Effects of Depot Medroxyprogesterone Acetate, the Copper IUD, and the Levonorgestrel Implant on Testosterone, Sex Hormone Binding Globulin, and Free Testosterone Levels: Ancillary Study of the ECHO Randomized Clinical Trial

This ancillary study of the ECHO randomized clinical trial examined the effects of depot medroxyprogesterone acetate (DMPA-IM), copper IUD, and levonorgestrel (LNG) implant on testosterone, sex hormone-binding globulin (SHBG), and free testosterone levels in 398 women aged 18 to 35 over 6 months. The LNG implant significantly increased free testosterone levels by 29% compared to DMPA-IM and resulted in lower SHBG levels than both DMPA-IM and the copper IUD. These hormonal changes could affect sexual function, mood, bone health, and side effects like acne and hirsutism, emphasizing the need to consider the endocrine effects of contraceptive methods for better user counseling.