MALE CONTRACEPTION

For the past three decades, a significant amount of research has been done to identify the perfect male contraceptive. The method should be easy to use, devoid of side effects, reversible and unexpensive. Targe ts of male contraception include (1) the testicular level: inhibition of spermatogenesis, suppression of sperm maturation or, ultimately, sp erm destruction; (2) the pituitary gonadotroph cells with the inhibiti on of GnRH action and the suppression of LH and FSH secretion. A contr aceptive acting at the testicular level has still not been identified. Gossypol, ketoconazole, spironolactone, acetazolamide as well as othe r compounds have been studied. They all present an unacceptable degree of toxicity. Immunization towards sperm surface antigens is not yet a vailable. After the initial hope of inhibin, steroids (progestagens as sociated with an androgenic replacement therapy or high doses of andro gens alone) have been used in a more success,full manner to inhibit go nadotropin secretion. This regimen produces azoospermia in a limited n umber of cases (60%). GnRH agonists, in association with androgens to maintain normal sexual function, produced disappointing results. Alter natively, the use of GnRH antagonists in association with testosterone seems more at tractive, although they presently require daily subcuta neous injections of expensive peptidic analogs. The perfect male contr aceptive is not yet available. Major drawbacks of hormonal male contra ception are the long delay of action (2 to 3 months), the long delay o f reversibility, as well as the necessity of an androgen substitution. The development of a more feasible method may reverse the lack of int erest for this research of both couples and funding agencies.