Side effects and acceptability

Possible side effects of hormonal male contraception might be caused by too high or too low testosterone levels or by additional substances. Decreased testicular volumes reflecting suppression of spermatogenesis is inherent to all hormonal methods, but is not considered a serious effect by the volunteers as long as sexual function remains unaltered. Weight gain is most likely an anabolic effect of testosterone. Due to the high peak serum testosterone levels caused by testosterone enanthate in the earlier studies, acne and mild gynecomastia could be observed in individual cases. Except for local skin reactions, side effects of GnRH analogues are mainly attributable to decreased testosterone levels, not sufficiently compensated for by testosterone supplementation. Sweating and in particular, nocturnal sweating is a feature of some added progestins (see Table 23.2).

Depending on the type and doses of progestin, significant decreases are observed in sex hormone binding globulin. This indicates the influence of progestins on liver function and may enhance the androgenicity of the testosterone preparation, since the unbound free fraction of testosterone in circulation may increase. Some of the effects seen when progestins are added may be due to this phenomenon. When adding levonorgestrel or 19-noresthisterone acetate or enanthate an increase in prolactin is seen, which remains without biological significance. An increase in red bloodwas more pronouncedwhen progestins were added to testosterone than when testosterone was given alone. Hemostasis is affected by testosterone alone (down-regulation) and by progestin (in this case norethisterone) alone (up-regulation), but given in combination, the effects appear to be neutralized (Zitzmann et al.

Overall, very few subjects left the trials due to side effects, but it has to be kept in mind that all studies so far were of relatively short duration and long-term effects need to be investigated. This should best be done with a combination showing enough contraceptive efficacy to become marketed.

Similarly, the acceptability of hormonal male contraception can only be assessed when a final product becomes available. Nevertheless, interviews with volunteers in contraceptive trials and systematic opinion polls in different cultural settings indicate that a substantial proportion of men would be ready to take a hormonal male contraceptive, preferably a pill, but injections or implants would also attract users (Martin etal. 2000; Weston etal. 2002). Above all, the female partners would be quite in favour of the men using a contraceptive (Glasier etal. 2000).

Table 23.2 Side effects noted in three trials for male contraception using testosterone undecanoate intramuscular alone (1000 mg/6 weeks) or in combination with oral levonorgestrel (0.5 mg/day) or intramuscular norethisterone enanthate intramuscular (200 or 400 mg/6 weeks) or oral norethisterone acetate (10 mg/day)

Table 23.2 Side effects noted in three trials for male contraception using testosterone undecanoate intramuscular alone (1000 mg/6 weeks) or in combination with oral levonorgestrel (0.5 mg/day) or intramuscular norethisterone enanthate intramuscular (200 or 400 mg/6 weeks) or oral norethisterone acetate (10 mg/day)

TU alone n = 14

TU + LNG n = 14

TU + NETE n = 40

TU + NETA n = 14

Body weight

(t)

t

t

t

Testis volume

I

I

I

I

Prostate volume

-

-

-

-

PSA

-

-

-

-

Blood pressure

-

-

-

-

Libido/sexual function

-

-

-

-

(Mild) acne

+

+

+

-

Nocturnal sweating

-

+

++

++

SHBG

(I)

II

II

I

Prolactin

(t)

t

t

t

Erys, Hb, Hk"

(t)

t

t

(t)

HDL cholesterol

I

I

I

II

LDL cholesterol

-

-

(t)

-

Lp (a)

-

I

I

I

ApoA-1

I

I

I

I

Glucose basal

-

-

-

-

Glucose tolerance

-

-

Plasmin a2-anti-

Plasmin complex

(PAP)

I

-

-

a Erys = erythrocytes, Hb = hemoglobin, Hk = hematocrit Kamischke 2000, 2001, 2002; Zitzmann et al. 2002

a Erys = erythrocytes, Hb = hemoglobin, Hk = hematocrit Kamischke 2000, 2001, 2002; Zitzmann et al. 2002

The Natural Acne Remedy

The Natural Acne Remedy

Download this Guide and Discover 50 Ways To Treat Acne Using Only Natural Remedies. About Time You Got Rid of Your Acne? Inside this guide, you'll discover: 50 ways to treat acne using natural remedies. The benefits of treating acne using natural remedies. Natural acne remedies to treat acne scarring. The side effects of popular acne medicines and treatments plus much, much more.

Get My Free Ebook


Post a comment