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

Norethisterone, Nestorone Gel

A depot female contraceptive with similar effects to TU makes this combination attractive for male contraception. A study conducted in 1988 showed suppression with a combination of oral norethisterone and TU.[82] Subsequent studies have shown high efficacy in a small group of Caucasian patients (74 total patients) with either oral or i.m. norethisterone and TU.[83,84] 8-week intervals of treatment had a higher azoospermic rate than 12-week treatment. No short-term changes in the prostate were seen. Longer-term studies are necessary to better evaluate changes in prostate size, PSA and so on. This combination is very attractive for a depot, as the 8-week injection of both testosterone and norethisterone is highly efficacious in a potentially single injection.

A recent clinical trail by Mahabadi et al.[85] showed that transdermal Nesterone and a relatively high dose of testosterone gel (10 g; Testim) had an additive effect on gonadotropin suppression. This randomized, multicenter, unmasked trial showed that the gel applications were well tolerated with few short-term adverse effects. The effects on cholesterol were mixed with a small drop in low-density lipoprotein and high-density lipoprotein. Because Nesterone is a progestin without estrogenic or androgenic activity, it represents a noteworthy candidate to augment the effectiveness of testosterone alone. A sperm suppression study with this regimen is planned.

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