Desogestrel plus testosterone effectively suppresses spermatogenesis but also causes modest weight gain and high-density lipoprotein suppression

Objective: To test the hypothesis that oral desogestrel (DSG) plus testoste rone would uniformly and rapidly suppress sperm concentrations in young men as effectively as levonorgestrel (LNG) plus testosterone and cause less hi gh-density lipoprotein (HDL) suppression and weight gain. Design: Single-blind, randomized trial. Setting: VA Puget Sound and University of Washington, Seattle, Washington. Patient(s): Twenty-four healthy young men, aged 20-49. Intervention(s): Subjects were randomized to three groups of men who were a dministered 6 months of therapy with oral DSG plus im testosterone enanthat e: 150 mu g of DSG plus 50 mu g of testosterone (DSG 150-T 50), 150 mu g of DSG plus 100 mg of testosterone (DSG 150-T 100) or 300 mu g of DSG plus 10 0 mg of testosterone (DSG 300-T 100). We compared these three groups to two groups of historical controls of 100 mg of im testosterone alone or 150 mu g of oral LNG plus 100 mg of im testosterone (LNG 125-T 100 group) enrolle d in similar studies. Main Outcome Measure(s): Suppression of sperm counts to severe oligoazoospe rmia (sperm counts <1 X 10(6)/mL) and azoospermia, weight gain, and serum h igh-density cholesterol (HDL) suppression. Result(s): Azoospermia was achieved in all eight men receiving DSG 150-T 10 0 and seven of the right men in the DSG 300-T 100 group. DSG 150 or 300 plu s T 100 suppressed spermatogenesis as effectively as LNG 125-T 100 and more effectively than DSG 150-T 100 or testosterone alone. All groups tended to gain weight compared with their baseline, but the weight gain was greatest land statistically significant) in the DSG 150-T 100, DSG 300-T 100, and L NG 125-T 100 groups. Serum HDL levels were modestly suppressed in all group s, and this effect was greatest in the DSG 300-T 100 and LNG 125-T 100 grou ps. Conclusion(s): The combination of DSG plus testosterone is a very effective regimen for suppression of spermatogenesis and has acceptably low side eff ects. (Fertil Steril (R) 2000;74:707-14. (C) 2000 by American Society for R eproductive Medicine.).