The going attitude among heterosexual people who are sexually active is that the men are typically responsible for bringing condoms to any event that could lead to sex. A survey conducted by Indiana University earlier this year found that two-thirds of condoms are purchased by men and 65 per cent of women have never bought condoms. (Although, it also found that the stigma of women buying condoms has all but disappeared.)
However, the onus of contraceptive use tends to shift once a couple agrees to monogamy, which leaves many women feeling like they’re left holding the bag when it comes to family planning. In a 2015 United Nations report on world contraceptive use, the dominant methods for married or in-union women were the pill and other female-centric contraceptives. Only eight per cent relied on condoms.
It’s an attitude that is starting to wear on women and men alike, both of whom are ready and willing to adopt an alternate form of contraception. Meanwhile, women have had the birth control pill since 1960 (as well as the diaphragm, IUD and others) and men are still relegated to condoms, a vasectomy or the pull-out method.
What’s going on in the world of male contraceptives?
“When we talk about male birth control, and specifically a hormonal oral contraceptive analogous to the female pill, the major hurdle has been the development of oral androgens that can be dosed once a day,” says Dr. Stephanie Page, chief of endocrinology at the University of Washington School of Medicine.
“But in the last few years some headway has been made in that problem. A feasible and safe male hormonal contraceptive is likely less than 10 years away.”
Women don’t want to bear the burden of birth control
For some women, this can’t come soon enough.
“Often the responsibility of birth control comes down to the woman and the pressure to get on the pill or get an implant like an IUD is strong,” says Charla Caponi, a college instructor in Italy. “I think, subconsciously, I refuse to go on the pill or get an IUD just because I don’t want the responsibility to be completely on me.”
As a result, Caponi and her husband have always used condoms (except for the times they tried for children, which resulted in two daughters). She says it’s not ideal, although it hasn’t hindered them from having a healthy sex life.
Her feelings of pressure to bear the responsibility of family planning aren’t unique. A study conducted by the Public Health Service of Amsterdam in 2014 found that condoms were used in only 14 per cent of steady relationships among couples with a median age of 25.
“We found that when partners are more familiar with each other and when they are more alike, inconsistent condom use becomes more prevalent,” study lead Amy Matser said to Reuters.
But what if men had other contraceptive options aside from condoms? It’s a question whose answer has been more than 50 years in the making.
A brief history of male birth control
In the 1950s, Swiss physician Dr. Marthe Voegeli discovered, through observing steam workers who had difficulty procreating, that temporary infertility could be induced in men by having them sit in hot water (116 degrees F, approximately 46 degrees C) for 45 minutes a day for three weeks. This killed their sperm production for at least six months.
That same decade, WIN 18,446, a non-hormonal pill, was tested on prisoners at the Oregon State Penitentiary (back when it was still legal to do that). It proved very effective in decreasing sperm output, but when prisoners got their hands on a bottle of contraband booze, they got very sick. As it turns out, WIN is in the same class of compounds as drugs that are used to treat alcoholism by inducing vomiting. (It is currently being tweaked to attempt to retain its contraceptive abilities without making users sick if they mix it with alcohol.)
Later, doctors discovered that suspensories (or jockstraps) were effective in lowering sperm count because they kept the testicles very close to the body. This has the effect of warming them enough to stop sperm production (much like Voegeli’s experiment) and mimics cryptochidism (or undescended testicles). The only problem is the suspensories would need to be worn for 16 hours a day, presenting an obvious scenario of discomfort.
Most recently, a study of a male birth control injection was halted last year when participants complained of adverse side effects. The injection, which was a mix of progestogen and androgen, was administered to suppress sperm count and was found to have a 96 per cent success rate. However, the study was cut short when 20 participants dropped out complaining of side effects including depression, mood disorders, pain at injection site, muscle pain, increased libido and acne.
“Some depressive symptoms were concerning,” Page says, including suicidal tendencies. “But the cause hasn’t been identified. The low level of circulating androgens could have contributed to that, but we don’t know.”
Basically, an alternative male birth control method has been in development (in some form or another) since the mid-20th century, but the fact that we still don’t have something concrete to offer men is a result of a couple of factors: pharmaceutical companies’ reluctance to pour money into research and the perceived disinterest from men.
Are men really interested?
For Caponi, the latter certainly seems true. She says that Italian attitudes toward male contraceptives is somewhat archaic compared to Canada (her birthplace), and her husband would never entertain the idea of a vasectomy the way some of her friends’ partners have in Canada and the U.S.
“Men aren’t willing to take on that role yet, at least not in Italy. I highly doubt they would be open to male birth control or a vasectomy,” she says. “I don’t know anyone here who has had [a vasectomy], or if they have, they are very private about it.”
But experts in the field say otherwise.
“One article in the journal Human Reproduction asked specifically if men would be willing to take a birth control pill and half indicated that they would be interested,” says Aaron Hamlin, executive director of the Male Contraceptive Initiative, a non-profit organization in Washington, D.C.
So, the fact that one hasn’t been developed yet isn’t necessarily a reflection of male attitudes.
“Cultures are changing,” Page says. “There are some exceptions in certain countries, but almost universally men are interested. We’ve done lots of studies and the men all ask the same question: when will we have this?”
Some argue, however, that big pharma is reluctant to cut into the $10 billion market for female contraceptives worldwide and the $3.2 billion of annual condom sales.
“The fact that the big companies are run by white, middle-aged males who have the same feeling — that they would never do it — plays a major role,” Dr. Herjan Coelingh Bennink, a gynecology professor and former head of research and development in women’s health for Organon International, said to Bloomberg. “If those companies were run by women, it would be totally different.”
How feasible is a contraceptive for men?
That’s where organizations like Hamlin’s come in. Recently, they awarded a $500,000 research grant to Vibliome Therapeutics, Inc., for the development of a non-hormonal birth control pill for men.
“There’s a problem with funding for male contraception in the U.S. because there are so many issues with trials and toxicology and making sure the drug is bioavailable. These issues all cost so much money to researchers,” Hamlin says. “We act as a resource linking them with other agencies and organizations that can provide direct funding.”
The Vibliome grant will go towards developing a drug that will inhibit the production of homeodomain-interacting protein kinase 4 (HIPK4), a protein that’s essential for male fertility. It’s being developed by researchers at Stanford University but is still in its infancy. So far, they’ve deduced that mice lacking the HIPK4 gene have impaired spermiogenesis, but human trials are still a ways away.
In the meantime, researchers going down the hormonal path have been struggling with finding the right cocktail.
“When we think about women, we’re blocking one egg per month, but men make 1,000 sperm per second and have millions of sperm in every ejaculation,” Page says. “There’s a numbers game in terms of physiology.”
Then there’s the fact that safety regulations have significantly increased since the pill was introduced in 1960. As Page points out, female contraceptive methods have improved over the years and have decreased their side effects, as a result, the safety bar has been raised. And since a contraceptive method for men doesn’t have a direct health effect on them the way it does on women (i.e. pregnancy), there’s room and time to perseverate on a drug or technique.
“The physiological challenges have been overcome with science, but the regulatory issues are still there,” she says.
What’s in the works
At present, the most promising contraceptives come from India and Indonesia. Coming out of the former, Vasalgel, is a reversible inhibition of sperm under guidance (RISUG) technique that involves injecting a gel into the vas deferens (the tube sperm swim through). The gel carries a positive charge that damages the heads and tails of sperm, rendering them infertile. To reverse the process, the man would receive a second shot to break down the gel. It is, in effect, a reversible vasectomy. And yes, it does involve taking an injection in the scrotum.
“I think there is concern in the field of reversibility in humans,” Page says about the method. “Whether it can be done cost-effectively is another question. It’s hard to get a needle into a small space so reliably, so there are some technical challenges that could arise.”
Gendarussa, an herbal contraceptive that’s derived from a shrub native to Indonesia, has gone through three trials so far with promising results. In the last trial, 350 couples participated and it proved to have a 99.96 per cent success rate. In March, scientists from Airlangga University in East Java, where the pill is being developed, secured a private partner to begin mass production. But a final year-long clinical trial and approval from Indonesia’s Food and Drug Administration is needed before the pill can be made available.
Other methods include an anti-Eppin drug that will either be ingested or injected — it works by binding to the protein on the surface of sperm and stopping it from swimming. And the so-called Clean Sheets Pill that relaxes the muscles in the vas deferens thus preventing ejaculation.
It’s worth noting that the most promising methods are non-hormonal, indicating that either researchers are reluctant to delve into the intricacies of male hormones or it’s simply unappealing to men.
“When researchers were looking at how they could make a male contraceptive, they looked to birth control as a guiding post, but that’s proven challenging,” Hamlin says. “It’s not terribly difficult to fool the female body into thinking it’s pregnant; in men, there’s no normal off switch, so it takes more hormones and there are issues with side effects. It’s unfortunate that we spent all this time taking that route, but we don’t have to do that anymore. We can move forward in a way that’s more intelligent while recognizing that this space was not used as efficiently until now.”