Research finds birth control for men to be safe and effective. Why is it inaccessible?

By: Jack Stewart

Almost half of all pregnancies in the United States are unintended (Healthy People 2030, 2013). This statistic alone indicates an unmet need for contraception (i.e birth control). Modern society tasks women with pregnancy prevention, conditioning men to disregard the matter. These gendered relationship roles are largely to blame for the discrepancy in the variety of birth control methods available for men compared to those available to women. 

Critics of male contraception claim that men are not willing to use new birth control methods. But, research shows that seven out of ten men in clinical trials would use a contraceptive method if it were available (Gava & Mariggiola, 2019).  Motivation ranges from lightening the burden for their partner to better controlling their own fertility and the idea is gaining traction for men and people of other genders. Unfortunately, researchers argue that male contraception should be 100% effective with little to no side effects (Amory, 2016), a standard far beyond existing female contraception.

Types of Contraception

Taking stock of current birth control options, and their pros and cons, will help us see options for male contraception.  

Common female hormonal methods like the pill, patch, implant, ring, some Intrauterine Devices (IUDs), and injections influence hormone levels to inhibit fertility. Although they affect hormones that already exist in the body, side effects are common. Such side effects include spotting, changes in sex drive, ovarian cysts, depression, dizziness, nausea, headaches, sore breasts, acne, and cramping. These methods range from 93% to 99% effective (Bedsider, 2021). Long-acting reversible contraceptives like IUDs are increasingly popular because they are highly effective and low-maintenance.

Barrier methods like diaphragms and internal (female) condoms apply a physical barrier to prevent the egg from meeting the sperm. Barrier methods require active, correct use every time the user has penile-vaginal sex. The external (male) condom is more widely used.

All of these methods temporarily prevent pregnancy without affecting long-term fertility. Tubal ligation or ‘getting your tubes tied’ is a surgical method that is nearly 100% effective at preventing pregnancy (Bedsider, 2021) but is permanent.

In contrast, men have just three options for preventing pregnancy: external condoms, withdrawal (aka ‘pullout method’), and vasectomy. All these methods are non-hormonal. Condoms are the most popular. Condoms and withdrawal involve active, consistent use and leave room for error, especially in the heat of the moment. Additionally, many people find it challenging to convince their sexual partners to wear a condom, worrying about “stealthing,” a phenomenon where the condom is removed during sex without a partner’s consent. Condoms are 87% effective on average (Bedsider, 2021).

Vasectomies, a surgical option nearing 100% effectiveness, can be reversed in some situations but are typically considered permanent (Bedsider, 2021). Contraceptive options for men are limited, to say the least, and completely lacking in hormonal options.

Male Contraception and Side Effects

In recent years, male birth control research has dramatically increased and expanded to include several emerging methods. Dimethandrolone undecanoate (DMAU), a hormone-based method, is taken every day by mouth, similar to existing hormonal birth control pills, or administered by injection weekly. It works by limiting a type of testosterone production to prevent the production of sperm, then, supplements the body with another type of testosterone to maintain normal levels (Roth, 2012).  Three to six months after stopping the drug, sperm production resumed in most men. While DMAU is still in clinical trials, it is proving to be effective with only minor side effects such as weight gain and decreased sex drive (Amory, 2016)—both of which can also happen with female contraception.

Another emerging option is Nestorone, a hormone-based skin gel applied daily to the upper arms. Like DMAU, Nestorone decreases some testosterone to prevent sperm production while maintaining normal levels with another gel. Like vaginal birth control rings, Nestorone is absorbed through skin. During clinical trials, participants expressed satisfaction and interest in the product in real life (Amory, 2016). DMAU and Nesterone are possible hormonal contraception designed for male anatomy. Unfortunately, their minor side effects have prevented them from gaining FDA approval. 

Developed in Germany, yet another option, Coso, uses ultrasound waves to limit sperm’s mobility via a sleek in-home model. Coso has not yet started clinical trials, but has potential to be a short-term, effective, reversible, nonhormonal option for men (The James Dyson Award, 2021).

Vas occlusion, a method studied in India and China, may offer long-term, highly effective contraception, and requires no ongoing effort after the initial procedure (Khourdaji et al., 2018). Instead of cutting the vas deferens (tube that transports sperm), the procedure uses a gel to temporarily plug the vas deferens. Researchers hope to find a way to reliably dissolve the gel to reverse the procedure.

A new non-hormonal pill developed by a team at the University of Minnesota has been 99% at preventing pregnancy in mice, with no apparent side effects. The pill works by blocking proteins from binding to vitamin A, which is known to be crucial to fertility and virility in mammals. Human trials could start by the end of the year.

Research has identified several options that appear to be safe and effective. So what’s the holdup?

Reasons for Delay

Proposing male contraception, especially hormonal, usually elicits a host of counter-arguments—most commonly, that they wouldn’t work biologically speaking. While they work differently, we’ve just described plenty of viable options. Opposition to male birth control development is principally based on gender stereotypes and cultural attitudes towards sex and gender, not anatomy.

These concepts also infiltrate medicine and as such, medical science typically consider sexuality only in terms of reproduction (Hatfield et al., 2011). Overlooking non-reproductive motivations for sex, such as intimacy and self-affirmation, impedes important research and is an unrealistic lens for our society. From a young age, we all understand the social norms for how men and women are “supposed” to act and what responsibilities they are “supposed” to have. These expectations are to blame for women bearing the burden of pregnancy prevention, with men mostly staying out of the conversation.

Since the invention of the pill, females have tolerated side effects like nausea, headaches, mood swings, and weight gain. These same side effects have stalled male birth control approval. The FDA weighs side effects against the medical condition treated when approving any new drug. For females, birth control is a response to pregnancy, not to a potential child. Since pregnancy involves significant changes to the body and poses health risks, treatments can be approved even with significant side effects. However, the FDA contends that birth control for men is not treating any condition. Thus, it is difficult to approve male contraception even with infrequent, minor side effects. This argument problematically excludes men from bearing any responsibility for preventing pregnancy, solely because they don’t carry the fetus.

Institutions of our medical system, influenced by dominant ideas about gender and sex, hinder the approval and widespread access of male birth control. But the tides are changing! As our social attitudes toward sex continue to evolve, the medical system will eventually follow suit. All of the emerging methods discussed above are still in clinical trials, it will likely be at least a few more years before men can access more forms of birth control, but there is hope that in the near future, all people will have more control over their fertility.