Male Birth Control Is Starting to Feel Like a Pipe Dream
Editor's note: We at POPSUGAR recognize that people of many genders and identities may have penises or produce sperm. For this particular story, experts and studies we relied on generally referred to people with penises as men.
I've been on birth control since I was 16 years old. At the time, I'd been dating my high school boyfriend for about a year, and after catching us in a sexual act on the living-room couch, my mom decided it was probably time for a visit to the doctor's office.
As I sat in the cold, beige exam room, I listened to the nurse practitioner read off an extensive list of birth-control options, some of which seemed downright terrifying (looking at you, IUD). The pill felt the least invasive and I was already a morning person, so I figured I'd just add it to my daily routine.
Fast forward 11 years: I'm married to that high school boyfriend, and I'm still on the exact same pill.
Between the fluctuating libido and unexpected mood swings, it hasn't been easy shouldering the primary responsibility of birth control. Yes, we could have used condoms for protection instead, but those are only 98 percent effective when used correctly — and who wants to take those chances, especially post-Roe?
So, headlines that tease a male birth-control option have always caught my eye — and I've seen many of them since I took my first birth-control pill. But in all that time, nothing has ever hit the market. It's always "10 years away" — leaving men with two options: condoms or vasectomies (which often can be reversed but are intended as permanent sterilization).
Neither option seems ideal to Logan Nickels, PhD, the research director for the Male Contraceptive Initiative (or MCI, a nonprofit focused on the funding and advocacy of nonhormonal male birth-control methods). Even so, he decided to have a vasectomy about eight months ago, shortly before his wife gave birth to their second son. "My wife and I felt our family was complete," he tells POPSUGAR. And after the overturn of Roe, Dr. Nickels says the decision to have a vasectomy felt even more crucial. "I've not been able to contribute to our family-planning goals in the way that I would have [with male birth control]," Dr. Nickels says. "So I took the option that made the most sense for us as a family, because there are no reversible options on the market [for men]."
But why aren't there, exactly? And what will it take to make birth-control options for men a reality? Here's what experts want you to know.
When will male birth control be available?
It's coming, just not as soon as you'd hope.
"You're not going to see it in five years. You won't see it in 10 years. You may see it in 20 years," says Diana Blithe, PhD, the chief of the contraceptive development program at the National Institute of Child Health and Human Development (NICHD), which is part of the National Institutes of Health (NIH). Blithe admits the reality of the timeline can feel "depressing" but says there's been encouraging progress recently.
For example, the NIH is currently funding the research for a once-a-day contraceptive gel that would be applied to the shoulder and is designed to block the signals sent from the brain to the testicles that tell them to make sperm. (In other words, the gel reduces sperm count; it doesn't stop ejaculation, though.) This gel, a combination of the progesterone drug Nestorone® and testosterone, is the first sperm-targeted birth control to progress past the initial steps in the clinical trial process. It's currently in Phase IIb for safety and efficacy evaluation. To put things in perspective, "no product has made it to Phase III," says Dr. Blithe.
Other birth-control options are further behind in the development process but still promising. Dr. Nickels says he's most excited about Adam, a nonhormonal injectable hydrogel designed to block sperm traveling from the testicles. "You can think of it as an IUD for men," he says. Adam is currently in early clinical trials.
Why does the development process take so long?
After talking to experts, it seems that the biggest hurdles fall within these four primary categories: safety and efficacy, funding, regulation, and stigma.
When it comes to safety and efficacy, we're talking about the basics: does the product do what it's meant to do, and can it do its job safely and consistently with little side effects? "We want to keep men virile and interested in sex, and so we can't affect their libido or their sexual activity," says Paula Cohen, PhD, a professor and associate vice provost for life sciences at Cornell University, who is currently leading research that aims to alter cells in the body before they even become sperm.
"The reality is, healthy people are going to use this product for a long time. So it has to have virtually no real side effects or safety issues," says Dr. Blithe. This "takes a long time and a lot of people to prove." When it comes to male birth control, not only do scientists have to prove efficacy and reliability, but reversibility as well.
The funding and regulatory hurdles tend to go hand in hand, says Stephanie Page, MD, PhD, a professor and endocrinologist at the University of Washington School of Medicine and the lead investigator at the Seattle site for the NICHD-funded male contraceptive gel. As a product progresses through trial and study phases and gets closer toward federal regulation, so does the necessary research intensity. And more intense research equates to more funding.
For example, when the contraceptive gel Dr. Page is working on is ready to move to a Phase III study, "we'll need to involve probably a few thousand couples. Right now, the current study has 450 couples in it," she explains. "A trial like that costs a lot of money. And the way that drug development is structured in this country, that money would have to come from a pharmaceutical company or an investor of some sort. It's unlikely to be fully supported by NIH or nonprofits."
The downside? Investors tend to be cautious when dealing with a product that has no prior regulatory roadmap. Nothing like this has ever made it far enough to hit the Food and Drug Administration's (FDA) desk, so there is no clearly defined process ahead. "And without that guidance, it becomes pretty risky for companies to invest, because they can't really predict what the likelihood is that the product will get to the market," says Dr. Page.
Then, there's the stigma. "There's this idea that men wouldn't use it and that somehow their masculinity is tied to their sperm count or something," says Dr. Page. "And that women wouldn't trust their partners [to take it]." But in reality, roughly nine in 10 men (87 percent) who are dissatisfied with condoms are very or somewhat interested in potential new methods, according to MCI research. What's more, one study showed that very few women (only two percent surveyed) said they wouldn't trust their partner to use a hormonal male contraceptive.
Still, stigma works like a game of telephone. Once a narrative is spread, it becomes virtually impossible to reel it back in.
Were the current oral contraceptives so slow to develop?
If it feels as though researchers and medical experts are being more cautious with these new birth-control options than they've been with the options that are currently on the market, you're not wrong. After all, the same side effects (e.g. low libido, depression, mood changes) that experts are so focused on avoiding with the birth-control drugs designed for those assigned male at birth have burdened many people who already take oral contraceptives for decades — and all too often, doctors and medical professionals have dismissed reports of these symptoms.
In addition, the regulatory processes for passing the first oral contraceptive were very different than what we're seeing with these new medications. The pill that was first approved in 1960 was initially tested on psychiatric patients at Worcester State Hospital in Massachusetts, according to PBS — and then it was tested on women coerced from poor communities in Puerto Rico, per Bese.
"It's a comment on both the, if not sexist, absolutely 10,000 percent gendered history behind contraceptive development," says Dr. Nickels. "It's also a commentary on the changing regulatory standards of the FDA and how maybe the pill wouldn't be approved today."
That's another reason experts are taking their time to develop sperm-targeted birth control. They know that they have to do better. "It's not fair that we didn't have this [thought process] for women," says Dr. Cohen. This time, she says, "we have to do it right."
What would male birth control look like in a post-Roe world?
It's still hard to tell, says Dr. Page. While birth control remains legal in the United States, there are several states that have given doctors and pharmacists the green light to refuse to prescribe or dispense contraception. The same freedoms may be applied to sperm-targeted birth control when it's out.
"The way the dynamics in this country are right now, I wouldn't be surprised if it wasn't covered [by insurance]," says Dr. Page. "But by the time we get there, hopefully, that will have changed." The goal is to make this "something that can be used globally. So as far as we're concerned, every effort will be made to make the costs as low as possible," she adds.
While there are still so many unknowns regarding the development of male contraception, Dr. Nickels is sure about one thing: "Male contraception has the opportunity to create better dudes. I think that men, by and large, are not aware of their partner's costs when it comes to reproductive health." By creating new contraceptive options for men, Dr. Nickels is hopeful that it will give them the tools and language they need in order to thoughtfully have those conversations, so that next time couples are discussing their reproductive intentions, there will be less of a misogynistic lens through which responsibility is viewed.
Once reproduction can no longer be pigeonholed into being a "women's issue," we start to poke holes in some of the logic that was applied in order to overturn Roe, and it also begins to "crack the armor around other gender-based barriers or divides," Dr. Nickels says.
And wouldn't that be nice? Too bad we'll have to wait another 20-plus years before it happens.