Why Don't We Have Birth Control For Men?

Patches and implants deliver small doses of hormones that similarly suppress the ovulation process. Intrauterine devices, or IUDs, release either copper ions or a localized hormone in the uterus. The hormone works similarly to the pill and thickens the mucus to prevent ovulation. The copper ion IUD changes the fluids in the fallopian tube and uterus, making them inhospitable to sperm. Sperm entering these parts of the body won’t be viable and can’t fertilize an egg.

Besides always wearing a condom, men do have the option of a permanent form of birth control - a vasectomy. In this form of sterilization, surgeons make a small incision in each testicle and cut or seal off the vas deferens, the tiny tubes that carry sperm to the urethra and out of the body. The surgery blocks sperm from reaching the semen. Sometimes, this procedure can be reversed, but most of the time, it is permanent. 

Needless to say, because of its permanence, this could be an uncomfortable choice for many men. Therefore, it is most often the woman's responsibility to prevent pregnancy.

Male contraceptives? 

Biologists have been working for years on a reversible, long-term birth control method for men that doesn't involve a scalpel going anywhere near their testicles. The research is slow-moving because there are so many important factors that must go into it: Ideally, it needs to be effective, affordable, easy to use, reversible after stopping use, and not full of pesky side effects (such as weight gain, problems with sex drive, acne, etc). 

There are several ways in which a male birth control option may work. Researchers have proposed approaches that keep the body from producing sperm, prevent sperm from leaving the body, prevent sperm from fertilizing the eggs, or slow sperm down dramatically. Researchers have found injectable hormone-based drugs are the most effective, but for obvious reasons, they are not an ideal solution – so the search continues.

Progress on an oral contraceptive has also been stymied because available oral forms of testosterone may cause liver inflammation, and they clear the body too quickly for once-daily dosing, thus requiring two doses a day. 

Where we are now

Currently, there are a couple of different versions of male contraceptives in various stages of development. In 2019, a drug called Dimethandrolone undecanoate (DMAU) passed clinical trials and became one of the most promising options. It uses hormones to suppress the testicle's ability to produce sperm as well as the development of testosterone. SImilarly to the pill for women, it combines the activity of an androgen (male hormone) like testosterone, and progestin, and is taken once a day. The two hormones work together to reduce the chance of serious side effects. However, it is unknown whether it actually reduced the sperm count among the participants.

Another promising product was announced in 2020. UC Davis Health in Sacramento, California asked for participants to join phase two of clinical studies for a gel-based form of male contraception. A small amount of the gel is placed on the shoulder every day. It reduces sperm count and decreases the production of testosterone using a synthetic progestin called segesterone acetate. To prevent side effects from a decrease in testosterone, it also contains synthetic testosterone.

It is expected to take between four and six months for the gel to lower the male's sperm count to pregnancy-prevention levels. "At that point, the couple will use the study contraceptive gel as their only form of birth control for 12 months. The man will have monthly checkups over the course of the trial, with sperm count testing and testosterone monitored at each visit," the press release read. 

Additionally, it is expected to take about four months for the sperm count to go back to normal after stopping use. "After 12 months, the man will stop using the study contraceptive gel and will continue to be followed until his sperm count returns to the normal range."

“We’re excited to be one of the new sites studying male contraception. We have been widely involved in developing new female birth control methods at UC Davis and know, from our patients, that a male method is highly desired by both men and women,” remarked Mitchell Creinin, the director of family planning and the lead study investigator at UC Davis Health.

“The study allows us to follow each man’s testosterone levels closely to make sure he is getting enough testosterone, and we can even give him more to make sure his energy level won’t change. We can all feel excited to be closer to having a male method other than condoms and vasectomies.”

There's also a shot made of polymer that is injected into the vas deferens and blocks sperm from being able to exit the penis. It may not sound like much fun, but it's pretty similar to having a vasectomy but reversible with another shot to break the polymer down. Called vasalgel (and there's an Indian equivalent called RISUG), it is non-hormonal and research has shown it could dependably be reversed in rabbits.

What's the holdup? 

There are all these interesting products, but none that are widely used and available globally. You'd think something would be on the market, but that's not our reality just yet... so why do we not have male contraceptives? As it turns out, the answer is pretty simple. 

It's just more difficult to develop a reversible form of birth control for men that has minimal side effects. And there's no male analog to women's options which trick the body into thinking they are pregnant, thus stopping ovulation so that pregnancy can not occur.

Some biologists predict we are still ten years away from a reliable form of birth control for men. Hopefully, that estimate is wrong and something comes on the market soon.