Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA.
Best Pract Res Clin Endocrinol Metab. 2022 Sep;36(5):101627. doi: 10.1016/j.beem.2022.101627. Epub 2022 Feb 23.
Rates of unplanned pregnancies are high globally, burdening women and families. Efforts to develop male contraceptive agents have been thwarted by unacceptable failure rates, side effects and a dearth of pharmaceutical industry involvement. Hormonal male contraception consists of exogenous androgens which exert negative feedback on the hypothalamic-pituitary-gonadal axis and suppress gonadotropin production. This in turn suppresses testicular testosterone production and sperm maturation. Addition of a progestin suppresses spermatogenesis more effectively in men. Contraceptive efficacy studies in couples have shown male hormonal methods are effective and reversible, but also may come with side effects related to sexual desire, acne and serum cholesterol and inconvenient methods of dosing and delivery. Recently, novel androgens as potential contraceptive agents are being evaluated in early clinical trials and look to overcome these drawbacks. Here we summarize landmark studies of prototype male hormonal contraceptives, showcasing recent advances and future prospects in this important area of public health.
全球范围内，意外怀孕的发生率居高不下，给女性和家庭带来了沉重的负担。开发男性避孕药的努力因不可接受的失败率、副作用以及制药行业参与度低而受阻。激素男性避孕药由外源性雄激素组成，这些雄激素对下丘脑-垂体-性腺轴产生负反馈作用，抑制促性腺激素的产生。这反过来又抑制了睾丸睾酮的产生和精子成熟。添加孕激素可更有效地抑制男性的精子发生。在夫妇中的避孕效果研究表明，男性激素方法是有效且可逆的，但也可能伴随着与性欲、痤疮和血清胆固醇相关的副作用，以及不方便的给药方式。最近，新型雄激素作为潜在的避孕药物正在进行早期临床试验，有望克服这些缺陷。在这里，我们总结了原型男性激素避孕药的标志性研究，展示了这一重要公共卫生领域的最新进展和未来前景。
