Steroid Hormones for Contraception in Men

A Cochrane review [Abstract] 1 included 33 studies. The proportion of men who achieved azoospermia varied widely.

• Levonorgestrel implants (160 μg per day) combined with injectable testosterone enanthate (TE) were more effective than levonorgestrel 125 µg daily combined with testosterone patches
• Levonorgestrel 500 μg daily improved the effectiveness of TE 100 mg injected weekly
• Levonorgestrel 250 μg daily improved the effectiveness of testosterone undecanoate (TU) 1000 mg injection plus TU 500 mg injected at 6 and 12 weeks
• Desogestrel 150 μg was less effective than desogestrel 300 μg (with testosterone pellets)
• Testosterone undecanoate (TU) 500 mg was less likely to produce azoospermia than TU 1000 mg (with levonorgestrel implants)
• Norethisterone enanthate 200 mg with TU 1000 mg led to more azoospermia when given every 8 weeks versus 12 weeks
• Four implants of 7-alpha-methyl-19-nortestosterone (MENT) were more effective than two MENT implants.

Several trials showed promising efficacy in terms of percentages with azoospermia. Three examined desogestrel and testosterone preparations or etonogestrel (metabolite of desogestrel) and testosterone, and two examined levonorgestrel and testosterone.

Comment: The quality of evidence is downgraded by limitations in study quality (e.g., imprecise terminology), by inconsistency (heterogeneity in interventions and outcomes) and by imprecise results (limited study size for each comparison).

References

• Grimes DA, Lopez LM, Gallo MF et al. Steroid hormones for contraception in men. Cochrane Database Syst Rev 2012;(3):CD004316. [PubMed] .