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 microg of DSG plus 50 mg of
testosterone (DSG 150-T 50), 150 microg of DSG plus 100 mg of testosterone
(DSG 150-T 100) or 300 microg 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 microg 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 eight 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 50-T 100 or testosterone alone. All groups tended to
gain weight compared with their baseline, but the weight gain was greatest
(and 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