A hormonal contraceptive for men: how close are we?

Novel contraceptive methods for men are still not available, and the opinions about their need among experts and lay public are polarized between enthusiasm and scepticism. Of the different strategies, hormonal methods aimed at suppression of spermatogenesis have been most extensively studies, are most promising, and are the only approach with the potential of breakthrough in the near future. Their principle is to block pituitary gonadotropin secretion, which will eliminate the endocrine stimulus for testicular androgen production, thereby eliminating its support for spermatogenesis. Testosterone alone or in combination with progestin is the most promising lead. However, many obstacles still have to be overcome before a practical and acceptable method is available. The reasons for the slow progress are partly biological and partly practical and economical. It is difficult to design a method that would be effective in most men, have no side effects and be reversible, economical, and acceptable by all cultures. Unfortunately, the pharmaceutical industry is currently not participating in the development work, and the research in the field is suffering from lack of political and financial support. Ironically, with relative modest additional effort a hormonal contraceptive method for men would be available. We review in this chapter the main principles of hormonal male contraception, the results of the latest clinical trials and shed light on some future perspectives in the field.