Time to Man Up: The Future of Male Birth Control

 

By Elizabeth Akincilar-Rummer

 

MEN!!! Are you ready?? Birth Control for men is here….almost.

 

Contraception. For some of us, that word has been a saving grace in preventing unwanted pregnancies and diseases. For others, it is fraught with moral and ethical dilemmas. But, those who are the most concerned with and often the most involved with contraception, are women. Let’s be real, women, versus men, take the brunt of birth control. And, maybe we should, since we are the ones who would have to endure 40 weeks of pregnancy and the birth of a child. Maybe the responsibility should be primarily on our shoulders. But, what about everything that occurs after the birth of a child? That lifelong responsibility of a child parents accept when they decide to conceive is on both parents, right? So, why wouldn’t the responsibility of birth control be for both the man and the woman? Good question. I think it should. I think we should have a choice. I think a couple should be able to decide, together, who should take on the responsibility of birth control.

 

Before you get your panties in a bunch, I know what some of you are going to say. You’re thinking, we already have a choice. Men can use a condom, they can use the withdrawal method, or they can undergo a sterilization procedure. Uh huh. Right. As if those are great choices. Let’s look at each option. Studies show that if you use the withdrawal method perfectly, 4 women out of 100 will get pregnant. If it’s done incorrectly, 27 out of 100 women will get pregnant. And, by the way, the withdrawal method is extremely difficult to do correctly if the man doesn’t have excellent self-control, men who ejaculate prematurely, and for men without a significant amount of experience. Condoms are 98% effective when used perfectly. Studies have shown that up to 40% of men use condoms incorrectly. And, sterilization isn’t an option for most couples since many of them will actually want to eventually get pregnant, and sterilization is not easily reversible. Where does that leave us? Not with a good choice, that’s where.

 

First, let’s just look at some numbers. How popular is birth control? Who uses it? I’ll tell you. Many, many, many women.

  • 99% of  sexually active women from 2006 to 2010 in the US used at least one form of contraception1
  • 12 million women take oral birth control pills each year in the US2
  • 89% of at-risk Catholic women, 90% of at-risk Protestant women, 83% of black women, 91% hispanic and white women, and 90% of asian women in the US use contraception3,4

 

What are the available birth control options available for women?

  • Hormonal methods, such as the pill, patch, injectables, hormonal IUD, and the vaginal ring
  • Non-hormonal IUD
  • Read Jandra Mueller’s two-part blog post for the full story on IUDs: part 1 and part 2

 

What the possible side-effects for hormonal methods of birth control?

  • Intermenstrual spotting, nausea, breast tenderness, headaches, weight gain, mood changes, decreased libido, vaginal discharge
  • In some women, dyspareunia and pelvic pain
    • Read Dr. Gonzalez’s two-part blog post about the birth control pill, hormones, and pelvic pain: part 1 and part 2
  • Associated with increased blood pressure, benign liver tumors, and a slight increased chance of developing cervical cancer
  • Increased risk of heart attacks, stroke and blood clots, which can be fatal

 

Are there hormonal birth control methods available for men? No.

 

Is it possible? Yes.

 

Let’s look at the history behind this curious absence in modern medicine.

 

Over the last century, many contraceptives have been introduced for women, yet not even one has been commercially introduced for men. Medicine has recognized the need for reversible and reliable birth control for men. It is agreed that a reversible hormonal method that suppresses sperm is the most practical implementation. Although reversible hormonal suppression of spermatogenesis (making sperm) was realized in the 1930’s, the first hormonal studies were only undertaken in the 1970’s. However, these feasibility studies were only further explored in the 1990’s. The studies in the 1990’s showed very effective and reversible sperm suppression, superior to condoms, and comparable to female contraception, with weekly testosterone injections.

 

In the last four decades, many studies have shown that hormonal suppression of spermatogenesis can prevent pregnancies, but development of commercially available products have stalled. Some of the early studies used supraphysiological doses of testosterone which had potential long-term adverse effects in healthy men. However, later studies found that the testosterone dose can be lowered by co-administering progesterone, essentially. However, there were only two studies that examined that method of administration.

 

The first study published in 2011 looked at administering progesterone and testosterone via an implant. It prevented 100% of pregnancies and was easily reversible. They did not report any serious adverse effects, but did report a high discontinuation rate among the participating men. This product was only a prototype and was not commercially available; therefore, it would require a significant amount of industrial research and development. They concluded that this study showed that male hormonal contraceptive products are considered medically and scientifically feasible.

 

The second study also published in 2011 also looked at administering progesterone and testosterone via an implant. They showed that 80% of the men in the study had a sperm count below the threshold of criterion for contraception. It also reported a high discontinuation rate among the participating men. They concluded that this study justified additional studies.

 

That brings us to the most recent study published in The Journal of Clinical Endocrinology and Metabolism in October 2016. The World Health Organization commissioned a trial that utilized a two hormone intramuscular injection to lower sperm count. The study included 10 study centers, worldwide, with 320 participants, but 100 continued users. They performed two intramuscular injections every eight weeks for up to four injection visits. The initial findings suggested a 96% effective rate with near complete suppression of spermatogenesis. They also showed that most of the participants returned to full fertility on an average of 26 weeks after discontinuing the injections. However, the Stage II Trial was interrupted due to reported side effects. The side effects reported were acne, injection site pain, increased libido, and mood disorders. The incidence of mild to moderate mood disorders was relatively high, but mostly in one of the study centers. Two independent safety committees evaluated the side effects and although they came to different conclusions, the study was terminated early. Since there was a difference in opinions from the two safety committees, the authors of this study feel that there is no definitive answer as to whether the potential risks outweigh the positive benefits in this study. The study also noted that while there is a risk for the men involved, albeit small, it is not a fatal risk, like that women risk by taking the birth control pill because of blood clots. It is important to note that for those that  completed the first phase of the trial, more than 75% of the participants reported being satisfied and would be willing to use the product if it was available.

 

I wonder why one of the safety committees found the side effects so alarming that they had to terminate the study when hormonal birth control drugs for women cause similar and even more dangerous side effects, yet MILLIONS of women take the birth control pill every day. If we really want to compare dollars to donuts, one of the primary reasons this study was terminated was the adverse effect of mood disorders. I wonder if that safety committee is aware of this recent study published in JAMA psychiatry that reported 30% of women taking the birth control pill stopped taking it because of dissatisfaction secondary to side effects. They found that hormonal birth control was linked to a subsequent depression diagnosis and use of antidepressants. They also found a 40% increased risk of depression after six months of birth control pill use.

 

A few questions come to mind. Maybe safety committees have become more cautious compared to the time when many of the female hormonal drugs were being tested?  Why aren’t there more studies examining male hormonal contraceptives? Why are the subject drop out rates so high in all of these studies? Why hasn’t there been any interest in commercially developing a product? Is it because the market research shows that men aren’t actually interested in such a product? Is there such a significant gender bias regarding birth control in our culture that there isn’t motivation to develop this product?
It seems that male hormonal contraception should already be a reality, but surprisingly, it’s not. I think a lot of women are more than ready to share the burden of contraception. The real question is, men, are you ready?

 

 

References:

 

  1. Daniels K, Mosher WD and Jones J, Contraceptive methods women have ever used: United States, 1982–2010, National Health Statistics Reports, 2013, No. 62
  2. WebMD, Comparing birth control pill types, accessed 26 February 2015.
  3. Jones J, Mosher WD and Daniels K, Current contraceptive use in the United States, 2006–2010, and changes in patterns of use since 1995, National Health Statistics Reports, 2012, No. 60
  4. Jones RK and Dreweke J, Countering Conventional Wisdom: New Evidence on Religion and Contraceptive Use, New York: Guttmacher Institute, 2011.
About the Author

Elizabeth Akincilar-Rummer

Elizabeth received her master’s in physical therapy at the University of Miami Medical School. Liz is a Pennsylvania native, but spent most of her professional career in San Francisco. Leading PHRC’s recent expansion to the Boston area, she is happy to be back on the east coast. Liz loves to read, garden, and is an adventurous traveler.



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