Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA.
Yale J Biol Med. 2020 Sep 30;93(4):603-613. eCollection 2020 Sep.
Unintended pregnancy is a global public health problem. Despite a variety of female contraceptive options, male contraceptive options are limited to the condom and vasectomy. Condoms have high failure rates and surgical vasectomy is not reliably reversible. There is a global need and desire for novel male contraceptive methods. Hormonal methods have progressed the furthest in clinical development and androgen plus progestin formulations hold promise as a marketable, reversible male contraceptive over the next decade. Investigators have tested androgen plus progestin approaches using oral, transdermal, subdermal, and injectable drug formulations and demonstrated the short-term safety and reversibility of hormonal male contraception. The most commonly reported side effects associated with hormonal male contraception include weight gain, acne, slight suppression of serum high-density cholesterol, mood changes, and changes in libido. Efficacy trials of hormonal male contraceptives have demonstrated contraceptive efficacy rates greater than that of condoms. Although there has been less progression in the development of nonhormonal male contraceptives, potentially reversible vaso-occlusive methods are currently in clinical trials in some countries. Various studies have confirmed both men and women's desire for novel male contraceptives. Barriers to development include an absence of investment from pharmaceutical companies, concerns regarding side effects and spermatogenic rebound with hormonal methods, and lack of clear reversibility and proven effectiveness of nonhormonal methods. The ultimate availability of male contraceptives could have an important impact on decreasing global unintended pregnancy rates (currently 40% of all pregnancies) and will be a step towards reproductive justice and greater equity in family planning.
意外怀孕是一个全球性的公共卫生问题。尽管有多种女性避孕选择，但男性避孕选择仅限于避孕套和输精管切除术。避孕套的失败率很高，而输精管切除术并不可靠地逆转。全球需要并渴望新的男性避孕方法。激素方法在临床开发中进展最快，雄激素加孕激素配方有望在未来十年成为一种有市场、可逆转的男性避孕药。研究人员已经测试了雄激素加孕激素方法，包括口服、透皮、皮下和注射药物配方，并证明了激素男性避孕的短期安全性和可逆性。与激素男性避孕最常报告的副作用包括体重增加、痤疮、血清高密度胆固醇轻微抑制、情绪变化和性欲改变。激素男性避孕药的疗效试验显示避孕效果优于避孕套。尽管非激素男性避孕药的开发进展较少，但一些国家目前正在临床试验中研究潜在可逆的血管阻塞方法。各种研究证实了男性和女性对新型男性避孕药的需求。发展的障碍包括制药公司缺乏投资、对激素方法的副作用和生精反弹的担忧，以及非激素方法缺乏明确的可逆性和经过证实的有效性。男性避孕药的最终可用性可能会对降低全球意外怀孕率（目前为所有怀孕的 40%）产生重要影响，并将朝着生殖正义和计划生育更加公平的方向迈出一步。
