Male Hormonal Contraception

January 20, 2012

By Kaley Myer, Class of 2012

Faculty Peer Reviewed

As a female, I like the idea of males taking hormonal contraceptives. In a semi-sadistic way, I relish the idea of a man taking a pill every day to prevent impregnation of my gender. Traditionally, contraception has been a female responsibility, from diaphragms to oral contraceptive pills to intrauterine devices. Male condoms, coitus interruptus, and the more permanent vasectomy require male participation, but these methods do not dominate the contraceptive market. Indeed, couples are encouraged to go beyond condom use (which is often inconsistent) with a form of female birth control. Vasectomy is not advisable unless a man is certain that he does not desire future fertility. And coitus interruptus is ineffective at preventing pregnancy.

In 2006-8, the National Survey of Public Growth studied 61.8 million women of childbearing age (15-44 years old).[1] Sixty-two percent were using some form of contraception. The most common methods were…

Oral contraceptives – 28%

Tubal ligation - 27%

Condom – 16%

Vasectomy – 10%

Intrauterine device – 6%

Withdrawal – 5%

That the burden of birth control falls upon females is related to the female hormonal cycle and its production of a single egg per month, which is easily manipulated. Also, placing this burden on females just makes sense. If birth control fails, it is the woman who becomes pregnant, who experiences physical and psychological changes, and who must take time away from her life and career. A woman thus has more of a stake in taking control of her reproductive status and only creating a life when desired.

This thinking can be a bit unfair, however. There are males who take great responsibility for their reproductive potential and who, upon creating a life, care for the child with equal or greater zeal than their female counterparts. Shouldn’t these men have the same opportunity to control their ability to reproduce?

The problem that remains for these men is that they constantly produce millions of spermatozoa without variations in hormonal cycles. However, research in hormonal suppression of the male hypothalamic-pituitary axis has revealed a safe, reliable mechanism for inhibiting spermatogenesis while maintaining normal levels of blood gonadotropins. Testosterone alone reduces sperm counts, but not to levels low enough to prevent pregnancy reliably. Near-azospermia can be accomplished by combining oral medroxyprogesterone acetate and percutaneous testosterone (OMP/PT).[2]

An open-label, non-placebo-controlled French clinical trial of OMP/PT treated 35 men with normal spermiograms with progesterone 20 mg daily and testosterone 50-125 mg daily for up to 18 months.[3] At 3 months, 80% of the men had sperm counts less than 1 million per milliliter. Sperm counts returned to normal within months of stopping the regimen. The subjects cited a number of reasons for electing to participate, including adverse events with use of contraception and a desire to share the responsibility of contraceptive management.

The adverse effects OMP/PT are not yet completely known, but men may be attracted by the anabolic effects of testosterone on building lean muscle mass. However, similar to the worry with anabolic steroids, testicular volume can decrease due to the lack of spermatogenesis. This decrease is usually minimal and not reported by patients,[4] but the prospect may be unappealing to potential users. Other known side effects from supplemental testosterone include acne, hair loss, and gynecomastia. The frequency of these side effects with the testosterone in male contraception is not yet established.

OMP/PT seems promising, but one wonders how trusting our patients will be of this novel approach. Male sperm counts are reduced to near-zero levels, but are not zero. These levels are low enough for contraceptive efficacy,[3] but will they be adequate to gain the trust of the general population? Will females trust their reproductive fitness to their mates? To females, it can be unnerving to rely upon someone else in a matter as serious as reproduction. Indeed, one of the women in the Soufir clinical trial became pregnant due to her partner’s nonadherence to progesterone-testosterone.[3]

Also, do male patients want to take on this responsibility? They have long entrusted this duty to their female partners, and taking a medication every day can be a burden that leads to nonadherence. Testosterone is delivered not by a pill like female contraception, but via patches, gels, or injections, which are unappealing to some patients.

Still, increasing contraceptive options is inherently beneficial. Some couples desire male-initiated birth control for a variety of reasons, and it will be freeing for some women to trust the responsibility to someone else for a change. Other reversible methods of male contraception should be explored so that men, like women, have options.

Kaley Myer is a 4th year medical student at NYU School of Medicine

Peer reviewed by Robert Lind, MD, Assistant Professor Dept of Medicine (endocrine) and Orthopedic Surgery, NYU Langone Medical Center

Image courtesy of Wikimedia Commons

References:

1. Mosher WD, Jones J. Use of contraception in the United States: 1982-2008. Data from the National Survey of Family Growth. Vital and Health Statistics, 2010, Series 23, No. 29.  http://www.cdc.gov/nchs/data/series/sr_23/sr23_029.pdf

2. Nieschlag E. Male hormonal contraception. Handb Exp Pharmacol. 2010;(198):197-223.  http://www.ncbi.nlm.nih.gov/pubmed/20839093

3. Soufir J-C, Meduri G, Ziyyat A. Spermatogenetic inhibition in men taking a combination of oral medroxyprogesterone acetate and percutaneous testosterone as a male contraceptive method. Hum Reprod. 2011;26(7):1708-1714.  http://humrep.oxfordjournals.org/content/26/7/1708.full

4. Ilani N, Swerdloff RS, Wang C. Male hormonal contraception: potential risks and benefits. Rev Endocr Metab Disord. 2011;12(2):107-117.

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