Exogenous Testosterone as Male Contraception: Current Evidence and Ongoing Trials
Mechanism and Efficacy Evidence
- Exogenous testosterone suppresses pituitary gonadotropins (LH and FSH) through negative feedback to the hypothalamus and pituitary gland, leading to decreased or absent spermatogenesis, as stated by the American Urological Association 1, 2, 3
- The degree of testosterone-induced suppression determines whether spermatogenesis decreases or ceases altogether, with only 50-70% of Caucasian men achieving complete azoospermia with testosterone-based regimens 2, 3
Current Guideline Recommendations
- The American Urological Association states that exogenous testosterone therapy "should not be used in men trying to conceive" and "can put patients in severely oligospermic or azoospermic states" 1
- The American Urological Association and American Society for Reproductive Medicine guidelines emphasize that exogenous testosterone "provides negative feedback to the hypothalamus and pituitary gland that can result in inhibition of gonadotropin secretion" leading to decreased or absent spermatogenesis 2, 3, 4
- The American Academy of Pediatrics recommends discussing the lack of evidence and poor efficacy of exogenous testosterone as a contraceptive method with transgender and gender-diverse adolescents 5, 6
Risks and Adverse Effects
- Testicular atrophy and potential infertility or azoospermia are recognized complications of testosterone therapy, with the FDA specifically listing "infertility or azoospermia" as a potential risk 7, 8, 9
- The FDA has required manufacturers to conduct the TRAVERSE trial to evaluate cardiovascular safety of testosterone therapy in hypogonadal men 7, 8, 9
- Polycythemia, elevated prostate-specific antigen levels, increased blood pressure, gynecomastia, fluid retention, and sleep apnea are potential adverse effects of testosterone therapy 7, 8