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Abstract

Determinants of the rate and extent of spermatogenic suppression during hormonal male contraception: An integrated analysis 
Liu,Peter Y.; Swerdloff,Ronald S.; Anawalt,Bradley D.; Anderson,Richard A.; Bremner,William J.; Elliesen,Joerg; Gu,Yi-Qun; Kersemaekers,Wendy M.; McLachlan,Robert I.; Meriggiola,M.Christina; Nieschlag,Eberhard; Sitruk-Ware,Regine; Vogelsong,Kirsten M.; Wang,Xing-Hai; Wu,Frederick C.W.; Zitzmann,Michael; Handelsman,David J.; Wang,Christina
Journal of Clinical Endocrinology and Metabolism 93(5): 1774-1783
Publication date: 2008


Context
Male hormonal contraceptive methods require effectivesuppression of sperm output.

Objective
The objective of the study was to define the covariablesthat influence the rate and extent of suppression of spermatogenesisto a level shown in previous World Health Organization-sponsoredstudies to be sufficient for contraceptive purposes (1 million/ml).

Design
This was an integrated analysis of all published malehormonal contraceptive studies of at least 3 months' treatmentduration.

Setting
Deidentified individual subject data were providedby investigators of 30 studies published between 1990 and 2006.

Participants
A total of 1756 healthy men (by physical, blood,and semen exam) aged 18-51 yr of predominantly Caucasian(two thirds) or Asian (one third) descent were studied. Thisrepresents about 85% of all the published data.

Intervention(s)
Men were treated with different preparationsof testosterone, with or without various progestins.

Main Outcome Measure
Semen analysis was the main measure.

Results
Progestin coadministration increased both the rateand extent of suppression. Caucasian men suppressed sperm outputfaster initially but ultimately to a less complete extent thandid non-Caucasians. Younger age and lower initial blood testosteroneor sperm concentration were also associated with faster suppression,but the independent effect sizes for age and baseline testicularfunction were relatively small.

Conclusion
Male hormonal contraceptives can be practicallyapplied to a wide range of men but require coadministrationof an androgen with a second agent (i.e. progestin) for earlierand more complete suppression of sperm output. Whereas considerableprogress has been made toward defining clinically effectivecombinations, further optimization of androgen-progestin treatmentregimens is still required.