Hormonal male contraception: Progress and prospects for the 21st century
Handelsman, D.J.
Australian and New Zealand Journal of Medicine 25(6): 808-816
1995
ISSN/ISBN: 0004-8291 PMID: 8770357 DOI: 10.1111/j.1445-5994.1995.tb02885.xDocument Number: 300841
In 1993, 12 international public sector agencies, including the International Women's Health Coalition, identified the development of reliable and reversible male contraceptive methods as a top priority at the Mexico City International Symposium "Contraceptive Research and Development for the Year 2000 and Beyond." Even though such methods do not yet exist, men worldwide are willing to share burdens as well as benefits of effective family planning and to increase their share of responsibility, but their greater participation depends on more reliable and attractive reversible male contraceptive alternatives. Two landmark World Health Organization male contraceptive efficacy studies found that a prototype androgen-alone regimen can induce azoospermia and oligospermia to levels that provide effective, reliable, and reversible contraception with acceptable levels of minor side effects. The focus must be on developing second-generation contraceptive methods that improve suppression of spermatogenesis and are convenient. Androgens alone as well as combination regimens with progestins or gonadotropin-releasing hormone antagonists appear to form the basis of reliable and reversible male contraceptives. In China and Indonesia, existing, affordable, non-optimized contraceptive prototypes have already achieved acceptable levels of contraceptive efficacy and safety. They are not entirely convenient, however. The answer to the question on whether or not improved male contraceptives will reach the wider market depends largely on political factors, specifically funding of research and development in male contraception and taking actions to stop exploitation of product liability laws. Developing countries may need to lead the way, since there is an urgency to provide a wider range of attractive family planning options. They can introduce the first practical hormonal male contraceptive regimens.