Spermatogenesis in men treated with injections of medroxyprogesterone acetate combined with testosterone enanthate

Abstract

The effects of a combination of medroxyprogesterone acetate and testosterone enanthate, on the exocrine and endocrine testicular function were examined in adult men. The treatment was carried out with 2 different regimens and lasted for 8 months. Group I received an initial injection of 1000 mg medroxyprogesterone acetate and 500 mg testosterone enanthate followed by monthly maintenance dose of 150 mg medroxyprogesterone acetate and 500 mg testosterone enanthate. In group II, after an initial high dose of 1000 mg medroxyprogesterone acetate and 250 mg testosterone enanthate treatment was given as biweekly injections of 75 mg medroxyprogesterone acetate and 250 mg testosterone enanthate. Complete spermatogenic arrest of variable duration was achieved in all 9 subjects enrolled. Restoration of spermatogenesis occurred in both groups, in a few cases during the treatment, and there was a delay of full recovery of sperm counts up to 5 months after cessation of therapy. None of the subjects enrolled in this study complained of decrease in libido or change in sexual behaviour. Clinical evaluation and measurements of various urine and serum components revealed no significant changes during the treatment period. The dosage and the different administration schedule of the hormone combination described here was inadequate to maintain azoospermia in all subjects during treatment.

A Review of Androgen‐Progestin Regimens for Male Contraception

“…In these preliminary trials, profound sperm suppression was induced with the initial high dosage. However, the steroid regimen administered to maintain suppression failed to do so (Alvarez‐Sanchez et al, 1977, 1979; Frick et al, 1982). More recent studies in which different hormonal combinations have been used both in primates and in men have shown that it is indeed possible to maintain sperm suppression for as long as 32 weeks with lower hormone doses than those used to induce the suppression (Weinbauer et al, 1988; Swerdloff et al, 1998; Costantino et al, unpublished data).…”

“…Oral MPA was given in combination with oral T, such as methyl‐T, or with percutaneous dihydrotestosterone (DHT; Tables 1a and 2; Bain et al, 1980; Guerin and Rollet, 1988; Soufir et al, 1983). Depot medroxyprogesterone acetate (DMPA) injected every 4–6 weeks was given in combination with TE (Alvarez‐Sanchez et al, 1977; Brenner et al, 1977; Frick et al, 1977a; Melo and Coutinho, 1977; Alvarez‐Sanchez et al, 1979; Faundes et al, 1981; Frick et al, 1982; Wu and Aitken, 1989; Pangkahila et al, 1991; WHO 1993); testosterone propionate (TP; Frick et al, 1977a); testosterone cypionate (TC; Paulsen et al, 1980; Lee et al, 1979); 19‐nortestosterone (19‐NT); or T pellets (Knuth et al, 1989; Handelsman et al, 1996; WHO 1993; (Tables 1a and 3). Oral combinations were less effective than injectable DMPA (Figure 3) in the suppression of spermatogenesis ( P ≤ .001).…”

“…DMPA plus injectable T was administered in a combined‐continuous or sequential fashion (Alvarez‐Sanchez et al, 1977, 1979; Frick et al, 1977b; Faundes et al, 1981; Frick et al, 1982; Knuth et al, 1989; Table 2). Sequential regimens included an initial period during which the 2 steroids were administered at higher doses, followed by a second phase in which lower steroid doses were administered.…”

Inhibition of spermatogenesis in men using various combinations of oral progestagens and percutaneous or oral androgens

“…In the last 15 years, several clinical studies have been published concerning combination treatment with progestagens, mainly medroxyprogesterone acetate (MPA), and androgens, mainly testosterone enanthate (TE). Both steroid classes are generally administered by intramuscular injections, with high initial doses followed by maintenance doses injected monthly or biweekly (Coutinho & Melo, 1973;Alvarez-Sanchez et al , 1977;Schearer et al, 1978;Faundes et al, 1981;Frick et al, 1982). Side-effects are reduced and azoospermia or severe oligozoospermia are generally obtained; however, a secondary rise in sperm count is often observed.…”