Testosterone undecandoate is used as a male contraceptive by suppressing follicle stimulating hormone and luteinizing hormone, resulting in decreased sperm count. It has been successful in Asian men but less so in other countries. It can be administered through injection, orally, or transdermal patch, but side effects include headache, weight gain, and depression.
Testosterone undecandoate might be prescribed for the treatment of hypogonadism in men, but more recently the androgen has been used as a male contraceptive. Since the 1980s, researchers have been testing variations of testosterone in an effort to develop one. While this testosterone ester produces effective results in Asian men, the hormone requires the addition of other hormones to produce equally positive results for men in other countries.
This testosterone ester suppresses follicle stimulating hormone (FSH) and luteinizing hormone (LH), interfering with the signals required by the testicles to produce sperm and resulting in a decrease in sperm count. Men usually don’t experience the full effects of treatment, however, until after the first two to three months of receiving the drug. The sperm count therefore remains low for the duration of the treatment. Counts generally return to normal two to six months after stopping treatment.
Chinese researchers first combined 200 milligrams (mg) of testosterone undecandoate with tea tree oil and administered the formula by intramuscular injection. The men received periodic injections over the course of 30 months. During the first trials, 80% to 90% of the men in the study developed sperm counts of less than one million sperm per milliliter (ml) of ejaculate. Normal semen has an average of about 20 million sperm cells per mL. After three months of treatment, the male contraceptive was 90% to 100% effective.
Subsequent trials involved 308 men who were given 500 mg of testosterone undecanoate every 12 weeks. The first semen samples indicated that 299 men had counts of less than 3 million per mL. After a year, out of 296 men, only one man had gotten his wife pregnant. Studies involving men in other countries have been less successful and have generally shown only 60% efficiency.
Researchers have proposed chemical and genetic mechanisms as to why only Asian men respond well to testosterone undecanoate therapy, but have been unable to provide a conclusive explanation. Testosterone undecandoate has been combined with various forms of progestin. The non-Asian men received injections of 1,000 mg of testosterone every six weeks. They also received 200 mg of norethisterone every six weeks. After 32 weeks of treatment, 13 of 14 males were azoospermic or sperm free.
Testosterone undecanoate can be administered by injection, orally, or by transdermal patch. It can also be applied topically, in gel form or as small pellets implanted under the skin. The patch was the least popular method, as men often experienced itching, redness, and blisters. The hormone was also not absorbed easily using this method and provided less protection.
Side effects of testosterone undecanoate, with or without a progestin, include headache, slight weight gain, and depression. Men might also experience male pattern baldness and oily skin. Lab results show that men can experience a 10-20% decrease in high-density lipoprotein (HDL) but an increase in hemoglobin, hematocrit, and prostate-specific antigen (PSA) levels.
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