Here’s Why We Still Don’t Have a Birth Control Pill for Men

 

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Male birth control medication can also cause side effects like low libido. Getty Images

The idea of a male birth control pill may seem like a novelty, but it’s not.

For roughly the last half-century, researchers have studied different hormonal drugs with that singular purpose in mind.

None have ever reached the market.

Drug companies are apparently uninterested in them. Perhaps men are too.

But the lag between the development of female and male hormonal contraception is far more complex, driven by social reasons and scientific ones.

 
 
Why men don’t have ‘the pill’

A large part of why male hormonal birth control has seemingly fallen by the wayside is simple.

“The pill” combines the hormones estrogen and progestin and is capable of preventing pregnancy in females. First approved by the Food and Drug Administration in 1960, it was more revolutionary than anyone could have imagined.

The popularity and efficacy of the birth control pill, however, also had the unintended consequence of cementing the role of women as the bearers of the contraceptive burden.

In the shadow of such a monumental development in human reproduction, a male birth control pill might almost seem redundant.

But in the years since, researchers say that not only would such a drug fill an unmet need — namely as another effective method of reducing unplanned pregnancies — but also finally rectify the burden of contraception on women.

You won’t see male birth control on store shelves this year or next. But researchers are hopeful you will in the next decade.

 
 
Experimental research

Promising new research has demonstrated the safety of several new formulations of male contraception, including two oral formulations (pills) and a topical gel.

The first pill, dimethandrolone undecanoate (DMAU), has passed human safety tests. So has a more novel drug, known as 11-beta-MNTDC.

However, both DMAU and 11-beta are both still relatively young in their development cycle.

A topical gel formulation known as NES/T, a combination of the hormones progestin and testosterone, is significantly further along. Not only has it passed safety tests, but couples trials are currently underway to test its efficacy as a contraceptive in the long run.

The goal of those trials is for couples to eventually only use NES/T as their sole form of contraception.

All three methods work similarly.

“Fundamentally they rely on the same things that female hormonal contraception relies on: exogenous hormones, testosterone as opposed to estrogen, plus progestin,” said Dr. Stephanie Page, a professor of medicine at the University of Washington School of Medicine.

“What that does is it blocks the signal from the brain, in this case to the testicle, which means the testicle stops producing testosterone, and without that high amount of testosterone in the testicle, the sperm do not mature,” said Page, who’s involved in the research of all three drugs.

But interfering with testosterone has proven tricky, and interfering with hormones in either men or women causes side effects.

For female contraceptives, this means anything from weight gain and moodiness to more serious effects, like high cholesterol and blood clots.

For male contraceptives, it can mean things like erectile dysfunction and lower libido, which, unsurprisingly, has been a serious snag for development.

“The issue was that whenever the attempt was to try to come up with a medication, the side effects profile was too demanding or taxing. Mainly the decrease in libido, increase in erectile dysfunction — that basically goes hand in hand with the same hormones, [such as] testosterone, that are responsible for sperm production,” Dr. Tomer Singer, director of reproductive endocrinology and infertility at Lenox Hill Hospital in New York City, told Healthline.

 
The possibility of a breakthrough

However, recent research on 11-beta could help allay the fears of debilitating side effects.

In a small trial of 40 participants, only five men reported a mildly diminished sex drive. Two reported mild erectile dysfunction. None of the participants chose to stop taking the drug because of these side effects.

“That’s very, very reassuring, because essentially if most of them were able to tolerate it, every guy will have to decide risks and benefits and choose themself whether or not to use it,” said Singer, referring to those results.

For men seeking contraceptive methods, options have been limited. There are condoms, of course, and on the other side of the spectrum there’s vasectomy. This surgical procedure is designed to be extremely effective, but it’s also permanent.

A hormonal contraceptive for men is designed to meet in the middle: offering highly effective contraception while also being reversible.

And the potential reasons for men to be interested are many. For single men, it could mean taking more control and autonomy over their sex life. For couples, it offers new options to share responsibility.

“There are lots of men who feel like they want to be part of it. They want to be a contributor. They want to share the burden of contraception. So, lots of men are up for it, so to speak,” Page said.

Male contraception also offers a practical solution to a problem that’s shown no signs of going away: unintended pregnancy. In the United States, almost half of pregnancies are unplanned.

“This is the real issue in the U.S. and around the world,” Singer said.

“Despite the fact that there are a number of options available to women… we still have a problem. Unplanned pregnancy has an enormous health, emotional, and economic burden for the globe. There’s clearly an unmet need,” Page said.

Still, options for men are likely years away. Before any of the current drugs go to market, they would first have to undergo large-scale rigorous testing.

Contraceptives also have a longer timeline than some other drugs because they have to work continually. That means these drugs need to be used for a year or two before they can be proven effective.

“We think that it will be a decade, and that really does have to do with the fact that we have more work to do. The trials that will need to be done by their very nature will take some time,” Page said.