Male Contraceptives: Will this finally be the new era in contraception?

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Last research in the field suggests that some effective contraceptive measures designed for men -pills, gels, monthly injections and non-permanent chemical vasectomies- could take their place on the shelves of pharmacies around the world by the end of this year.

Last research in the field suggests that some effective contraceptive measures designed fomen -pills, gels, monthly injections and non-permanent chemical vasectomies- could take their place on the shelves of pharmacies around the world by the end of this year.

The researchers believe that these new drugs will be a milestone for family planning and sexual health, and undoubtedly will be a further step towards gender equality.

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In 1979, Indian researchers first published that they were developing a form of male hormonal contraception: Reversible Inhibition of Sperm Under Guidance (RISUG). More than 40 years later, RISUG is only undergoing phase 3 of clinical trials.

In contrast –a very sharp contrast- the female combined oral contraceptive pill was researched, tested, and mass-produced in less than 4 years; and it has been widely available since 1960.

Today, contraceptive measures for men are limited to condoms and permanent surgical vasectomies.

This could change in 2021 with new techniques that are being tested, some of which have efficacy rates up to 97%.

Currently, there are three potential methods of male contraception that are currently being formally developed: pills, gels and injections.

Gel NES/T

So far, the most prominent method, currently in phase 2 of clinical trials in a research led by Dr. Christina Wang. The gel is composed by segesterone acetate, a synthetic progestin, and it is used every day. It comes in a dispenser that provides a standard amount in each use and is rubbed on the shoulders.

The promising results suggest that it successfully blocks the natural production of testosterone in testicles and reduces sperm production; it also contains testosterone replacement to help maintain sex drive and other functions that depend on the hormone.

Pill and injection

The daily pill and monthly injection methods are developed with an experimental drug called dimethandrolone undecanoate (DMAU), which combines synthetic anabolic steroids (AAS) such as testosterone, with progestin. Stephanie Page, from Washington University, leads the first clinical trials of this method.

Page’s team has completed phase 1 testing of DMAU pills in 2020, and believes they could be introduced to the market by the end of the year.

Temporary Vasectomy

Vasectomy is a minor surgical procedure that prevents male reproductive function, but it is usually permanent, so it is not widely accepted. So, the researchers of the Medical Research Council of India are working on a temporary method that could last up to 13 years, based on the same premise as RISUG.

This reversible and non-surgical male contraceptive, injects a synthetic polymer called styrene maleic anhydride (SMA) into the vas deferens, which transport sperm from the testicle to the ejaculation ducts, and disables the channel function.

Dr. Radhey Shyam, principal investigator, believes it’s an exciting and effective breakthrough. “It has been thoroughly tested on more than 300 volunteers with superior efficacy, more than 97.3% without side effects”.

All this makes us think about two questions:

1 Why did it take fifty years for substantial research into male non-surgical contraceptives to begin, and why are there still no options available?

The lack of male contraceptive methods has real global impact on women. United Nations (UN) data show that 70% use female (hormonal) instead of male (condom, vasectomy) contraception; and even in surgical methods there is a gap: 23.7% of users have had a hysterectomy or tubal ligation, while only 2% of users have had a vasectomy.

Male methods have been rejected again and again in different stages for their significant side effects: headaches, weight gain, mood swings and decreased libido… Does that sound familiar to you, women? These are the side effects (the mildest, in fact) of most female birth control methods.

Historically, pharmaceutical companies have accepted side effects -in many cases severe- caused by female contraceptives, but not male ones.

2 Why the leaders of two of the three most promising male contraception projects are women?

It’s the limit… On the other hand, it is unfortunately obvious: women are more interested because we are the most affected. Women have been practically the only ones responsible for reproductive controls throughout human history.

Anyway… The research seems to have gained a new momentum, and it seems to be closer than ever to be a reality. We wait anxiously.

Globally, 85 million pregnancies (40% of all pregnancies) per year are unplanned. In 2005, a study of 9,000 men in 9 different countries found that 55% of men with stable sexual partners were willing to use some form of contraception, but in Mexico 58% of young people do not use contraception during their sexual relations (although 84% have some knowledge about it).

Pharmaceuticals’ argument about lack of demand can only be countered with men stepping forward and showing interest. Innovative and effective male contraception options may be easily available, but they will not be a real breakthrough unless apathy ends. It’s time for men to take over their part of responsibility, after a lifetime of women bearing the financial, medical and personal cost of birth control.

Are we on the eve of a new era of contraceptive justice? We will be looking forward to it.

(Well, at least about that part. Then we will have to continue fighting stigma, the economic gap, access…)

Sources

Male contraception clinical trial launches in Sacramento (2020) UCDavis Health
First Trial Launches to Test Effectiveness of Male Contraceptive Gel (2018) The Lundquist Institute
The Birth Control Pill A History (2015) Planned Parenthood Federation of America
Acceptability of contraception for men: a review (2010) Glasier, A.
Fundación México Vivo: Día del Condón (2021) Rodrigo Moheno
Attitudes toward male fertility control: results of a multinational survey on four continents (2005) Heinemann K, Saad F, Wiesemes M, White S, Heinemann L.
World Health Organization World Contraception Patterns (2015)