The Injectable Contraceptives Depot Medroxyprogesterone Acetate and Norethisterone Enanthate Substantially and Differentially Decrease Testosterone and Sex Hormone Binding Globulin Levels: A Secondary Study from the WHICH Randomized Clinical Trial

    August 2024 in “ PLoS ONE ”
    Chanel Avenant, Mandisa Singata‐Madliki, Alexis J. Bick, Donita Africander, Yusentha Balakrishna, Karl‐Heinz Storbeck, Johnson M. Moliki, Sigcinile Dlamini, Salndave B. Skosana, Jenni Smit, Mags Beksinska, Ivana Beesham, Ishen Seocharan, Joanne Batting, G Justus Hofmeyr, Janet P. Hapgood
    TLDR Both injectable contraceptives lower testosterone and SHBG levels, with NET-EN having a greater effect than DMPA-IM.
    The study, involving 521 HIV-negative women aged 18-40 in South Africa, examined the effects of two injectable contraceptives, depot medroxyprogesterone acetate (DMPA-IM) and norethisterone enanthate (NET-EN), on testosterone and sex hormone binding globulin (SHBG) levels. Both contraceptives significantly decreased total testosterone, free testosterone, and SHBG levels over 25 weeks, with NET-EN causing a more substantial reduction than DMPA-IM. Despite these hormonal changes, there was no observed decrease in risky sexual behavior or sexual function among users, suggesting that the androgenic effects of the contraceptives themselves, rather than decreased endogenous testosterone, may influence behavior. The study underscores the need for further research to understand the complex mechanisms of these contraceptives' androgenic effects.
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