Male contraception: Where are we at?
Whether it’s the pill, injection, coil or rod, the ways to prevent pregnancy are endless for women so, why isn’t there the same for men? Alice Wade explores the trials and tribulations of male contraception research and where we are currently at with it.
Credit: Reproductive Health Supplies Coalition, Unspalsh.
I remember the first time I visited the doctor for contraceptive reasons. I was 16 and had recently had sex for the first time with my boyfriend at the time.
Wandering in, I was deliciously naive, my trust soft and supple like the pillowy smell of a newborn baby’s head (one which I was trying to prevent).
Of course I’d barely done any research. Of course I trusted whatever my male doctor told me. “I’m prescribing the mini pill,” he said the moment I uttered the word ‘contraception’.
Like many women, the pill did not gel with me and after two years struggling with my mental health, I went looking for alternative before eventually landing on the coil, bullying my doctor to give me one, and the sitting through what I can only describe as the most excruciating 20 minutes of my life as it was savagely slotted into my cervix. Lush!
And I’m not alone in my poor experience with the pill. A recent study showed that 77% of women experience side effects while on it and 36% of those say they felt it triggered their anxiety. Libido was another reported side effect, with 21% of women saying they had seen a dramatic change in their sexual desire. The list goes on.
At no point did I think to suggest to my then boyfriend, “I’ve been on this depression-inducing mania pill for two years now, perhaps it’s your turn to try the pill?”
And not because he was an especially controlling or selfish person but because there wasn’t an option to do so.
But that’s all about to change… Well, maybe.
Over the years, there’s been an abundance of research looking at the options for hormonal male contraception. Some passed with flying colours but failed for their ‘too severe side effects’ while some have passed as both effective and side effect free. The latter are currently undertaking further stages of study.
It’s worth pointing out that it can take on average 10-15 years for a new drug to enter the market.
Any new contraceptives must pass through three stages of clinical trials before the drugs are approved and licensed, meaning that even the most promising could take a decade before they eventually make their way onto the market.
Though researchers are optimistic about a future where contraception can be divided equally among the sexes of the sexually active, the NHS says we are still ‘several years’ from this becoming a reality.
What are the male birth control options?
Since pretty much forever, contraception has been a woman’s responsibility.
As of now, the only options available to men whose partners don’t have contraception, is using condoms or getting a vasectomy, which aren’t very popular since they’re not always reversible and usually have to be done privately.
Why isn’t there a male contraception pill yet?
In 2000, it was reported that the trials for a male contraceptive pill had been a “100% success”. The drug, which was called 11-beta-MNDTC, worked by blocking the hormones involved in sperm production and it did so to an incredible degree of accuracy.
Despite its success in preventing pregnancy, it never made it to a second trial because the side effects reported by male participants were deemed too extreme for the research to continue.
Does acne, weight gain, depression and anxiety, sound familiar? Yep, these were all side effects of the 11-beta-MNDTC and though these are commonly listed among side effects on female contraceptive pills, it rendered the trial for the male pill a complete flop (heaven forbid a man endure suffering for the sake of preventing pregnancy).
Another form of male contraception that failed was the injectable NES/T, which used synthetic progesterone to halt sperm production, and synthetic testosterone to counter unwanted effects
It was the latter element of NES/T that resulted in its downfall. Though it worked to prevent pregnancy – only four out of 214 couples fell pregnant – it failed to progress to the next stage due to reported side effects including headaches, fatigue, and change in sex drive (again, is any of this sounding familiar?).
Ongoing trials for male contraception
There are some male contraceptives that have made it through the first trial - since 2019, trials have been ongoing for NES/T gel, a male contraceptive that is rubbed onto the chest and shoulders.
Its gel formula contains synthetic forms of progesterone (nestorone) and testosterone which “switches off” sperm production in the testicles while also lowering levels of natural testosterone.
The gel is used topically, designed to be rubbed into the shoulders and chest every day so it can be absorbed quickly into the bloodstream through the skin.
In its first trial, the gel was 90-95% effective and had few side effects bar a kilo or two of weight gain in some men. It’s thought that – much like condoms – if the medication is used properly, it would be as effective as female contraceptives like the pill, which is 99% effective with perfect use.
NES/T has a more positive story than its side-effect-ridden predecessors. The first clinical trial was recently finished and the results were promising. If it makes it to the next stage, it might not be too long before we’re replacing massage oils with a sensual NES/T rub down.
Others are still in their first clinical trial. At the end of last year, a group of British men were set to trial YCT-529, a hormone-free type of retinoic acid receptor-alpha (RAR-alpha) inhibitor that stops vitamin A production which is needed for sperm production.
We can aim to see whether it passed the first stage of clinical trials by the end of summer next 2025 so there is hope yet for a male pill.
Would men actually use the pill?
While it felt normal for my mum to march her sexually active 16-year-old daughter into the doctors to get her on the pill, far more eyebrows are raised at the prospect of the roles being reversed.
According to a 2021 study published in the Journal of Sex Research, the amount of men willing to try male contraceptives ranges between 34% to 82.3%.
It’s clear from previous trials that side effects play a big factor in deciding whether to move forward with male contraception.
Toni, 21, from Albania, admits he could be swayed if symptoms associated with the pill were unpleasant. “As a young man, I would be interested in using the male contraceptive pill, if that specific type is deemed safe to use and there weren’t any side effects.”
Barney, 21, from London, is also interested in taking his share of the pregnancy prevention but is cautious. “I would be happy to try male contraception, as long as it’s nothing permanent. If women do it I see no reason why I wouldn't try.”
The caveat of safe and non-permanent contraception is certainly a fair one. The lack of definitive research puts some off completely.
Zade, 28 from Cardiff says, “I don’t really trust random new drugs they bring out. I’d rather just wear a condom.”
But while most decades of men have been happy to sow their wild oats with a breathy “are you in the pill?” just before an impassioned and carefree sexual encounter, it’s not clear that women would be so easily convinced by this.
A recent survey showed that 42% of women wouldn’t feel comfortable with their male sexual partners taking the pill because they would be too worried they would forget to take it.
So maybe they won’t be jumping with quite as much joy as researchers expect…
While women are carrying the load (sorry) when it comes to contraception at the moment, hope is on the horizon. We might not need to cling so dearly onto our coil strings or have to remember to take the pill on a night out. Before long, we might be the ones calling the shots, dicking around, and breathlessly demanding, “why aren’t you on the pill?!”