Recent methodological advances in male hormonal contraception

Contraception - what about the men? Experience, knowledge and attitudes: a survey of 2438 heterosexual men using an online dating service

Background There is little research on men's contraceptive knowledge, attitudes and beliefs, yet the male partner is known to influence contraceptive choices. This study investigates contraceptive experiences, knowledge, attitudes and beliefs of a sample of sexually active, heterosexual men via an online dating site.

METHODS

An anonymous online survey was sent to men who had logged onto an online dating site within the previous year.

RESULTS

We analysed 2438 survey responses. A contraceptive method was used at last intercourse for 82% of men <50 years old versus 69% of men ≥50 (P<0.0001). Condoms (35%), vasectomy (22%) and the contraceptive pill (21%) were the most commonly used methods. Older men were less likely to use condoms than younger men (P<0.0001). More than 80% of participants had heard of each method. The greatest perceived harm was with the emergency contraceptive pill, with 32% responding that it was 'harmful to the health of the user' and 37% not sure. Belief that contraception decision-making should be shared between partners increased from 57% in a 'one-night stand' to 75% in a casual relationship, to 92% in a long-term relationship.

CONCLUSION

Among this sample there is high contraceptive use, especially vasectomy in older men and a desire to share contraceptive decision-making with their partners, especially in long-term relationships. However, low awareness of some methods and misperceptions about hormonal contraceptive method safety, especially the emergency contraceptive pill, highlight the need for education for men.

The future of male contraception: a fertile ground

The continued and rapid expansion of the Earth’s population mandates the need for safe and effective measures of contraception. While a plethora of options exist for women, methods of contraception for the male partner are limited to condoms and vasectomy. The sequela of this discrepancy has led to the family planning burden falling disproportionately on the female partner. For the past several decades, extensive research has been undertaken exploring the feasibility of hormonal male contraception. This proposed method of contraception has focused on suppressing spermatogenesis by exploiting the hypothalamic-pituitary-gonadal (HPG) axis. Beginning with proof of concept studies in the early nineties, administration of testosterone in healthy male subjects has been shown to be an efficacious method of inducing sterility. Owing to ethnic differences in spermatogenesis suppression and the comparatively low rate of azoospermia in Caucasian men with androgen-only regimens, investigators have explored the addition of progestins to further enhance the efficacy of hormonal contraception. Though studies have revealed promise with androgen-progestin regimens, the lack of long-term studies has precluded the development of a marketable product. Recently, more research has been directed towards identifying non-hormonal alternatives to male contraception. These non-hormonal options have ranged from the development of devices facilitating reversible occlusion of the vas deferens lumen to medications disrupting various pathways in the process of spermatogenesis. Underlying the development of hormonal and non-hormonal strategies is the shared enthusiasm men and women have towards these male directed methods. The willingness of couples to pursue these alternatives combined with the global need to reduce the psychological and socioeconomic implications of unintended pregnancy ensures that research will continue to bring this goal to fruition.

Male Hormonal Contraception: Where Are We Now?

Hormonal male contraception clinical trials began in the 1970s. The method is based on the use of exogenous testosterone alone or in combination with a progestin to suppress the endogenous production of testosterone and spermatogenesis. Studies using testosterone alone showed that the method was very effective with few adverse effects. Addition of a progestin increases the rate and extent of suppression of spermatogenesis. Common adverse effects include acne, injection site pain, mood change including depression, and changes in libido that are usually mild and rarely lead to discontinuation. Current development includes long-acting injectables and transdermal gels and novel androgens that may have both androgenic and progestational activities. Surveys showed that over 50 % of men will accept a new male method and female partners will trust their partner to take oral “male pills.” Partnership between government, nongovernment agencies, academia, and industry may generate adequate interest and collaboration to develop and market the first male hormonal contraception.

Social constructions of the male contraception pill: When are we going to break the vicious circle?

Social constructions of men towards the availability of a male hormonal contraceptive, the 'male pill', were explored. A qualitative approach applying semi-structured interviews and scenarios with 22 men (mean age 35 years) from the North East of England revealed two core constructs and six sub-constructs using a Thematic-Construct Analysis in line with the method of Toerien and Wilkinson and Clarke and Kitzinger. Verbal accounts were inductively used to balance the deductively created two core constructs 'Constructing the male pill norm: dominant system of sensemaking' and 'Living by the male pill norm' to represent a normative framework within a changing ideology of shared responsibility in contraceptive choice. Constructing the male pill norm was divided into two sub-constructs: 'Male pill: we are going to join the women and become responsible - too!' and 'Male pill: you look so girly - what are they going to think of me?' The 'Living by the male pill norm' was further divided into four sub-constructs 'Male pill - thank you for giving me promises not to have to become a dad as yet!'; 'Male pill: thank you for the idea of fun - sorry about my morals!'; 'Male pill: in stable relations - yes, I would have you now - sorry, I am too late!' and 'Male pill, we love you - but we are too anxious - we are not ready as yet!' From this male discourse, it is clear that discussions over the male pill follow the line of a vicious circle. In order to establish long-term side effects, Phase IV studies are necessary, and these cannot commence without the male hormonal contraception being a marketable product. So, unless this circle gets broken by some brave men, the male pill will remain a virtual rotating idea for a long time.

Feasibility of poly (ϵ-caprolactone-co-DL-lactide) as a biodegradable material for in situ forming implants: evaluation of drug release and in vivo degradation

The purpose of this study was to evaluate the technical feasibility of poly (ϵ-caprolactone-co-DL-lactide), P (CL/DL-LA), for injectable in situ forming implants (ISFI). The ISFI was prepared by dissolving P (CL/DL-LA) in N-methyl-2-pyrrolidone (NMP), and Testosterone undecanoate (TU) was used as model drug. The effect of various polymer concentrations, molecular weights (Mws) and drug loads on the drug release from the TU-loaded ISFI systems was investigated in vitro. The release of TU-loaded ISFI was also evaluated in rats. In addition, a subcutaneous rabbit model was used to evaluate the degradation and foreign-body reaction of P (CL/DL-LA) ISFI. The use of higher concentration of P (CL/DL-LA) with higher molecule weight and larger CL:DL-LA monomer ratio for the TU-loaded ISFI gave a slower drug release. The ISFI of 80/20 P (CL/DL-LA) (Mw 61 753):NMP 20:80 with 16% TU formulation increased serum testosterone levels in rats over a period of three months. The in vivo degradation and biocompatibility study of ISFI shows that P (CL/DL-LA) degrades by a process of bulk degradation and that the foreign-body reaction of this biomaterial is relatively mild. In summary, our investigations demonstrate that in situ parenteral drug delivery systems can be obtained from P (CL/DL-LA) solutions.

Attitudes towards the male contraceptive pill: psychosocial and cultural explanations for delaying a marketable product

Even though years of research on the male contraceptive pill have been conducted, a marketable product is still absent from the arsenal of male and female products of contraception. In this paper, the following psychosocial and cultural factors have been elicited from the literature in order to reveal explanations for this delay: acceptability, trust, fear of side-effects, perceptions of contraceptive responsibility and fear of losing connotations of masculinity. Regardless of cultural variation, overall there seems to be a positive attitude towards the acceptability of male contraceptive for both males and females, especially males in stable relationships. Some indication shows that the media have played an important role in distorting the results of research regarding male and female trust. Ongoing and future researches into several projects on psychosocial and cultural factors are described.

Synthesis and evaluation of eight- and four-membered iminosugar analogues as inhibitors of testicular ceramide-specific glucosyltransferase, testicular β-glucosidase 2, and other glycosidases

Eight- and four-membered analogues of N-butyldeoxynojirimycin (NB-DNJ), a reversible male contraceptive in mice, were prepared and tested. A chiral pool approach was used for the synthesis of the target compounds. Key steps for the synthesis of the eight-membered analogues involve ring-closing metathesis and Sharpless asymmetric dihydroxylation and for the four-membered analogues Sharpless epoxidation, epoxide ring-opening (azide), and Mitsunobu reaction to form the four-membered ring. (3S,4R,5S,6R,7R)-1-Nonylazocane-3,4,5,6,7-pentaol (6) was moderately active against rat-derived ceramide-specific glucosyltransferase, and four of the other eight-membered analogues were weakly active against rat-derived β-glucosidase 2. Among the four-membered analogues, ((2R,3S,4S)-3-hydroxy-1-nonylazetidine-2,4-diyl)dimethanol (25) displayed selective inhibitory activity against mouse-derived ceramide-specific glucosyltransferase and was about half as potent as NB-DNJ against the rat-derived enzyme. ((2S,4S)-3-Hydroxy-1-nonylazetidine-2,4-diyl)dimethanol (27) was found to be a selective inhibitor of β-glucosidase 2, with potency similar to NB-DNJ. Additional glycosidase assays were performed to identify potential other therapeutic applications. The eight-membered iminosugars exhibited specificity for almond-derived β-glucosidase, and the 1-nonylazetidine 25 inhibited α-glucosidase (Saccharomyces cerevisiae) with an IC(50) of 600 nM and β-glucosidase (almond) with an IC(50) of 20 μM. Only N-nonyl derivatives were active, emphasizing the importance of a long lipophilic side chain for inhibitory activity of the analogues studied.

Cancer/testis (CT) antigens, carcinogenesis and spermatogenesis

During spermatogenesis, spermatogonial stem cells, undifferentiated and differentiated spermatogonia, spermatocytes, spermatids and spermatozoa all express specific antigens, yet the functions of many of these antigens remain unexplored. Studies in the past three decades have shown that many of these transiently expressed genes in developing germ cells are proto-oncogenes and oncogenes, which are expressed only in the testis and various types of cancers in humans and rodents. As such, these antigens are designated cancer/testis antigens (CT antigens). Since the early 1980s, about 70 families of CT antigens have been identified with over 140 members are known to date. Due to their restricted expression in the testis and in various tumors in humans, they have been used as the target of immunotherapy. Multiple clinical trials at different phases are now being conducted with some promising results. Interestingly, in a significant number of cancer patients, antibodies against some of these CT antigens were detected in their sera. However, antibodies against these CT antigens in humans under normal physiological conditions have yet to be reported even though many of these antigens are residing outside of the blood-testis barrier (BTB), such as in the basal compartment of the seminiferous epithelium and in the stem cell niche in the testis. In this review, we summarize latest findings in the field regarding several selected CT antigens which may be intimately related to spermatogenesis due to their unusual restricted expression during different discrete events of spermatogenesis, such as cell cycle progression, meiosis and spermiogenesis. This information should be helpful to investigators in the field to study the roles of these oncogenes in spermatogenesis.