This week researchers from UCLA and the Population Council reported that their combination hormone contraceptive gel lowers sperm count in many of the men who take it. Is this the advance we’ve been waiting for?
MCIP applauds the Population Council’s work on Nestorone, a “designer progestin” that is more pure in its action than current synthetic progestins and could have significant advantages in women’s contraceptives. But we continue to support NON-hormonal male contraceptive research, for two reasons.
First, hormones are not one size fits all. As seen in previous trials, the standard dose of testosterone may be too much for one man (making him aggressive or giving him acne) and too little for another man (making him depressed). The risk of depression is what brought the big recent WHO hormonal trial to a halt.
Second, we have concerns about the long-term effects of progestins in men. Testosterone is pretty well understood, but the progestin, which is added here to make the method more effective, is another matter. As seen with hormone replacement therapy for women, it could be 60 or more years before we begin to understand the health effects of adding a synthetic progestin. And in this case it’s in men, who aren’t normally exposed to the high levels women have during part of their menstrual cycle. It could turn out to be a great thing for health, but progesterone is complicated in men, and we just wouldn’t know for many years. We ran that experiment in the 1960’s and 1970’s with women and the Pill, but by now we should be able to do better.
A final thought: The continuation and effectiveness rates were not great, meaning that this method would be a challenge from a practical standpoint. Fifty-six of the 99 men used it properly and continued for the whole study period, a little more than half. What was the experience of the other 43 men, and why did they quit? Did they forget to use it for too many days? Or did they have side effects? And of the men who kept going, sperm counts reached the desired levels in 88-89% of the men, meaning 1 in 10 didn’t work well enough to be under the sperm cutoff line. By themselves each of these might seem like a small issue, but put together they add up.
We applaud the researchers for carrying this through and getting answers. But we continue to press for development of nonhormonal, more targeted methods- and preferably ones that are long-acting. It’s easy to forget things that have to be done every day– that’s human nature, for men or women. We know from studies of contraceptives in women: the less you have to think about a contraceptive, the more effective it will be.