Male contraception: narrative review of ongoing research

BackgroundSince the release of the combined oral contraceptive pill in 1960, women have shouldered the burden of contraception and family planning. Over 60 years later, this is still the case as the only practical, effective contraceptive options available to men are condoms and vasectomy. However, there are now a variety of promising hormonal and non-hormonal male contraceptive options being studied. The purpose of this narrative review is to provide clinicians and laypeople with focused, up-to-date descriptions of novel strategies and targets for male contraception. We include a cautiously optimistic discussion of benefits and potential drawbacks, highlighting several methods in preclinical and clinical stages of development.ResultsAs of June 2023, two hormonal male contraceptive methods are undergoing phase II clinical trials for safety and efficacy. A large-scale, international phase IIb trial investigating efficacy of transdermal segesterone acetate (Nestorone) plus testosterone gel has enrolled over 460 couples with completion estimated for late 2024. A second hormonal method, dimethandrolone undecanoate, is in two clinical trials focusing on safety, pharmacodynamics, suppression of spermatogenesis and hormones; the first of these two is estimated for completion in December 2024. There are also several non-hormonal methods with strong potential in preclinical stages of development.ConclusionsThere exist several hurdles to novel male contraception. Therapeutic development takes decades of time, meticulous work, and financial investment, but with so many strong candidates it is our hope that there will soon be several safe, effective, and reversible contraceptive options available to male patients. ContexteDepuis la sortie de la pilule contraceptive orale combinee en 1960, les femmes ont assume le fardeau de la contraception et de la planification familiale. Plus de 60 ans plus tard, c'est toujours le cas, car les seules options contraceptives pratiques et efficaces disponibles pour les hommes sont les preservatifs et la vasectomie. Cependant, il existe maintenant une variete d'options contraceptives masculines hormonales et non hormonales prometteuses qui sont a l'etude. Le but de cette revue narrative est de fournir aux cliniciens et aux profanes des descriptions ciblees et a jour de nouvelles strategies et cibles pour la contraception masculine. Nous incluons une discussion prudemment optimiste sur les avantages et les inconvenients potentiels, en soulignant plusieurs methodes aux stades precliniques et cliniques du developpement.ResultatsEn juin 2023, deux methodes contraceptives masculines hormonales faisaient l'objet d'essais cliniques de phase II pour leur innocuite et leur efficacite. Un essai international de phase IIb a grande echelle, portant sur l'efficacite de l'acetate de segesterone transdermique (Nestorone) et du gel de testosterone, a recrute plus de 460 couples et devrait etre acheve pour la fin de 2024. Une seconde methode hormonale, l'undecanoate de dimethandrolone, fait l'objet de deux essais cliniques axes sur l'innocuite, la pharmacodynamique, la suppression de la spermatogenese et des hormones; le premier de ces deux essais devrait etre acheve en decembre 2024. Il existe egalement plusieurs methodes non hormonales a fort potentiel aux stades precliniques de developpement.ConclusionsIl existe plusieurs obstacles a la nouvelle contraception masculine. Le developpement therapeutique necessite des decennies de temps, un travail meticuleux et un investissement financier ; mais avec autant de candidats solides, nous esperons qu'il y aura bientot plusieurs options contraceptives sures, efficaces et reversibles, disponibles pour les hommes.

Automated summary

This article discusses novel strategies and targets for male contraception, with two hormonal methods undergoing phase II clinical trials for safety and efficacy. There are also several non-hormonal methods showing strong potential in preclinical stages of development.