Advances in contraception have been almost exclusively female-directed despite the widespread use of male methods worldwide and increasing calls for the burden of contraception to be more evenly shared. Of the several potential approaches to novel male methods, the hormonal approach is the nearest to fruition. The use of testosterone as a reversible contraceptive agent in men has been demonstrated in studies undertaken by the WHO over the last decade. However, an agent that results in universal azoospermia without significant side effects remains elusive. Consequently, combination approaches with progestogens, anti-androgens, 5 alpha-reductase inhibitors and gonadotrophin-releasing hormone (GnRH) antagonists have been evaluated with the aim of improving contraceptive efficacy. Different methods of androgen delivery are also being developed in order to minimise extra-testicular effects and improve acceptability. This review will focus on efforts to develop a safe, acceptable, efficacious hormonal contraceptive for men.
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