Diary of my experience with male hormonal contraception

We're a couple in our forties with a grown daughter who's more than enough for us. There's no question of reliving the charming first years of a child, with the sleepless nights, the diapers, the mush on the walls and the social no-life that this blessed period engenders.
My partner was fed up with taking hormones, and after trying IUDs, spermicidal ova, condoms, Ogino and withdrawal, nothing worked for us: either too aggressive, or a love-killer, or not effective enough to dispel the fear of the bun in the oven.
So I was willing to try and do my bit. But I wasn't about to let a doctor take a scalpel to my testicles
I wasn't too keen on the idea of her having her ovaries and uterus butchered either.

I'd heard for some years that a reliable hormonal method existed for men, so I went fishing for information with the ARDECOM association, which campaigns for the development of alternative male contraception methods (vasectomy, heated underwear and male hormonal contraception - MHC-).
I was very well received and was able to contact their president by telephone, who gave me all the necessary explanations about this method (which has been successfully tried out for over thirty years!), as well as the contact details of one of the only French specialists in the field, Dr Soufir, an andrologist in Paris.

Appointment made with this doctor (end of 2018), I travel to Paris from Pas-de-Calais where I live. The train ticket costs an arm and a leg, but I can't complain, I don't live that far away, and I've found a free plan for accommodation on the spot.
The man is quite old, he must have passed retirement time a while ago, but he's as friendly as he is professional.
After asking me the eliminatory questions (prohibitive medical conditions: sleep apnea, vascular, cardiac, hepatic, hormonal, psychiatric problems...) and performing the classic auscultation (weight-heart-lung-tension), it's time for the motivational questionnaire.
This is where things get tricky. I'm in my late forties. And he's doing everything he can to push me towards a vasectomy, which he says is less risky and more suited to my age. Or heated underwear.
But I'm not crazy, I was expecting it (thanks ARDECOM) and I'm beating him to the punch: I've got testicular problems that may contraindicate these methods (cyst, tearing, varicoceles...) and I'd like to be able to relive the joys of a new fatherhood in the event of masochistic regression later on. And in my retrograde mind, vasectomy is mutilation, period. To finish off, I mention my firm intention to share this burden with my partner, out of anti-sexist awareness (and I think this "political" argument convinced him).

Assured of my motivation, he agreed to launch the procedure and explained the following steps: Blood tests (formulation/numeration, liver markers and above all testosterone dosage), and a first spermogram (yes, there will be several). And I have to do all these tests in specific laboratories in Paris. He swears by them, and there's no way he's going to trust some little lab he doesn't know in the provinces. Calculating the SNCF fees I'll have to pay gives me a bit of a headache, but I leave his office with a smile on my face.

The following week, I return to Paris for my examinations, the blood test is quick and harmless; where it gets a little tricky is for the second test: the spermogram.
I am admitted to the Laboratoire de Biologie de la Reproduction at the Hôpital Cochin. I feel a bit like an extraterrestrial, because this is the place where couples who can't have children go. There are posters about gamete donation on every wall, and I've come to find out why I can't have any more gametes or kids.
Once the small inconvenience of the medical questionnaire with the secretary had passed, the big inconvenience came, the spermogram itself.
The secretary accompanies me into an aseptic 6m² room, with a bench, erotic posters, washbasin and flat screen TV. She explains how the video player works, allowing me to choose a porn film to my liking if I wish (teen, gangbang, facial, sodo etc...), explains how to decontaminate my glans before stimulating it, how to signal to the laboratory that they can collect "my sample", then leaves me alone with the ordeal of the test tube I have to fill with semen.
The mission is not an easy one. Despite the porn, the mandatory five-day abstinence and the desire to do it quickly and well, it's extremely difficult to maintain an erection and take pleasure when you're alone in a place that smells of Dakin and where you can hear the comings and goings of medical staff and patients on the other side of the door.
After a good half-hour of turgidness and debandades, the effort finally pays off and I manage to release my 6.5 milliliters of sperm into the test-tube (and a few drops next to it), put it away in the indicated receptacle, press the lab button, and leave the premises with a sense of duty accomplished (and my penis seriously flayed by too much dry sex with my right hand).

Once I've received my test results, I see the doctor again a month later.
Everything's fine, my blood work is top-notch and I'm very fertile, so we can start treatment. "No longer than 18 months", he says, "and given your age I won't renew the treatment beyond that, after which other methods will have to be considered".
He prescribes Androtardyl, an oily form of injectable testosterone, which is normally used for people who don't produce enough testosterone naturally or for trans men undergoing FTM reassignment.
An intramuscular injection into the buttocks every week, he prescribes the product and nursing care for 4 months. I will have a spermogram check-up after 3 months and a second one just before our next appointment. I'll also have blood tests to check that I'm tolerating the treatment well. At this point, I can feel the mental burden shift...
Finally, he tells me that the prescription will be "hors AMM", which means I'll have to pay for my treatment out of my own pocket. It's "only" €40 a month, but added to the cost of transport, CHM is definitely not for everyone!

11/03/2019
Administering the treatment isn't the most pleasant thing, taking a 4cm needle in the buttock every week isn't what I'd call harmless, but you get used to it.
The side effects are fairly mild, even positive: slight weight gain (you build muscle more easily), strengthened bones, acne localized on the chest and upper back, slight extra hair growth, increased libido, better sleep, increased energy. In short, it's a good thing I'm hairless, skinny (not very athletic) and an insomniac. And the healing of my shoulder tendonitis seems to have accelerated. So, apart from the acne and the pain in the buttocks, I'm fine.
On the other hand, it's possible to have negative effects on the blood (too many platelets and red blood cells, lipid abnormalities), to become aggressive, to go bald or to have inflammation of the liver, but it's rare, and I haven't suffered any such inconveniences to date.

And it works!
The principle is simple: the artificial supply of testosterone tricks the central hormone-regulating system, which in turn instructs the testicles to put themselves to rest: they produce neither testosterone nor spermatozoa.
This brings me to the last side-effect, which is that your cuckoo clocks shrink and you feel much more zen with this forced vacation. And it's actually quite comfortable.
It takes a few weeks after the start of treatment for the gamete stock to run out, but once that's done, you become sterile or almost so, and it's fully reversible when you stop treatment.
The spermogram at three months indicates that I'm responding well to the treatment, the volume of sperm remains normal, but I have almost no sperm left, and the few that remain are in such poor condition that they are unable to travel to the nearest egg.
The last spermogram is even more categorical: after four months of treatment, I've become azoospermic: I no longer produce any sperm, I'm sterile.

Dr. Soufir renewed his prescription for four-month periods. After two renewals, I tried to have my family doctor (Dr. T.) take over, so I wouldn't have to travel to Paris.
But my hopes were dashed by doctors' lack of knowledge of the method and judicial paranoia: I was too afraid of making a mistake, of being rapped on the knuckles by the Ordre des Médecins or the Contrôleurs de la Sécu, and then "it's dangerous to administer hormones like that, there could be side-effects, you'd be better off having a vasectomy".
Patients on the contraceptive pill will appreciate this clear-cut opinion...

Finally, I managed to get the head doctor of the local Family Planning Center to take up my cause, and he agreed to take over the prescriptions. No more transport costs to Paris, and the icing on the cake is that he stopped writing "hors AMM" on my prescriptions, so I'm reimbursed.
On the other hand, I had to agree to have a rectal examination twice a year, so that he could make sure that the treatment wasn't harming my prostate. No worse than the twice-yearly gynecological check-up for women on the pill, if you think about it.

Lastly, the eighteen-month maximum treatment limit has been exceeded, as a precaution linked to the duration of the clinical trials carried out to date.
But when you consider that testosterone injections are used on a long-term basis by certain elderly men "in good society" as an elixir of youth, it puts the risks I'm taking with this breach of the initial contract into perspective.

I'm now two years into CHM, I haven't had a new kid and I'm not afraid of having one every time my partner ovulates.
The side-effects I mentioned earlier are there, so I have to pop a spot on my chest from time to time, my libido sometimes annoys my partner when hers doesn't keep up, and sometimes after the weekly injection I get morning erections that are a little too persistent for a guy my age. It's a revival of my teenage years, but nothing dramatic, and it's actually quite pleasant to live with.

My partner no longer has to worry about her contraception and the possible consequences of our sex, she no longer has migraines or loss of libido linked to the pill, in short, she's more zen about it.
I expect to be able to continue this treatment until she reaches menopause, and I recommend it to all guys (in a relationship or not) who want to take control of their fertility and the risks of unwanted fatherhood that their sexuality puts them at risk of.

I hope that this method will be democratized, and I'm trying to get the word out about it by writing this article, spreading the word around me, and making all the doctors I meet aware of it.
It's worth pointing out that the ARDECOM association also offers CHM training courses for healthcare professionals.

Further information: ARDECOM : www.contraceptionmasculine.fr

Updated 03/23/2023

Today, after 4 years, the end of my hormonal contraception has been announced.
I'll come back to this below. I'll just mention a few chronological milestones:

- 19/01/2021 : The head doctor of the Planning Center has handed over to one of her subordinates, for reasons of organization of her department.
She will see me only once, and has difficulty in agreeing (I have to argue a lot) to renew my Androtardyl treatment only once, as I have exceeded 18 months of treatment and the studies published on this method have not gone beyond that.
I have 3 months left to find an intermediary with a specialized doctor.

- 18/02/2021 : Dr. E., an endocrinologist, agrees to see me and takes over the prescription. She prescribes the treatment for one year. However, the prescription is "hors AMM", and the pharmacy no longer delivers the treatment to me via the "tiers payants" system, but the Sécurité Sociale continues to reimburse me on the basis of the care sheets sent to me by the pharmacy (this must be an error on their part, following the prescription without the mention "hors AMM" by the CPEF doctors, which suits me because the treatment costs a little over 300€ per year).

- 10/03/2022: My contraceptive method is still working well, blood tests are normal, no annoying side-effects, except sometimes when I'm a little too "dosed": I have little nocturnal priapisms which subside after waking for a few minutes, I adjust the dose downwards the following week and it balances out without a problem.
Dr. E. renews my treatment for another year, but tells me that the prescription will not be extended beyond my 50th birthday because of his concerns about the risk of cancer. I'm only 46, so I've still got a few years ahead of me.

- June 2022: My GP (Dr. T.) has unwittingly been implicated in the trafficking of forged prescriptions to a rogue home care nurse. Her responsibility has been cleared after investigation by the police and Social Security, but she is extremely worried about taking any professional risk with regard to possible Social Security controls.
She therefore informs me that, as my Androtardyl prescription is "off-label", she refuses to prescribe the weekly injections by the nurses who have been treating me for 3 years. Likewise, she agrees to prescribe the anaesthetic patches I use to make the injections less painful, but asks me to tell the Social Security that it's for tattooing purposes, should I be subject to a check-up by them.

- July 2022: I've run out of nurses to give me injections. I have a 2nd year level of nursing studies, I know the technical gesture, so I start injecting myself. Intramuscular injections into the buttocks aren't easy or practical, but I manage, albeit with a good dose of stress over the first ten or fifteen injections. As I got used to it, and realized that I injected relatively better than one of my two nurses (she was stressed by the technical gesture and therefore didn't always inject well), the Monday evening injection became a routine. Sometimes it's a bit stressful, but on the whole I'm coping well with it, and it's also positive because I'm becoming more autonomous (no more appointments with the nurses to keep, my injection times adapt to my work/family schedule rather than the other way round).

- 27/02/2023: Last monthly supply of my Androtardyl at the pharmacy. The pharmacist warns me that he won't be able to issue me with a "feuille de soins", as he has been contacted by the Social Security control department, who have asked him to stop issuing me with this document, as my prescription is "hors AMM". As a result, my treatment will now cost me €36 a month, and I'm liable to have the Social Security collect the sums I've wrongly received in previous years.

- 23/03/2023: Appointment with Dr E. for my renewal. I'm confident: My blood tests are fine, no prostate problems, no liver problems, the only slightly elevated marker is the iron ratio in the blood, but it's not at a pathological level. Still no troublesome side-effects, self-injection is now well under control and suits me well.
As soon as I enter the doctor's surgery, I fall head over heels.
Dr E. tells me she won't be seeing me for a consultation.
The Social Security inspector has sent her a registered letter with acknowledgement of receipt concerning me, so she has decided to stop prescribing my contraception.
I try to find out more about what she's been accused of, but she's as tight-lipped as a drum, and just tells me that I won't be getting any more prescriptions from her.
I leave her office disappointed, but not without expressing my incomprehension and disappointment at the lack of courage and commitment of the female doctors I've dealt with along the way.

- 25/03/2023: Contact with Dr A. from Toulouse, an andrologist in a specialist department that prescribes thermal methods and, to a lesser extent, hormonal methods. He is not surprised by my story, and tells me that his department regularly receives registered letters from the Sécu concerning Androtardyl prescriptions, to which he is obliged to reply in order to justify the validity of the prescription. Indeed, as soon as the Social Security doctors see Androtardyl outside the AMM, they immediately suspect that it's being used for doping or trafficking.
Refused to take over from my CHM, no first prescription in visio consultation, and considers that after 40 years this method has not been studied and should not be offered. He suggests that I find out about vasectomy, use condoms or be abstinent.

- 29/03/2023 : The end of treatment approaches inexorably. I'm off to find out what's in store for me.
A connoisseur of one of the circles where testosterone supplementation is most widely practised (a bodybuilder's supplements store manager) tells me that when long-term testosterone is stopped, for men over 45 (but fortunately this concerns bodybuilder doses, i.e. supraphysiological ++), some bodybuilders experience chronic hypogonadism; it's not obligatory, but it can happen and be long-lasting. He advises me to take vitamin D and tribulus supplements, and mentions a shock treatment that exists in case of difficulty in restarting endogenous testosterone production: Pregnyl (HCG) or its equivalent still on the market (Ovitrelle).
I did a little digging on the Internet, and indeed testosterone levels can take one, three, 6, 12 or 24 months to recover in men who have abused steroids (including testosterone) over the long term. In some clinical cases, at 36 months they were still below normal. The prescription of Ovitrelle is complicated to obtain (RTU therapeutic pathway) but possible. I hope that I won't have to go through that, and that I'll respond as well to stopping as I did to starting.
I've had a telephone exchange with a contact I was given in Parisian circles who campaign for male contraception. Our exchange is not very fruitful in terms of prescription relay leads, but he reassures me about the "difficulties of restarting" and I take his advice to sign up for an online discussion group on the subject.

- 30/03/2023: My request for advice on the online group resulted in a unanimous suggestion: contact Dr Soufir again to inform him of my experience of exceeding the 18-month limit. I took this advice despite the fear of being yelled at for exceeding the prescribed duration, and sent him an e-mail.

- 02/04/2023 : Dr Soufir has been very responsive, we've exchanged several emails since Friday. I've sent him information on the effects the treatment has had on me, as well as the biological analyses I've had over the period.
He's rather reassuring about all my questions and suggests a protocol for monthly monitoring of certain hormonal parameters (testosterone, LH, FSH) and biological parameters (spermograms) when the treatment is stopped.

- 03/04/2023: Last injection of Androtardyl.
I find the reply e-mails from the contact belonging to the Paris collective in my spam folder. He is rather reassuring about the aftermath, and cites a study which concludes that the side effects of withdrawal are non-existent or minimal in "normal users" compared with "abusers" (doping) who take doses 3 to 20 times higher.
He gives me contacts to try to find a relay or convince Dr E., but I think it's clearly too late, I've already made up my mind to stop the treatment.
He also sends me the link to the manufacturer of the USB heating briefs, so maybe I'll explore that avenue.

- 07/04/2023: Start of daily vitamin D (35µg / 1400UI) and zinc (30mg) supplementation.

- 10/04/2023: First injection-free Monday in 4 years.

- 04/13/2023: Receipt of examination prescription from Dr Soufir.
No particular signs of withdrawal, except slight fatigue at the end of the day.

- 18/04/2023: Start of tribulus terrestris supplementation (extract 20:1 40g equ. fruits).

- 20/04/2023: Fatigue more marked for several days. Spontaneous libido low, despite everything, several sexual encounters without "breakdowns", but anorgasmic, last week.

- 25/04/2023: Very tired. Very low libido. Struggle against depression.

- 29/04/2023: I think I'm past the "bottom of the wave", my shape is improving and my morale is also starting to improve noticeably. I start taking ashwaghanda (5g a day, in the evening).

- 03/05/2023: Fitness and morale OK. 5th day of abstinence in view of spermogram. Testicular pain radiating into the lower abdomen (colitis type) +++. It's been 4 years since I've experienced this type of congestive pain characteristic of long periods without ejaculation. It's probably a sign that "the machine has started working again", it's barely bearable (taking painkillers and antispasmodics in the evening) but it's quite positive, seen from a purely functional point of view.

- 04/05/2023: Spermogram and hormonal blood test this morning. As expected, the pain disappeared gradually during the day. Results of spermogram within 3-4 days and hormone test within a week.

- 05/05/2023: The spermogram has already arrived. Still azoospermia. A little bummed, even though I expected it, I'm going to have to stick with at least one more spermogram.

- 10/05/2023: The hormonal workup is incomplete, but the first results are in:
FSH OK: 7.1 mIU/mL (12/2018: 2.8 mIU/mL)
LH OK: 5.6 mIU/mL (12/2018: 5.1 mIU/mL)
Testosterone still low: 3.16 ng/mL (12/2018: 7.82 ng/mL)

- 22/05/2023: End of hormone test:
Bioavailable testosterone: 0.43 ng/mL (12/2018: 0.57 ng/mL)
Fatigue has decreased even if I don't feel "on top" at the moment. But nothing like the state I was in a month ago. Mood-wise, it's tending towards a return to normal. Libido is still low, although it's improving a little.
We're starting to be careful about intercourse, not knowing when it will become risky in terms of fertility. As my wife, who is over 40, is not allowed back on the pill ("too dangerous at this age", says Dr Soufir), we opt for spermicidal creams.

- 06/15/2023: Biological check-up at 2 months:
Still azoospermic.
FSH at 8.5 mUI/mL
LH at 5.4 mUI/mL
Bioavailable testo at 0.63 ng/mL
The lab forgot to ask for total testosterone.
Fitness + morale + libido OK

- 12/07/2023: Stop taking supplements (vitamins & tribulus).

- 02/08/2023: Biological tests:
LH and FSH at 7.8 mUI/mL
Testosterone at 5.90 ng/mL (within norms for a man my age)
Testo bioavailable at 0.86 ng/mL (above pre-contraceptive levels)
Spermatogenesis has resumed, concentration is still low (6.60 million/mL, normal being >15M/mL), with only 2% typical forms (normal is >4%).

- 06/09/2023:
Spermogram: 18 M/ml, the count is lower than before treatment (89 M/ml), but it is >15 M/ml so back within the norm; ditto for typical forms which at 6% are back above 4%.
I hope these results will be enough for Dr Soufir to stop the monthly check-ups.
FSH 7.4 mUI/mL
LH 8.6 mUI/mL
Testosterone at 7.19 ng/mL
Bioavailable testo at 0.87 ng/mL

Dr Soufir confirms that for him, follow-up is no longer necessary. He will undoubtedly contact me again in the near future as part of his studies.

Axel - 10-2023