**4. Discussion**

*3.3.1.2. Testosterone undecanoate (TU)*

306 Family Planning

*3.3.1.3. 7α-Methyl-19-nortestosterone (MENT)*

of azoospermia with minimal side effects.

decrease in bone density.

*3.3.2. Combination therapy*

• LNG + TE (efficacy 93%) [3].

them are:

literature.

TU is formulated in long acting depot preparations with a half-life of 70 days that can be administered intramuscularly in intervals of 4–8 weeks [3]. A clinical trial in China reported that 95% of test subjects achieved azoospermia, defined as sperm concentration < 1 million per milliliter. Pregnancy rates were at 1.1%. Sperm count was reversed after 15 months of stopping therapy. A European clinical trial by WHO produced similar results. However, trials

MENT is a synthetic androgen five times more potent than testosterone [3, 31]. MENT was developed to replace testosterone for contraceptive use because of the large amount of testosterone required to achieve long term infertility. Also because it is resistant to 5α-reductase, there is less prostate stimulation. However, substituting testosterone with MENT led to a

MENT has been introduced in implant form as a contraceptive and has been found to cause azoospermia in two thirds of men receiving it. To improve its efficacy researchers combined it with etonogestrel implants and levonorgestrel implants. Results were the same as with MENT alone. In addition, men receiving MENT and etonogestrel experienced loss of libido. Research are continuously being conducted on a form of dosing that will attain a higher rate

Exogenous progestins combined with testosterone provide better suppression of gonadotropins, thus more effective at producing azoospermia at lower doses [3]. There has been several researches combining various progestins with androgens for male contraceptive. Among

Data on reversibility, effect on libido of these tested regiments were not found on the

• Depot medroxyprogesterone acetate (DMPA) + TE (efficacy 98%) [3].

• Androgenic progestin Norethisterone (NET) + TU (efficacy 92%) [3].

• Oral Levonorgestrel (LNG) + testosterone patches (efficacy < 60%) [3].

• Antiandrogenic Progestogen Cyproterone Acetate (CPA) + TE [3].

• Synthetic progestin Desogestrel (DSG) + TE (efficacy 100%) [3].

• MENT implant + Jadelle implant (efficacy < 60%) [31].

were stopped due to reports of side effects such as mood swings.

In the past, male contraceptives have been acknowledged. There are few commonly applied methods of male contraception such as local application of heat, consumption of herbal medicines, coitus interruptus, vasectomy, and male condoms. Each of these methods has had drawbacks that cause them to only be used by a minority of the population. Heat application and herbal medicines lack evidence of overall efficacy. Coitus interruptus has a 12% failure rate even when practiced correctly. Condoms depend a lot on correct use, and are rendered useless in the case of breakage. Vasectomy has less than 50% reversal rates. There is still no long term, reversible contraceptive available for men.



Considering numerous hormonal contraceptive methods available for women, hormonal pathways have been studied to develop an effective and safe male contraceptive. Disappointingly,

Male Contraceptives

309

http://dx.doi.org/10.5772/intechopen.72163

Non hormonal contraceptives have shown more promise. RISUG and Gandarusa are undergoing relatively successful clinical trials in terms of efficacy and safety [7]. RISUG requires only a single injection, which has maintained infertility for up to 10 years now. Reversibility also requires only a single injection, but has yet to be tested on humans. Gandarusa is available in pill form, giving men the choice to be an oral contraceptives. The success of these agents, however, depends largely on the men's willingness to take responsibility for family planning. A review on male contraceptives shares the same conclusion that despite the expression of interest and tremendous advances in research however, a modern male hormonal contraceptive method has remained an elusive goal. Testosterone (T) alone, or in combination with a progestin currently provides the most promising lead to male hormonal contraception. The principle relies on enhanced negative feedback of exogenous T to suppress gonadotropins, thereby blocking the endocrine stimulus for the process of spermatogenesis. A serious drawback is the inconsistent suppression among men of different ethnic backgrounds. This has increased the quest for development to include other nonhormonal methods. In reality many obstacles still have to

To conclude, there are a variety of possible methods for male contraception. Non-hormonal methods RISUG and Gandarusa are undergoing clinical trials, and may be available in the near future. There are still no hormonal contraceptive ready to use for men (**Tables 1** and **2**).

\*

1 Division of Reproductive Health, Department of Obstetrics and Gynecology, Faculty of

2 Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia,

[1] Matthew V, Bantwal G. Male contraception. Indian Journal of Endocrinology and

[2] Nya-Ngatchou JJ, Amory JK. New approaches to male non-hormonal contraception.

no hormonal regiments have yet been approved for contraceptive use.

be overcome before an acceptable method is available [32].

and Yohanes Handoko<sup>2</sup>

\*Address all correspondence to: yohanes\_handoko89@yahoo.co.id

Medicine, University of Indonesia, Jakarta, Indonesia

**Author details**

Jakarta, Indonesia

**References**

Metabolism. 2012;**16**(6):9

Contraception. 2013;**87**:4

Eka Rusdianto Gunardi1

**Table 1.** Non-hormonal contraceptives.


**Table 2.** Hormonal contraceptives.

Considering numerous hormonal contraceptive methods available for women, hormonal pathways have been studied to develop an effective and safe male contraceptive. Disappointingly, no hormonal regiments have yet been approved for contraceptive use.

Non hormonal contraceptives have shown more promise. RISUG and Gandarusa are undergoing relatively successful clinical trials in terms of efficacy and safety [7]. RISUG requires only a single injection, which has maintained infertility for up to 10 years now. Reversibility also requires only a single injection, but has yet to be tested on humans. Gandarusa is available in pill form, giving men the choice to be an oral contraceptives. The success of these agents, however, depends largely on the men's willingness to take responsibility for family planning.

A review on male contraceptives shares the same conclusion that despite the expression of interest and tremendous advances in research however, a modern male hormonal contraceptive method has remained an elusive goal. Testosterone (T) alone, or in combination with a progestin currently provides the most promising lead to male hormonal contraception. The principle relies on enhanced negative feedback of exogenous T to suppress gonadotropins, thereby blocking the endocrine stimulus for the process of spermatogenesis. A serious drawback is the inconsistent suppression among men of different ethnic backgrounds. This has increased the quest for development to include other nonhormonal methods. In reality many obstacles still have to be overcome before an acceptable method is available [32].

To conclude, there are a variety of possible methods for male contraception. Non-hormonal methods RISUG and Gandarusa are undergoing clinical trials, and may be available in the near future. There are still no hormonal contraceptive ready to use for men (**Tables 1** and **2**).
