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Query: UMLS:C0020473 (hyperlipidemia)
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The 1st published study of efficacy of a hormonal male contraceptive, by the WHO Special Programme of Research, Development and Research Training in Human Reproduction, employed weekly deep intramuscular injections of testosterone enanthate. 271 fertile married men at 10 centers worldwide participated for 18 months. The goal of this preliminary study was to determine if azoospermia was necessary or sufficient for effective contraception. Azoospermia was produced in 157 men, who then participated in a 12-month trial. There was 1 pregnancy, for a failure rate of 0.8 per 100 person-years, highly effective in comparison with oral contraceptives, IUDs and injectables. There was a 12% annual discontinuation rate reasons cited were acne (4%), behavioral effects such as aggression or increased libido (1%), and other medical reasons (1%), e.g. weight gain, polycythemia, hyperlipidemia or hypertension. Recruitment of study subjects was difficult in developed countries until direct public appeals met with success. Future developments in the male hormonal contraceptive field will require a more acceptable administration route. To develop this, longer-acting injectables or implants utilizing testosterone cybutanate (20AET-1), or other combinations of testosterone with a progestin or a gonadotropin-releasing hormone antagonist are envisioned. The effect of incomplete azoospermia and the fertilizing capacity of remaining sperm is a serious issue for research. Each more crucial is resolution of the social, political and legal problems involved in male hormonal contraceptive research. Probably reform of the US product liability litigation procedures will do more to advance contraceptive development than any other single factor.
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PMID:Bridging the gender gap in contraception: another hurdle cleared. 199 93

Ten years ago research into a reversible method of male contraception proved unsuccessful, not for any objective reasons but because volunteers failed to comply with treatment. A change in social attitudes towards contraception, a constant demand for a reversible method of male contraception and the current interest in protecting germinal cell lines by blockage of spermatogenesis during chemotherapy led the authors to reactivate the study. Eighteen volunteers received a synthetic progestogen (Norluten) and a percutaneous testosterone gel. Clinical, biological, hormonal and seminal tests were performed each month. One patient, however, had to withdraw from the trial on medical grounds (hyperlipidaemia). Ten patients achieved azoospermia which is the only guarantee of efficacy. Immediate tolerance was good but protocol compliance was poor since 8 of the 17 volunteers abandoned the trial within a year. Treatment reversibility was evaluated in 15 patients whose F.S.H. level and spermatogenesis returned to normal when contraception was ended. This additional study demonstrates that hormone contraception in males is effective and well-tolerated, but the protocol placed too great a demand on the patients and 50% withdrew from the trial within a year.
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PMID:Contraception in men: efficacy and immediate toxicity. A study of 18 cases. 271 34

In China, an estimated 30 million men have undergone vasal voluntary sterilization, and about 11.97% of Chinese couples rely on vasectomy, according to a 1990 survey. The no-scalpel vasectomy (NSV) and the percutaneous chemical vas occlusion methods are major developments in vasectomy technique with an effectiveness rate of over 98% for both. In a study in Thailand, complication rates were 0.4/100 cases for NSV and 3.1 for the incisional approach. Since 1971, over 10 million Chinese men have undergone NSV. Vas ligation is the most popularly used method in China. It has provided 98% of effectiveness in a comprehensive survey involving 64,656 vasectomies in 8 provinces. As an alternative to vas ligation, electrocoagulation creates a firm scar that effectively occludes the ends of the vas. The contraceptive efficacy of electric cautery was reported at 99.62%-100% in 7439 vasectomies during a period of 10 years; azoospermia and complication rates were 0% and 0.53%, respectively, in 1088 vasectomies. The complication rate was less than 2%, including hematoma, infection, painful sperm granuloma, epididymitis, and sexual dysfunction, in a comprehensive survey involving 179,741 vasectomies in 8 provinces. 2 large cross-sectional epidemiologic studies done in Sichuan Province showed that men with vasectomies were not at greater risk of coronary heart disease, hypertension, hyperlipidemia, and diabetes than men who had not undergone the procedure. Recently, 2 epidemiological studies conducted in the US suggested that vasectomy may be associated with an increased risk of prostate cancer. The risk of developing prostate cancer by the age of 80 is about 1 in 500 in Shanghai. Whereas approximately 1 of 11 men in the US will develop prostate cancer. It is possible that the disease goes undiagnosed, but a combination of diet and hormonal factors related to race may help explain some of the variation.
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PMID:Vasal sterilization in China. 822 55