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

Testosterone and GnRH Analogues (Agonists and Antagonists)

Gonadotropin-releasing hormone is released in a pulsatile manner that is thought to be responsible for the episodic release of LH and FSH. GnRH agonists work by having paradoxical antigonadotropic effects through the downregulation of GnRH after an initial GnRH surge. GnRH antagonists cause competitive inhibition of GnRH receptors. They are familiar to clinicians for regulation of ovulation induction, treatment of advanced prostate cancer and endometriosis.

There have been 12 clinical trials with different GnRH agonists and testosterone resulting in a combined 23% suppression to azoospermia in 106 patients.[86,87] It appears that the lack of suppression is related to breakthrough of FSH secretion. Therefore, at this point, this combination has not been actively pursued.

However, trials combining TE and GnRH antagonists seem to have better results. Several studies dating back to the early 1990s[88–92] suggest a rapid onset of suppression of spermatogenesis to azoospermia. This group of studies, each with small populations, suggested a good response to this combined therapy. When GnRH was stopped, and maintenance was performed with testosterone alone, suppression of spermatogenesis was not maintained.[93] Initial trials were with short-acting GnRH antagonists with local side effects such as significant irritation at injection site. With the longer-acting GnRH antagonists available having less local side effects, this therapy may take on a more critical role in the future.

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