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Title: Male hormonal contraception : the effects of progestogens on the hypothalamic-pituitary-gonadal axis in the human male
Author: Brady, Brian M.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2006
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The Edinburgh cohort (20 subjects) of a multicentre study investigating the efficacy in suppression of spermatogenesis and gonadotrophins with 300μg oral etonogestrel (ENG) and intramuscular testosterone decanoate (TD) (400mg 4 or 6 weekly) over 48 weeks is reported. Despite persisting sub-physiological trough testosterone concentrations, profound spermatogenic and gonadotrophin suppression was observed and was greater in Group 1 receiving 400mg TD every 4 weeks than Group II (400mg TD every 6 weeks). Depot gestogen preparations may permit ‘dose-sparing’ thus minimising adverse metabolic effects, and allowing a more convenient dose interval. This regime was further investigated using ENG implants and i.m. TD for 48 weeks in a multi-centre study (130 subjects). Subjects received 204mg ENG implants (equivalent to 3 Implanon®) and either 400mg TD every 4 weeks, 6 weeks or 600mg 6 weekly for a period of 48 weeks. A similar profound suppression of spermatogenesis and gonadotrophins was observed again, with a lesser suppression in the lower testosterone group receiving 400mg TD 6 weekly. The effects of the same dose of etonogestrel implants was investigated in a further study (15 subjects) with a different testosterone preparation, 400mg pellets at 12 weekly intervals. Suppression of spermatogenesis was greater than the other regimes investigated with sperm concentrations of <1 x 106M/ml in all men by 16 weeks of treatment and eventual azoospermia in al subjects. Testosterone levels remained in the physiological range throughout. In contrast to the other regimes, there were no adverse metabolic effects with no weight gain, change in body composition or decline in HDL-C concentrations. The underlying mechanisms of the antigonadotrophic effects of gestogens in the male were considered.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available