Hormonal male contraception: end of a dream or start of a new era?
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Hormonal male contraception: end of a dream or start of a new era? Eberhard Nieschlag
Received: 22 September 2012 / Accepted: 1 November 2012 / Published online: 18 November 2012 Ó Springer Science+Business Media New York 2012
Pessimistic perspectives ‘‘Although the principle of hormonal male contraception has been established and the method works, I do not believe that enough men would take hormones over many years’’, the current President of the German Society of Andrology, the urologist Wolfgang Weidner, was recently quoted by a German newspaper. He underlined his pessimistic opinion with the fact that none of the 250 abstracts submitted to the 7th European Congress of Andrology 2012 deals with male contraception [1]. An unnamed representative of USAID, which has a long record of supporting male contraception research, was heard saying ‘‘This is the kiss of death for hormonal male contraception’’, referring to the suspension of the large-scale WHO/CONRAD efficacy trial, and—also referring to this trial—Farid Saad, a research representative of Schering-Bayer which has a long tradition in contraception research and even male contraception research, concluded his talk on ‘‘Acceptability of hormonal male contraception by the pharmaceutical industry and the consumer’’ at the 15th International and 13th European Congress of Endocrinology in Florence 2012 by stating ‘‘None of the big companies will touch hormonal male contraception again’’. Why, all of a sudden, are we hearing these negative comments from representatives of clinical research, sponsoring organisations and the pharmaceutical industry, after we had repeatedly been told over the last 40 years that a hormonal male contraceptive would be available for
E. Nieschlag (&) Centre for Reproductive Medicine and Andrology, University of Mu¨nster, Mu¨nster, Germany e-mail: [email protected]
general use within the next 5–10 years? This needs some explanation.
Approach to hormonal male contraception In the early 1970s, various organisations initiated searches for male contraception: WHO, by its Human Reproduction Programme as well as the Contraception Research Branch of the US National Institutes of Health, and the Population Council of the Rockefeller Foundation (for review [2–4]). Basic science approaches targeting sperm maturation, motility, and fertilizing capacity, as well as extensive searches among indigenous plants and in traditional medicines remained without viable issue and without any clinically applicable male contraceptive [5, 6]. Females became a model for men and in analogy to suppression of ovulation by steroids, clinical trials attempting to suppress spermatogenesis with hormones were initiated. When the idea failed that elimination of FSH alone by a single agent would result in loss of spermatogenesis, it became clear that FSH and LH needed to be suppressed simultaneously, and the concept of combining testosterone (or another potent androgen) with a second substance i.e., GnRH antagonists or gestagens was born [7]. Since
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