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Birth control is humanity’s ultimate compromise with nature — it’s our method for having it both ways. We can enjoy the pleasures of sexual activity while also controlling how and when we procreate. However, the options for male birth control are not nearly as advanced as the plethora of options available for women. While it’s the female body that takes on the burden of pregnancy, both parties are equally responsible, at least in theory, when getting frisky results in a new human being. So, why don’t men have the same options when it comes to birth control? Why does the responsibility of family planning always fall on the woman’s shoulders?
In layman’s terms, the dudes are getting the short end of the stick, despite pregnancy and family planning affecting both parties. Unintended pregnancies cost the U.S. up to $21 billion a year, and up to 25% of couples use a male form of birth control exclusively. The current options for men, mainly condoms and vasectomies, are not perfect methods by any means, and quite frankly, it’s high time men had a wider selection of methods for controlling the spread of their seed.
There are currently a few new forms of male birth control in the works — including a daily pill for men, an injection known as RISUG and a topical gel called Nesterone. It’s been decades since a decent new form of male birth control option entered the market, so it’s exciting to hear that these methods are in clinical trials and could be available soon. Their development, testing and hopeful dissemination has raised some big questions in the medical world, questions I was pondering on behalf of all the men in my life.
Why has it taken so long for a “pill for men” to be developed? Do men even want hormonal birth control? What side effects are men in these trials experiencing? I decided to consult some experts.
In this piece, we’re going to explore:
- The current methods of contraception that exist for men
- The methods currently being researched
- The hurdles that come with producing hormonal birth control for men
- What the future looks like for men who want access to birth control
We’ve consulted a group of medical experts ranging from urologists to medical researchers to men’s hormone specialists to see what the landscape looks like from a medical standpoint and to ensure we’re giving you the most accurate information possible. Ready? Let’s dive in.
Part I: Current Birth Control Methods for Men
There simply aren’t many birth control methods for men, at least not compared to the options available to women. There’s abstinence, which is more of a joke than a real form of birth control, and is completely ineffective at meeting the health needs of young people. Even the best condoms have a failure rate between 15% to 18% with regular use. There are also vasectomies, reversible surgical procedures that remove sperm from ejaculate.
Vasectomies are as effective as female IUDs (intrauterine devices) at preventing pregnancy, with a failure rate of about 1%. They can be reversed by a trained surgeon; however, the success rate of reversals goes down as time goes on. If you wait less than 15 years to get your vasectomy reversed, then your success rate is between 95-98%, which is pretty good! However, if you wait 15 years or longer, chances of successful sperm transmission post-snip drops to 60-70%. Also, the rate of achieving a pregnancy after a reversal, even if it’s successful, is between 40-50%.
The truth is, men simply don’t have a reliable and non-surgical form of birth control that they can reverse when they’re ready to become fathers, while women can go off the pill or remove their IUD when they’re ready to become mothers.
One final method should be mentioned here: the pull-out method. Although some men will swear it’s a viable form of male birth control, most medical experts refute its effectiveness. Dr. Chun Tang, a general practitioner at Pall Mall Medical, a private healthcare provider in the United Kingdom, notes that “contrary to popular belief, the withdrawal method of taking your penis out of your partner’s vagina before ejaculating is not a method of contraception and should not be used as such. This is because sperm can be released before ejaculation and can still lead to pregnancy and STIs.”
The name of the game when it comes to hormonal male birth control? Reducing the number of sperm the average dude is carrying around in his ejaculation — fewer sperm means less of a chance of fertilizing an egg and fewer babies. The problem is — how do you get there? And, how do you convince men this is a good idea? We ran through all of the options currently in the works for tackling this problem with some experts in the medical world.
Part II: Current Male Birth Control Methods Being Researched
So, we’ve covered what’s currently available, but what’s currently in development? There are a few different methods in clinical trials that include an injection called RISUG, a daily pill, known as DMAU and a topical gel known as Nesterone. RISUG is non-hormonal which gives it a boost in the eyes of the medical community and potentially users as well if it ever becomes widely accessible. DMAU and Nesterone are hormonal options.
Dr. Kim Langdon, an OGBYN with Medzino gave us the details on the RISUG injection (which sounds scary but we promise is not).
“RISUG and Vasalgel, which is a contraceptive method based on RISUG. After receiving a local anesthetic, RISUG uses a polymer gel that’s injected into the vas deferens (two tubes that carry sperm from the testes to the penis). This positively charged gel attaches to the inner walls of the vas deferens. When negatively charged sperm flow through the vas deferens, the gel damages their heads and tails, rendering them infertile.” RISUG is currently in phase-III clinical trials in India.
She described how the “good news is that these male birth control injections are also completely reversible. All it takes is a simple injection of water and baking soda to dissolve and flush the gel out of the vas deferens. Also, the shot appears to have no side effects.” (Emphasis added.)
Boom — two of the biggest cons to male birth control, reversibility and side effects, are no longer an issue.
Okay, but I hate needles. What about the pill?
Dr. Chris Airey, a practicing physician and Medical Director at Optimale, a telehealth clinic for men with low testosterone, shed some light on how hormonal male birth control pills would work and how they differ from female methods.
“There are promising developments with a male birth control pill that functions similarly to the female birth control pill. For feminine bodies, the pill uses estrogen and progesterone to stop the process of releasing an egg into the uterus. No egg, no pregnancy,” said Dr. Airey.
“The male birth control actually suppresses two hormones that are necessary to create viable sperm: follicle stimulating hormone and luteinising hormone, or FSH and LSH respectively. Suppressing these hormones actually causes testosterone to lower as well, and so far the evidence looks promising that it can lower testosterone without the negative effects of low testosterone.”
This is precisely what DMAU, or Dimenthandrolone Undecanoate, the frontrunner birth control pill for men, does. While its effect on actual sperm count hasn’t been thoroughly researched, it’s been shown to have an effect on male hormones that should limit the number of sperm present in ejaculate.
There’s also Nesterone, a synthetic hormone suppressor that’s combined with testosterone and applied as a topical gel. Kind of like lotion that’ll tame your baby makers. It’s been shown to effectively limit sperm count to the desired concentration of less than 1 million/mL of ejaculate in 89% of the men it was tested on when used for 20 days consecutively. Most of the men who took part in the study said they would use the regimen again — huzzah! Buy in and an easy application process? We’re sold. There’s currently a global clinical trial going on for this gel, and experts say it could be available soon.
There isn’t just the reality of pregnancy, children and family planning at stake when it comes to male birth control, but also giving men more of a reason to stay in touch with their healthcare providers and engage in preventative medicine rather than only seeking help when there’s a crisis. Wouldn’t you rather take a pill or lather on some gel than risk that stomach-dropping moment when a woman tells you you are, in fact, the father? We thought so.
So why hasn’t male birth control become a widespread thing yet?
Part III: Hurdles in the Development of Male Birth Control
Turns out there is a multitude of reasons, both medical and social, for why male birth control has lagged behind all these years despite male sexual drive being (you guessed it) quite high. Male birth control is more complicated to formulate when it comes to hormones and creating a method that’s as easy to take as a daily pill. There also just hasn’t been the same amount of funding dedicated to the study, research and execution of a widely-available male birth control method with few side effects. That brings us to another key reason why, I believe, male birth control doesn’t exist to the same scale that contraception does for women: side effects.
Carmen Abbe, a medical researcher focused on male birth control and current medical student, pointed out numerous hurdles to the creation of, and implementation of, widespread male birth control. She explained why there’s fundamentally less funding and interest coming from pharmaceutical companies in moving male birth control forward, and floated a theory as to why this is that I found fascinating.
She explained how “one of the biggest hurdles is assessing the balance of risks and benefits of male birth control. There are always risks of side effects when taking a medication. In the context of female birth control, those side effects can be weighed against the risks of pregnancy. So when investigators are developing a female contraceptive, if there are side effects, those effects can be compared to the risks of pregnancy and justified if the risks are less than those of pregnancy.”
While minimal side effects have been found during clinical trials of DMAU, or the frontrunner “pill for men” that’s in development, any side effects bring up an ethical question when it comes to physical sacrifice and avoiding pregnancy. With female birth control, the side effects are weighed against the chances of unwanted pregnancy. Men, however, don’t have to worry about getting pregnant. It’s not their body on the line — so can you ask someone to experience side effects for a burden they wouldn’t bear otherwise? I think if you asked, most women would respond with a resounding, “Hell yeah they can! Let them worry about messing with their hormones for once!” But not all medical experts agree.
“Male contraception is novel in that the man, or person with a penis, taking the birth control, is not preventing pregnancy in their body, but in their partner’s body. So if they experience side effects, those side effects can not necessarily be ‘justified’ since they would not experience the risks of pregnancy in their own body. This presents us with a new and interesting ethical dilemma – is it ethical to give someone a medication with potential side effects if it doesn’t have a direct effect on their body, but rather their partner’s?” She wrote a whole paper on this topic, which you can access here if you’re interested.
Are men willing to suffer side effects to spare their partner the burden of carrying a child or the shock of an unwanted pregnancy test? This also raises the question, if male birth control pills were available, would men actually take them? When a woman misses a pill, there’s the panic of getting pregnant. Men might not feel that, and therefore human error could be a big problem. Studies of common errors with condom use, like putting them on partway through sex, unrolling the sheath before putting it on or even using the wrong personal lubricant turned up incredibly high prevalence, sometimes as high as over 50%.
Based on these risks, would women trust men to stay on top of their contraception?
“In my opinion, birth control is a mutual decision that partners make together, so it is not as simple as preventing a physical pregnancy in one person. Rather, contraception, whether it is for males or females, is giving people the agency to make informed parenthood decisions with their partners and to bear the risks together,” said Abbe.
Men should have the option to take matters into their own hands when it comes to their future offspring and should feel emboldened by the development of new contraceptive methods. The future of male birth control is exciting for men, who will ultimately have more control over the outcomes of their sexual exploits. Men will no more be relegated to pithy sex advice like “no glove, no love” and will instead have real birth control options.
Whether they will actually take advantage of them, however, is a different story.
Part IV: Future of Male Birth Control
For now, we’re still waiting for the clinical trials of Nesterone, DMAU and the injectable Vasagel to finish and hopefully progress towards becoming widely available. We posed this question to our medical experts as well, and got their perspectives on what they view as the future of male birth control in the next couple of years and beyond.
“It seems we are a long way from commercial availability of a male contraceptive pill, but it would be a game-changer and take a lot of the onus for effective birth control off of women, who have been putting up with moderate to severe side effects of contraceptive pills for decades,” said Dr. Ailey.
“Hopefully effective, low side effect contraception made widely available to men will improve the dialogue around birth control, and lead to better research for female contraception that has less side effects too.”
Abbe said, “Male birth control will give both individuals and couples more options to have full control over their reproductive autonomy and parenthood plans.”
“The right to control one’s reproductive autonomy should not be available to only those who can get physically pregnant, but rather to any human capable of reproduction.”
So where do we go from here? Along with these new methods of male birth control comes a whole slew of new conversations for couples and individuals to have with each other and with themselves.
“Will you take this pill and suffer side effects so I don’t get pregnant?”
“This guy told me he’s on the pill, but do I trust that he takes it regularly?”
“Are we at the point in this relationship where we want to explore more intense birth control options?”
“Hey babe, will you rub my testi gel on me so we can get it on ~safely~ later?”
It’s hard to say exactly how each of these birth control methods will play out in the real world within real intimate relationships. Perhaps condoms will remain the go-to method for more casual sexual interactions and the pill will be saved for more serious, committed relationships. Maybe some men will put themselves on the pill just as women do, so they know they’re covered pregnancy-wise no matter how much sex they’re having or who they’re having it with. Perhaps some men will embrace male birth control as they’ve embraced other elements of sexual health and expression like sex toys, masturbators for men and couple’s sex toys.
Perhaps they’ll all fail to capture men’s attention and the patriarchy will win out.
Up to 40% of pregnancies are unintended. If new methods of male birth control become available, that can only be a net positive for humanity.