Male contraceptive options

Despite male contraceptives being studied since the 1970s, as it stands, there are no commercial hormonal male contraceptives and unfortunately it seems this will be the same for years to come. But why is this the case?

It’s not news that both socially and culturally, women are seen to have more responsibility when it comes to contraception. The fact that there are a plethora of contraceptives available to women compared to two male options solidifies this idea. Due to this disproportion, it is unsurprising that research finds women to be responsible for the planning and execution of contraception the majority of the time. Plus, even when taking into account shared methods such as condoms, women still remain disproportionately involved in managing their use.

However, this is not necessarily due to male unwillingness and most men are open to using contraception. A survey reported 55% of men actually want to try hormonal contraceptives. 

Here is the lowdown on everything you need to know about the future of male contraception.

Current male birth control

Vasectomy

A vasectomy is a simple surgical procedure which is done under local anaesthetic, usually at a GP practice or sexual health service, and can be done privately. It usually takes less than 15 minutes and is 99% effective.

It blocks or cuts a man’s sperm duct (vas deferens), to prevent sperm mixing with semen and leaving the body. It does not affect sexual function or ability to ejaculate.

Male condom

The male condom, a rubber sheath used to cover the penis during intercourse, is probably one of the oldest forms of contraception. It can be up to 98% effective depending on how well it is used. It also protects against sexually transmitted infections.

The challenges of researching a better male contraceptive

There is an ethical issue for researchers in the field of male contraception. Pregnancy is one of the most risky things a woman will do in her life, and therefore the risks of using contraception are almost  always better than the risks associated with pregnancy. For example there is a small increased risk of blood clots on the combined pill, but when weighed with the potential risk of blood clots in pregnancy, we consider this as an acceptable risk.

This isn’t the case for men, as they are taking a contraceptive with potential risks or side effects to prevent risk of harm to another person i.e. preventing pregnancy in their partner. 

Another issue is that women only ovulate on average 12 times per year and so stopping this is easier than preventing sperm production that occurs with each ejaculation. Men can produce pretty much unlimited sperm throughout the year.

Hormonal male contraceptives

The most common method used in developing male hormonal contraceptives include using both testosterone and progestogen in order to “switch off” sperm production. This means the body will produce semen without sperm or with too little sperm to cause fertility. These slightly differ from hormonal female contraception which usually takes a week to become effective, as it can take a few months to suppress sperm production. Male hormonal contraception has been developed in a few different forms with varying levels of success, these studies are discussed below.

Male hormonal contraceptive injection

Men are given an injection every 8 weeks to suppress the production of sperm. Hormonal injections have been found to be 98% effective in preventing unwanted pregnancy, which is similar to effectiveness of female hormonal contraceptives. Plus, after a year of stopping the injections, 94% of men had recovery of sperm concentration, showing evidence for its reversibility and three quarters reported they would be happy to continue using the method if it was available.

However, many trials have ended early due to adverse side effects such as acne, mood swings and the development of mood disorders (sound familiar?). It would be interesting to see how many trials for current female contraceptives would be ended early for the same reasons if they were to be trialed now.

Male hormonal contraceptive pill

Similar to female oral contraception, the male pill would have to be taken daily. A 2019 clinical trial found this to effectively reduce sperm, without any severe side effects (only mild reports of fatigue, headaches and acne). However, much more research is needed to detect long term outcomes as this study only observed the effects over 28 days despite the fact it takes at least 60-90 days for optimal sperm suppression. Don’t get too excited about this just yet, the researchers suggest safe, reversible hormonal male contraception should be available in about 10 years.

Male hormonal contraceptive gel

Topical gels which are applied daily to the shoulders and chest have shown promising results as a new male hormonal contraceptive. Trials have passed human safety tests and human clinical trials, the gels were more acceptable for men with 56% satisfaction rates.  Unlike the injection, the gel is metabolised by the body quicker, leading to less adverse side effects.

Non-hormonal male contraceptives

Organisations such as the Male Contraceptive Initiative are working to raise awareness and advance the development of new non-hormonal male contraceptives, which actually, is looking encouraging! Final trialing of the non-hormonal male contraceptive injection is currently underway in India and is also being tested in China, Bangladesh and the USA.

RISUG

Research suggests a non-hormonal male contraception called Smart RISUG (reversible inhibition of sperm under guidance) is promising. RISUG is similar to a vasectomy as it blocks the sperm duct, preventing sperm from mixing with the semen and leaving the body. Instead of cutting the sperm duct, RISUG works by an injection of non-hormonal chemicals partially blocking it and deactivating sperm before they leave the body. RISUG is the best of both worlds; working as a long-term contraceptive, which lasts up to 13 years but can also be dissolved if and when the patient wants.

The method has been found to have high sustained contraceptive efficacy with no significant adverse effects as seen experienced while using hormonal methods. Plus, while hormonal methods can take around 3-4 months to be effective, RISUG can be effective in as little 1!

ADAM (aka the male IUD)

This new long-acting reversible contraceptive, often referred to as the “male IUD,” works by injecting a gel into the vas deferens, which blocks the sperm duct and prevents sperm from entering the semen. The procedure is quick, taking about 20 to 30 minutes, and the gel remains effective for approximately one year before it naturally wears off. It’s currently in human trials in Australia.

Non-hormonal male contraceptive pill

There are 2 different types of non-hormonal male contraceptive pill that are in very early development (one of them still at the lab rat phase). One pill can temporarily immobilse sperm (in mice) so the can’t swim towards an egg for 24 hours. The other works by disrupting a vitamin A pathway in the testes that is crucial for sperm production. Animal studies have yielded positive results, showing that it successfully prevents pregnancy and can be fully reversed once the treatment ends. Research on this method has been ongoing for decades—scientists first discovered the link between blocking vitamin A and stopping sperm production in the 1930s, with the first human trials conducted more than 60 years ago!

Heating up testicles

Yes really. In development are thermal underwear or rings that push the testes higher up so the sperm increase in temperature. Just a couple of extra degrees can stop sperm production. And the 2021 winner of the James Dyson Award, is a device which heats up testicles with ultrasound waves, a so called ultrasound bath, to reversibly stop sperm production. This one hasn’t got to human trials yet.

The future of male contraception

Although it is unclear how long it will be before a new male contraception method will be available commercially, current research is promising. Hopefully in the years to come, this will continue with more rigorous, extended clinical trials to confirm the efficacy and safety of both hormonal and non-hormonal male contraception. Increasing men’s opportunity and contraceptive options will help to balance the responsibility for preventing pregnancy and provide reproductive autonomy for men and women.

The current methods of male contraception are clearly from one extreme to another, with a vasectomy being classed as ‘permanent’ (although it can be reversed in some cases) whereas a new condom needs to be used for every sexual encounter. Researchers have been trying to bridge the gap for some time now with varying success, developing hormonal methods similar to the range of female contraception available. Finding better male contraceptives has been named in the top 10 priorities for contraception research.

If we’ve peaked your interest, check out our podcast episode on male contraception!