Male hormonal contraception: hope and promise

摘要

Family planning is a shared responsibility, but currently available male-directed methods are either not easily reversible (vasectomy) or not sufficiently effective (condom). Despite this, approximately 20% of couples using a contraceptive method worldwide, and up to 80% in some countries, choose a male-directed method. Male hormonal contraception (MHC) is acceptable and highly effective, with perfect use failure rates of 0.6% (95% confidence interval 0.3–1.1%) provided sperm concentration are maintained below 1 M/mL. Upon cessation of MHC, sperm quality fully recovers in a predictable manner resulting in pregnancies and live births. Spontaneous miscarriage and fetal malformation rates overlap that observed in the general population. Short-term adverse events, namely acne, night sweats, increased weight and altered mood and libido are recognized, but are generally mild. Further optimization of specific androgen-progestin regimens followed by Phase 3 studies of lead combinations is still required for successful development of an approved MHC and to determine long term adverse effects.