Where is the ‘Male Pill’?

By Harleen

Misconceptions about Contraception

“Male contraception hasn’t changed much since the condom was invented over 5,000 years ago. You can blame biology.”
A Business Insider profile earlier this year explained the reasons for a lack of male contraceptive options, observing that they have not developed much beyond condoms and vasectomies. They attributed this to a lack of interest by pharmaceutical companies in developing hormonal male contraception, as previous trials had explored the suppression of testosterone; the side effect profile of which was considered to be unacceptable to men (predominantly due to reduced libido). There was also an apparent concern by pharmaceutical companies that women would not trust men to take hormonal contraceptives. 

There is a lot about these claims which is skeptical. Continue reading for a balanced view on the current state of contraception… 

Hormonal Methods
Female hormonal contraception works by administering enough man-made reproductive hormones (progestins +/- oestrogen) to dysregulate the normal menstrual cycle and stop pregnancy from occurring. The primary mechanism is through prevention of ovulation (the monthly release of an egg from the ovaries), however movement of the egg along the fallopian tubes is also decreased and cervical mucus thickens to stop sperm from entering the womb. As with all medications, there are a range of side effects, the most serious of which is an increased risk of developing blood clots, which can cause heart attacks, clots in the lungs and strokes. The more common side effects can also impact quality of life, with mood changes, high blood pressure, weight gain and swelling. However it is available in many forms, as a pill, injection, implant or intrauterine device; and the pill is often used therapeutically to improve acne and heavy or irregular periods. 

Male hormonal contraception was previously developed to reduce spermatogenesis (sperm production) through the administration of testosterone but the side effects were not tolerable. They were found to cause reduced “androgenicity” (i.e. characteristics caused by male hormones), negatively impacting on libido, hair growth and mood swings. More recent research suggests that male hormonal contraception remains a possibility and could in fact work similarly to its female counterpart. A combination of both a testosterone and progestin injection has been found to cause a more rapid (and reversible) reduction in sperm production. As a smaller dose of testosterone is needed, the side effect profile is also more acceptable to men. Further work has been done exploring the use of other male hormones (e.g. nandrolone) to prevent spermatogensis in a pill form. While these appear to have better side effects, early data suggests they will need to be taken with food, thus reducing their practicality.  

Non-hormonal Methods
For men, condoms are the age-old contraceptive method that are frequently used, but not particularly popular. They have no side effects and are the only form of contraception, which serve the dual purpose of protecting against pregnancy and sexually-transmitted infections. However they tend to interrupt sexual intercourse, and condoms have therefore failed to gain many fans.

Whilst the female equivalent, ‘femidoms’, are available, their use is not widespread. Instead, a reasonable non-hormonal method of contraception is the copper intrauterine device (IUD). Its primary mechanism of action is by acting as a ‘spermicide’ (i.e. killing sperm) to prevent fertilisation. It can also be used as a form of emergency contraception within five days of unprotected intercourse, suggesting that the IUD may also prevent implantation of a fertilised egg in the uterus. However, it comes with a range of side effects, the most common of which is heavier and more painful periods; and the most dangerous of which are pelvic inflammatory disease, perforation of the uterus and a relatively increased risk of ectopic pregnancy. 

A new gel is in development, as an option for male contraception. This gel could be injected into the vas deferens to create a reversible plug to stop sperm from travelling from the testes. Given that the the ideal male contraceptive method should be independent of the sexual act and without short- or long-term side effects and interference with libido … effective quickly, fully reversible, have no impact on eventual offspring, and be easily accepted by both partners– this gel could provide a much-needed solution. Human trials have not yet been conducted, although mammal models show promising results.

Permanent Methods (Sterilisation)
Men can undergo a vasectomy, a simple procedure performed under local anaesthetic, in which the vas deferens (i.e. the tubes through which sperm is delivered from testes) are cut or tied. Vasectomies are generally found to have good outcomes. The main complications are those associated with all surgical procedures – infection, bruising and bleeding.

Tubal ligation is the permanent option for women. This is a more complicated procedure performed under general anaesthetic, during which the fallopian tubes are tied off, so eggs are unable travel through the tubes into the uterus. This is done through keyhole surgery (laparoscopy) but with this, comes the risk of being converted to open surgery (laparotomy). The same risks of infection and bleeding apply, however there is also a higher rate of failure and and increased risk of ectopic pregnancy; the latter of which is a gynaecological emergency.

Final Thoughts
The Business Insider claimed that over half of men would be happy to take hormonal contraception. However the cited study showed considerable variation in nationalities (from 28.5% to 71.4%). Furthermore, the Business Insider paints a picture that women wouldn’t trust men to take contraception. However, another study found that only 2% of women wouldn’t trust their partners to take contraception

There is an obvious reason why focus has been on female contraception. If a woman becomes pregnant, it is ultimately the woman who sacrifices nine months of her life to carry a foetus. Female contraception therefore gives women a choice. However, male contraception would give women that same choice, by conferring the same protection against pregnancy.

Pharmaceutical companies and pseudoscience blogs avoid investigating male contraceptive methods, by citing “the lack of available options”, “unacceptable side effects” and “women’s mistrust” as the reasons for disinterest. The side effects for women’s contraceptive methods are arguably just as problematic; and there are emerging options for men, which require the support of pharmaceutical companies to become widely available. Given the wide availability of misinformation regarding your health and health choices; it is more important than ever to question, be critical and be skeptical. 

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