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A Novel Male Contraceptive Pill-Patch Combination: Oral Desogestrel and Transdermal Testosterone in the Suppression of Spermatogenesis in Normal Men

Department of Endocrinology, Manchester Royal Infirmary, University of Manchester, Manchester, United Kingdom M13 9WL

Address all correspondence and requests for reprints to: Dr. Frederick C. W. Wu, Department of Endocrinology, Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom M13 9WL.

Abstract

This study investigated the effect of transdermal T and oral desogestrel on the reproductive axis of healthy men. Twenty-three men were randomized to 1 of 3 treatment groups and received a daily transdermal T patch plus oral desogestrel at a dose of 75, 150, or 300 µg/d for 24 wk. Baseline blood and semen samples were obtained and then every 4 wk thereafter for 32 wk. The outcome measures were sperm density and plasma levels of FSH, LH, total and free T. The results show a dose-dependent suppression of spermatogenesis and gonadotropins. Seven of the 17 subjects became azoospermic. Desogestrel (300 µg daily) in combination with 5 mg daily transdermal T was the most effective (57% azoospermic), whereas a dose of 75 µg was ineffective (0% azoospermic). Total and free plasma T were reduced by approximately 30%. High density lipoprotein cholesterol was significantly reduced. No serious side-effects were encountered. We conclude that daily self-administered desogestrel with transdermal T is capable of suppressing the male reproductive axis, although the efficacy was less marked and less consistent than injectable regimens. The lower efficacy is likely to be due to failure of the transdermal T system to maintain circulating T levels consistently in the required range.

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