Male contraception: narrative review of ongoing research

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.

Male animal sterilization: history, current practices, and potential methods for replacing castration

“…In general, this approach has not worked consistently and can result in undesirable side effects, including hypokalemia, hypokalemic periodic paralysis, depression, and reduced libido ( 5 , 197 ). However, a synthetic progesterone with a testosterone derivative is being tested for contraception in men under the name DMAU (dimethandrolone undecanoate) with promising results ( 407 ).…”

The landscape of male contraception

“…Further studies are underway exploring transdermal, oral, and injectable hormonal contraception as well as non-hormonal vaso-occlusive, motility-based inhibition, and spermatogenesis inhibitive mechanisms. 35,36 Hormonal contraception is based on the inhibition of spermatogenesis via exogenous stimulation of the HGPAthe negative feedback from which shuts down the HGPA. There are three contenders in the current male hormonal contraceptive space that are most promising for commercial use: Segesterone acetate + testosterone (nestorone/T), Dimethandrolone undecanoate (DMAU), and finally 11β-methyl-19-nortestosterone dodecylcarbonate (11β-MNTDC).…”