Male birth control research is starting to make progress : Shots

Illustration of a decrease in sperm count.
Illustration of a decrease in sperm count.

Condoms have been used to prevent pregnancy since the Middle Ages, with rubber versions coming into the industry in the mid-1800s. Over the years, they have become more effective and comfortable to use.

But it was the invention of the birth control pill, followed by the IUD in the 1960s, that created a seismic shift in man’s ability to control reproduction. A wide range of pills, patches and implants are available for women. However, the elastic sheath that covers the penis remains the only medically approved form of contraception for men, short of a vasectomy.

But now, researchers are looking into hormonal and non-hormonal contraceptives for men with sperm. The hope is that couples will begin to consider contraception more as a shared responsibility.

“We want to create a menu of options for men that are the same as women that are available,” said Stephanie Page, a researcher and endocrinologist at the University of Washington.

(Note: The studies cited here were mostly conducted on cisgender men between 18 and 50, so this story refers to the drug as “male contraception,” and the target demographic as “men,” or “boys” although people of other genders can. produce sperm.)

Hormonal methods get new research

Laboratory Dr. Page is conducting clinical trials along with researchers at 15 other sites around the world, testing a topical gel that people apply to their shoulders every day. The gel contains a synthetic hormone – a combination of testosterone and progestin – that signals the brain to lower testosterone levels in the body. And because testosterone is necessary for sperm to mature, the testicles then produce fewer sperm.

Study Dr. Page registered couples – almost 450 people worldwide. Having women participate also means “they take consent as well as her, and they’re really both participants,” Page said.

The trial was conducted in phases. In the first phase, the man uses the gel every day, but the couple still uses other contraceptives during sexual intercourse. During this phase, researchers periodically monitor the man’s sperm count. Then when the count is enough to prevent pregnancy, the couple enters the second phase: they stop using other methods of contraception, while the man continues to use the gel every day.

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In the third and final phase, the man stops using the gel, and the researchers start monitoring the sperm count again. Researchers hope the results will show that the effect on fertility is reversible – just as women can regain fertility when they stop taking birth control pills.

Brian Nguyen, Ob-Gyn and professor at the Keck School of Medicine at the University of Southern California, who also researches male contraception said he was encouraged by what he heard from some people in the gel trial, especially those “who really just want to support their female partner .”

“I’ve heard stories about how men are really upset to hear about their partner having hormonal side effects or in some cases, complications related to the IUD or the implant,” she said. “And they want to do something about it.”

Nguyen’s lab is also working on a hormonal pill similar to the gel, and Page’s lab hopes to develop an injectable hormone solution.

In the 1990s, the World Health Organization encouraged trials for male hormonal contraception – where men are given high doses of testosterone – but the drug never came to market. Researchers thought they were not effective enough to sell, and the side effects were serious, including toxicity to the heart, liver and kidneys, and a potential increased risk of prostate cancer.

The University of Washington’s Stephanie Page said the gels and pills tested so far did not pose the same risk.

“We have worked very hard to develop a method that does not affect other physiological parameters,” said Page, “So we did not see any effect on kidney function, liver function and so on.”

As for side effects, some participants reported weight gain, changes in libido, acne, or mood changes.

Promising non-hormonal approach

Another area of ​​research is targeting precise points in the sperm’s life cycle, including their ability to swim, or fertilize an egg. These drugs are slightly more precise than hormonal ones, said Logan Nickels, director of research at the Men’s Contraception Initiative, which supports researchers working on non-hormonal contraceptives.

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“They target a specific link in the chain of generations or the age of the sperm and … if you break that link, there are no other body functions or broad signals that you are interrupting.” In other words, people who use this method will experience some effects aside, he said.

“The male reproductive system is amazing because there are hundreds and hundreds of links in this chain, [so] if you take one of them, you’re going to be infertile,” Logan said.

Another non-hormonal method undergoing trials in Australia is a gel that is injected into the vas deferens – the tube that carries sperm to the urethra in preparation for ejaculation – and blocks sperm transport. Logan says it could be like a reversible alternative to a vasectomy.

Why did it take so long?

Page estimates it will be another seven to ten years before this new method can be commercialized. So why should women shoulder the responsibility for contraception for so long?

“Women bear a life-threatening burden during pregnancy,” Page said. “And it’s the starting energy to make sure that women can control their own reproduction.”

And, he said, developing male contraception is more complicated. Females usually release eggs every month or two. Men produce millions of sperm every day – one ejaculation contains approximately 15 million to 200 million sperm per milliliter of semen. Researchers need to find out how much it takes to prevent pregnancy. They have now determined that there should be less than 1 million sperm per milliliter of semen, Page said.

And the FDA’s criteria for approving male contraception are unclear.

The pharmaceutical industry and the FDA use data from trials to weigh the benefits and risks for patients. But Dr. Page said in this case, the risk calculation should be different.

“When we think about risk, what are we protecting the man? In the case of female contraception, the woman is protected from the risk of unsafe pregnancy and abortion. But with men, they actually use contraception to protect their partners. If we only think about people as a single unit, there should be no side effects and no risks, he said.

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Another obstacle to bringing male contraception to market is the level of efficacy. Female contraceptive implants and IUDs are 99% effective, and birth control pills are 93% effective, according to Planned Parenthood. Male contraception may have to be good at preventing pregnancy in order to be sold.

“Drug companies invest millions and millions and millions of dollars into drugs before they see even a small profit,” Nickels said. “And when they take calculated risks, calculated investments, they try to make sure they’re going to see money in the end,” he said.

Nickels, Page, and Nguyen all expressed optimism that male contraception will come to market in the next decade, although funding may be a limiting factor.

Logan predicts that injectable non-hormonal gels, or topical hormonal gels will be the first to hit the market.

In order for male contraceptives to be successful in the market, says Brian Nguyen, it is important for men to learn about what women are going through.

“Men are often protected from discussions about menstruation, pregnancy, labor, infertility. There is a feeling of not being able to be disturbed among many people because they do not have to think about the need for contraception. And the only way to heal is by having more and more open conversations with people about reproduction, and responsibility in the process that is not just a woman’s problem.”

Women have been waiting for this mindset change for a long time. But even if it doesn’t happen immediately for most heterosexuals, maybe the freedom to pass the sheath will be motivation enough.

This episode’s audio was produced by Rebecca Ramirez, edited by Gisèle Grayson and fact-checked by Abē Levine. Tre Watson is the audio engineer.

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