Update on Male Hormonal Contraception: Is the Vasectomy in Jeopardy?

GJ Manetti and SC Honig

Disclosures

Int J Impot Res. 2010;22(3):159-170. 

In This Article

Desogestrel and Etonogestrel

Desogestrel is a potent oral progestin that is converted to the active agent, etonogestrel. Initial small studies performed with doses of 75, 150 and 300 μg per day showed variable results. A two-center study in Scotland and China with oral desogestrel 300 μg p.o. per day and 400 mg depot testosterone s.c. pellets led to suppression of spermatogenesis with azoospermia in 100% men.[76] There was noted to be a rise in high-density lipoprotein and weight gain. A subsequent study of 21 African men administered desogestrel and testosterone pellets showed similar results, but slightly less complete suppression with no negative effects on lipoprotein or hemoglobin.[58] Another study with 15 patients taking etonogestrel and testosterone pellets at 3-month intervals resulted in azoospermia in all subjects by 28 weeks.[77] A subsequent larger study (n=130) with the same investigators showed excellent sperm suppression with combination testosterone/progesterone implant when used monthly.[78] The combination of this two-drug pellet given every 3 months is a very palatable option for patients. A multicenter phase 2 trial was initiated in 2003, but terminated in 2006 by Schering-Organon for unclear reasons.

To minimize side effects, MENT has been combined with etonogestrel implants, hoping to decrease the dosage of MENT required to suppress spermatogenesis and eliminate some of the undesirable testosterone-related side effects. However, a recent study by Walton et al.[79] comparing MENT and testosterone in combination with etonogestrel implants in healthy men showed that suppression of spermatogenesis was inconsistent over time in the MENT/etonogestrel group, and still associated with persistent undesirable side effects (for example, reduced libido).

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