Male contraception and vasectomy

This review summarized the regulation of testicular function and the theoretical aspects subject to male contraception, lists and tabulates steroids effective in inhibiting spermatogenesis, and evaluates vasectomy in the light of the fact that no method is entirely effective, acceptable, and reversible. Possible male contraceptive techniques include hypothalamic agents such as MAO inhibitors, biogenic amines that inhibit releasing hormones, hydrazines, reserpine, analogs of luteinizing hormone-releasing hormone, drugs acting on the testis such as ethylenimine, colchicine, chlormmphenicol, prednisolone; and substances acting on sperm maturation, e.g., heavy metals, alpha-chlorohydrins. Most of these are toxic or teratologic. Testosterone in low doses inhibits spermatogenesis and testicular volume, at high doses maintains testicular volume, produces azoospermia, but has several unacceptable side effects like increasing beta-lipoporteins. Other androgens must be combined with testosterone. Estrogens cause loss of libido. Progestagens are effective, and some are metabolized into androgens. Ethinyl testerone (Danazol) and Cyproterone acetate both depress libido so they must be combined with testosterone. The most inconvenient drawback of these drugs is that several sperm counts must be done to ensure azoospermia. Vasectomy as the advantage of being simple, effective, and without any great risk, although it should be considered irreversible, and is not popular in France.