Despite male birth control being studied since the 1970s, as it stands, there are no commercial hormonal male contraceptives and unfortunately it seems this will be the same for years to come. But why is this the case?
It’s not news that both socially and culturally, women are seen to have more responsibility when it comes to birth control. The fact that there are a plethora of contraceptives available to women compared to two male options solidifies this idea. Due to this disproportion, it is unsurprising that research finds women to be responsible for the planning and execution of contraception the majority of the time. Plus, even when taking into account shared methods such as condoms, women still remain disproportionally involved in managing their use with studies finding 90% of the time, women are involved in managing any type of contraceptives. However, this is not necessarily due to male unwillingness and most men are open to using birth control. A recent survey reported 55% of men actually want to try hormonal contraceptives. Here is the lowdown on everything you need to know about the future of male contraception.
Current male birth control
a surgical procedure which blocks or cuts a man’s sperm duct (vas deferens), to prevent sperm mixing with semen and leaving the body
a rubber sheath used to cover the penis during intercourse
The current method of male contraceptives are clearly from one extreme to another, with a vasectomy being classed as ‘permanent’ (although it can be reversed) whereas a new condom needs to be used for every sexual encounter. Researchers have been trying to bridge the gap for some time now with varying success, developing hormonal methods similar to the range of female contraception available.
Hormonal male contraceptives
The most common male hormonal contraceptives include both testosterone and progestogen in order to “switch off” sperm production. This means the body will produce semen without sperm or with too little sperm to cause fertility. These slightly differ from hormonal female contraception which only take a week to become effective, as it can take a few months to suppress sperm production. Male hormonal contraception has been developed in a few different forms with varying levels of success…
Men are given an injection every 8 weeks to suppress the production of sperm. Hormonal injections have been found to be 98% effective in preventing unwanted pregnancy, which is similar to effectiveness of female hormonal contraceptives. Plus, after a year of stopping the injections, 94% of men had recovery of sperm concentration, showing evidence for its reversibility and three quarters reported they would be happy to continue using the method if it was available.
However, many trials have been ended early due to adverse side effects such as acne, mood swings and the development of mood disorders (sound familiar?). It would be interesting to see how many trials for current female contraceptives would be ended early for the same reasons if they were to be trialed now.
Male contraceptive pill
Similar to female oral birth control, the male pill would have to be taken daily. A 2019 clinical trial found this to effectively reduce sperm, without any severe side effects (only mild reports of fatigue, headaches and acne). However, much more research is needed to detect long term outcomes as this study only observed the effects over 28 days despite the fact it takes at least 60-90 days for optimal sperm suppression. Don’t get too excited about this just yet, the researchers suggest safe, reversible hormonal male contraception should be available in about 10 years. Sigh.
Male contraceptive gel
Recently, topical gels such as NES/T which are applied daily to the shoulders and chest have shown promising results as a new male hormonal contraceptive. Current trials have passed human safety tests and human clinical trials, with more than 80% saying the birth control gel was acceptable. Unlike the injection, the gel is metabolised by the body quicker, leading to less adverse side effects. In fact, participants of a current UK study testing the gel have reported very minimal negative side effects.
Non-hormonal male contraceptives
Organisations such as the Male Contraceptive Initiative are working to raise awareness and advance the development of new non-hormonal male contraceptives. Research suggests a non-hormonal male contraception called Smart RISUG (reversible inhibition of sperm under guidance) is not far off, predicted back in November 2019 to be ready in just 6 months (add that to the list of things that Coronavirus has taken away from us). Final trialing of the non-hormonal male contraceptive injection is currently underway in India and is also being tested in China, Bangladesh and the USA.
What is it and how does it work?
RISUG is similar to a vasectomy as it blocks the sperm duct, preventing sperm from mixing with the semen and leaving the body. Instead of cutting the sperm duct, RISUG works by an injection of non-hormonal chemicals partially blocking it and deactivating sperm before they leave the body. RISUG is the best of both worlds; working as a long-term contraceptive, which lasts up to 13 years but can also be dissolved if and when the patient wants.
The method has been found to have high sustained contraceptive efficacy with no significant adverse effects as seen experienced while using hormonal methods. Plus, while hormonal methods can take around 3-4 months to be effective, RISUG can be effective in as little 1!
The future for male contraception
Although it is unclear when a new male contraception will be available commercially, the current research is promising. Hopefully in the years to come, this will continue with more rigorous, extended clinical trials to confirm the efficacy and safety of both hormonal and non-hormonal male birth control. Increasing men’s opportunity and contraceptive options will help to balance the responsibility for fertility and take the weight of 90% of women’s shoulders.