The injustice of our current contraceptive regime needs no elaboration. Enough to say that it’s bizarre, at this late date, that male birth control still does not exist. Every couple of years some scientist says they’re on the brink, and the same stale monologue jokes are hauled out of storage; afterwards they are placed back on the shelf, with no expectation, on anyone’s part, that they’ve been heard for the last time.
What’s the obstacle here, exactly? Is it a lack of effort, or funding, or what? What specifically is it about society, or science, or the inner properties of the dick/ball system, that has to this point prevented the invention of male birth control? For this week’s Giz Asks, we reached out to a number of experts to find out.
Associate Professor and Associate Director at the Alden March Bioethics Institute and Associate Professor of Obstetrics & Gynaecology at Albany Medical College
Some argue that it’s the science – that it’s much harder to control millions of sperm, versus one egg. But I don’t think that’s the entire picture. I think there are many other factors involved, and that a lot of them have to do with gender norms.
For instance: we tend to conflate reproduction with women, and so assume that all reproductive matters are “women’s issues.” When we have that mentality, we ignore male reproduction – we overlook it altogether. Most people have never even heard of the field of andrology, which is the study of the male reproductive system. It’s not taught much in medical schools – and if students aren’t learning this stuff, how are they going to provide these services? It’s not surprising, then, that we didn’t start working on hormonal methods of contraception for men until 50 years after we started working on them for women.
Another major issue is that drug development requires the deep pockets of pharmaceutical companies – researchers can’t move forward exclusively with funding from NIH or other non-profit organisations. And pharmaceutical companies have not been interested. They say it’s not going to make money – that men are uninterested and that women won’t trust men to take it. But we actually have good empirical data contradicting both of those claims.
The Male Contraceptive Initiative, for instance, a non-profit looking to create more male contraception, just did a survey earlier this year reaching out to men of reproductive age to ask if they would be interested, and a large majority really were. And as for women not trusting men – pharmaceutical companies don’t seem to distinguish between casual sex partners and committed partners. Of course women aren’t going to trust casual sex partners – we don’t trust male strangers in all sorts of contexts. But there was one study that showed that 98% of women would trust their committed partner. Women trust their male partner on all sorts of high stakes things – if you’re in a partnership, that’s what you do. I’m hopeful these are maybe signs of change – but then, they’ve been saying the male pill is around the corner for 50 years.
“It’s not taught much in medical schools – and if students aren’t learning this stuff, how are they going to provide these services?”
Assistant Professor, Metabolism, Endocrinology and Nutrition at UW School of Medicine
One historical challenge to the development of male birth control has been the notion that men would not be interested in taking it, or could not be relied upon to take it. But surveys and studies are showing us that that’s not the case any longer – that men are definitely interested in sharing the responsibilities of family planning, and are enthusiastic about the prospect of male birth control.
Another challenge has been a lack of pharmaceutical industry funding. Research at this time is mostly driven by big research centres and government funding.
It’s also important to distinguish between hormonal and non-hormonal methods. Hormonal methods essentially alter how testosterone is produced in the male body, and how sperm is produced in the body. With those methods, the main hiccup is that altering hormonal levels causes side effects – changes in mood, acne, sexual dysfunction. It becomes a tolerability question: how much will men put up with? What dose is it safe to ingest at a given time? The bigger bar for the hormonal method, though, is being able to bring the sperm count low enough, so that the drug becomes a reliable method of birth control. So that’s the challenge: the dose can’t be so high as to cause bad side effects, but it needs to be low enough to reliably suppress the sperm count.
One of the main problems with the hormonal method is that most of them have used injections, and injections come with their own issues – they have to be combined with different agents called progestins, and so we can’t really ever be sure what’s causing certain side effects.
On the non-hormonal end, what they’re aiming to do it use methods that prevent the sperm from either being active or from being released in some way, and none of those methods have come as far as the hormonal method in terms of reversibility – most are currently sort of sterilisation methods, and their failure rates are high.
“It becomes a tolerability question: how much will men put up with? What dose is it safe to ingest at a given time?”
Professor of Medicine at UCLA, Investigator at the Lundquist institute, and Head of the Section of Diabetes and Metabolism, Harbor-UCLA Medical Centre
People interested in family planning have been thinking about male contraception for a long time. We’re presently working on some of these issues, under the auspices of the National Institutes of Health and the National Institute of Child Health and Human Development, two federal agencies that are supporting research into contraception through what’s called a contraceptive clinical trials network. Dr. Christina Wang, is the principle investigator of the project.
The idea is that family planning should be a shared experience – that men and women could contribute according to their wishes. We want to expand the options that are available for family planning. There have been a number of studies that have looked at acceptability of male directed contraceptives, and many are surprised to find that there’s a positive response from men and from women.
Right now, we are working with a number of different hormonal agents. These agents may be administered transdermally – applied to the skin – or they can be applied by injection, or they can be given as an oral agent. All of them operate on the concept of combining an androgen – a male hormone, like testosterone – and a progestogen, which is also used in female contraception treatments, such as oral birth control pills. This combination is much more effective than suppressing the male’s sperm count.
We’ve used combinations before in various types of trials, and they’ve proven to be effective. The largest study we’re doing right now is taking place worldwide, with sites in South America, Europe, Africa, and the United States. We’re hoping that the effect will be a positive one in terms of protection of fertility, and that it will be acceptable to the individuals, and of course reversible when recipients of the medication are ready to move ahead with having a family.
“...family planning should be a shared experience – that men and women could contribute according to their wishes.”
Associate Professor, Obstetrics, Gynaecology & Reproductive Sciences, Advancing New Standards in Reproductive Health, University of California, San Francisco
There already is male birth control. At least, there are methods of contraception that operate in or are controlled primarily by male bodies: condoms, withdrawal, and vasectomy. The trick is that many people – both men and women – are unsatisfied with these methods. If you might want children later, vasectomy isn’t going to work. If you want a method with a very high rate of preventing pregnancy (like over 95%), condoms or withdrawal are probably not for you. If you want a reversible, highly effective method, methods that work in female bodies are all that’s available.
Why, then, isn’t there reversible, highly effective male birth control yet? A big part of the answer is that, as a society, we consider the work of pregnancy prevention to be women’s work. The pharmaceutical and medical infrastructure expects women to be the ones in a heterosexual relationship who are contracepting – and going to the doctor to get a method, paying for the method, and experiencing any side effects – so available methods are made for female bodies and only women receive contraceptive counselling from their healthcare providers. And the socially-normalised relationship trajectory reinforces this idea, too: as a sign that a relationship is serious, women shoulder the burden of preventing pregnancy by, say, going on the pill. At multiple levels, powerful social narratives feminise responsibility for birth control. In so doing, they simultaneously assert that there is no need or demand for reversible, highly effective male birth control.
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Featured illustration: Benjamin Currie (Gizmodo)