Desogestrel plus testosterone effectively suppresses spermatogenesis but also causes modest weight gain and high-density lipoprotein suppression

Objective: To test the hypothesis that oral desogestrel (DSG) plus testosterone would uniformly and rapidly suppress sperm concentrations in young men as effectively as levonorgestrel (LNG) plus testosterone and cause less high-density lipoprotein (HDL) suppression and weight gain. Design: Single-blind, randomized trial. Setting: VA Puget Sound and University of Washington, Seattle, Washington. Patient(s): Twenty-four healthy young men, aged 20-49. Intervention(s): Subjects were randomized to three groups of men who were administered 6 months of therapy with oral DSG plus im testosterone enanthate: 150 mu g of DSG plus 50 mu g of testosterone (DSG 150-T 50), 150 mu g of DSG plus 100 mg of testosterone (DSG 150-T 100) or 300 mu g of DSG plus 100 mg of testosterone (DSG 300-T 100). We compared these three groups to two groups of historical controls of 100 mg of im testosterone alone or 150 mu g of oral LNG plus 100 mg of im testosterone (LNG 125-T 100 group) enrolled in similar studies. Main Outcome Measure(s): Suppression of sperm counts to severe oligoazoospermia (sperm counts <1 X 10(6)/mL) and azoospermia, weight gain, and serum high-density cholesterol (HDL) suppression. Result(s): Azoospermia was achieved in all eight men receiving DSG 150-T 100 and seven of the right men in the DSG 300-T 100 group. DSG 150 or 300 plus T 100 suppressed spermatogenesis as effectively as LNG 125-T 100 and more effectively than DSG 150-T 100 or testosterone alone. All groups tended to gain weight compared with their baseline, but the weight gain was greatest land statistically significant) in the DSG 150-T 100, DSG 300-T 100, and LNG 125-T 100 groups. Serum HDL levels were modestly suppressed in all groups, and this effect was greatest in the DSG 300-T 100 and LNG 125-T 100 groups. Conclusion(s): The combination of DSG plus testosterone is a very effective regimen for suppression of spermatogenesis and has acceptably low side effects. (Fertil Steril (R) 2000;74:707-14. (C) 2000 by American Society for Reproductive Medicine.).