Spermatogenetic inhibition in men taking a combination of oral medroxyprogesterone acetate and percutaneous testosterone as a male contraceptive method

Abstract

Background: We previously demonstrated in a small pilot study that oral medroxyprogesterone acetate and percutaneous testosterone (OMP/PT) induce reversible spermatogenesis suppression. The aims of this study were to determine the rate of spermatogenetic inhibition and recovery and to obtain preliminary data on efficacy for a larger population under OMP/PT. Methods: A total of 35 healthy men with normal spermiograms requesting male hormonal contraception were treated with OMP (20 mg/day) and PT (50125 mg/day) for periods up to 18 months. Couples were included in a contraceptive efficacy phase after a value of ≤1 million/ml spermatozoa was reached between 1 and 3 months of treatment. Results: Sperm counts decreased by 47 at 1 month, reaching 90 at 2 months and 98100 between 4 and 8 months. At 3 months, 80 of men had ≤1 million/ml spermatozoa. Follicle-stimulating hormone and luteinizing hormone decreased to 35 of pretreatment levels after 1 month of treatment and to 7580 at 2 and 6 months, respectively. Plasma testosterone and estradiol levels were in the eugonadal range at 3, 6, 9 and 12 months of treatment. Dihydrotestosterone concentrations were 24 times higher than pretreatment values. The rate of spermatogenetic recovery was rapid (73 ± 29.5 days). During the efficacy phase (211 months for 25 couples), one pregnancy attributable to poor compliance of the male partner was observed. Conclusions: OMP/PT efficiently inhibits spermatogenesis in 80 of men, maintains testosterone at physiological levels and avoids the need for parenteral administration, which is poorly accepted by French men. These Results: justify larger studies to define a more adequate dosage of OMP/PT and to confirm its efficacy and safety. © 2011 The Author.