Hormonal approaches to male contraception

Abstract

Purpose of review-Condoms and vasectomy are male controlled family planning methods but suffer from limitations in compliance (condoms) and limited reversibility (vasectomy); thus many couples desire other options. Hormonal male contraceptive methods have undergone extensive clinical trials in healthy men and shown to be efficacious, reversible and appear to be safe.Recent Findings-The success rate of male hormonal contraception using injectable testosterone alone is high and comparable to methods for women. Addition of progestins to androgens improved the rate of suppression of spermatogenesis. Supported by government or nongovernment organizations, current studies aim to find the best combination of testosterone and progestins for effective spermatogenesis suppression and to explore other delivery methods for these hormones. Translation of these advances to widespread use in the developed world will need the manufacturing and marketing skills of the pharmaceutical industry. Availability of male contraceptives to the developing world may require commitments of governmental and nongovernmental agencies. In a time when imbalance of basic resources and population needs are obvious, this may prove to be a very wise investment.Summary-Male hormonal contraception is efficacious, reversible and safe for the target population of younger men in stable relationships. Suppression of spermatogenesis is achieved with a combination of an androgen and a progestin. Partnership with industry will accelerate the marketing of a male hormonal contraceptive. Research is ongoing on selective androgen and progesterone receptor modulators that suppress spermatogenesis, minimize potential adverse events while retaining the androgenic actions.

Male hormonal contraception: Potential risks and benefits

“…Male hormonal contraception requires the suppression of spermatogenesis to near azoospermia with exogenous administration of androgens alone or in combination of a progestin. The subject has recently been reviewed [3][4][5]. In this review, we aim to outline the safety of male hormonal contraception and summarize the available information about potential risks and benefits of male hormonal methods.…”

The Blood-Testis Barrier and Its Implications for Male Contraception

“…Introduction. Unlike hormonal contraception (e.g., testosterone), which exerts its effects to disrupt the hypothalamic-pituitary-testicular axis (Page et al, 2008;Huhtaniemi, 2010;Wang and Swerdloff, 2010), or approaches that target the epididymis (O'Rand et al, 2007;Blithe, 2008;Kopf, 2008;Mruk, 2008;Sipilä et al, 2009), the development of nonhormonal male contraceptives, such as adjudin Cheng and Mruk, 2010b), bisdichloroacetyldiamines (Hogarth and Griswold, 2010;Amory et al, 2011;Hogarth et al, 2011), gamendazole (Tash et al, 2008a,b), indenopyridine 5SR,3,4,4a,5,-1H-indeno-[1,2-c]-pyridine-hydrochloride, also known as RTI-4587-073) (Hild et al, 2004(Hild et al, , 2007aKoduri et al, 2008), and immunological approaches that target sperm-specific postmeiotic germ cell antigens (Suri, 2005;Mruk, 2008;McLaughlin and Aitken, 2011), requires a better understanding of the BTB because these compounds exert their effects, at least in part, behind the BTB in the apical compartment of the seminiferous epithelium Cheng and Mruk, 2010b;Mok et al, 2011b). As described above, the BTB largely dictates how much drug can enter the apical compartment of the seminiferous epithelium to exert its effects behind the immunological barrier.…”

Testin and actin are key molecular targets of adjudin, an anti-spermatogenic agent, in the testis

“…1,2 In contrast to hormonal approaches which disrupt spermatogenesis by interfering with the hypothalamic-pituitary-testicular axis, [3][4][5] adjudin exerts its effects behind the blood-testis barrier (BTB) in a specialized microenvironment known as the adluminal compartment. The most obvious phenotype following administration of adjudin to adult rats is the loss of developing germ cells from the seminiferous epithelium, most notably elongating/elongated spermatids, followed by round spermatids and spermatocytes but not spermatogonia residing outside of the BTB.…”