testosterone have shown good results. Non hormonal reversible methods of male contraception like reversible inhibition of sperm under guidanceare very promising. In this article we have reviewed the current available options for male contraception.
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Affiliation(s)
- Vivek Mathew
- Department of Endocrinology, St. Johns Medical College, Bangalore, India
| | - Ganapathi Bantwal
- Department of Endocrinology, St. Johns Medical College, Bangalore, India
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