Male birth control: the pros and cons
Every year there seems to be another breathless headline promising that male birth control is, once again, almost here. This time it was a study from the University of Washington making news. The study featured promising results from a small clinical trial on men using a hormonal pill for a month. However, further details reveal the study’s limitations — mainly, the study has yet to be published in a peer-reviewed journal, and it was a Phase 1 trial, meaning it only studied a small number of people for a short amount of time and mainly focused on whether the drug is safe, not its effectiveness at preventing pregnancy. Even if the drug does prove effective and receive funding, the team estimates that it will not be ready for at least 10 years.
In the 50 plus years since female birth control debuted, a male version still has not been developed — and probably will not be for at least another decade. While it is pretty easy to answer why male birth control is not available already (biology, funding, etc.), the trickier question is whether we really need it. While it would be great for men to share the responsibility, health risks, and costs that women bear for birth control, is it realistic for women to rely on men for their own reproductive future? Is developing male contraception more important than improving women’s current options or making the available options more affordable, if not free?
The current state of birth control
Before getting into the hypothetical positives or negatives, let’s look at where we are with birth control. Aside from the copper IUD, all contraceptive devices and pharmaceuticals available to women alter our hormones with various side effects. For men, aside from condoms and withdrawal, a vasectomy is the only other option for preventing pregnancy. Since vasectomies are only sometimes reversible, this option is usually only viable for men who have decided they do not want any future children. Several male birth control products are making their way through clinical trials: a topical gel that blocks sperm production is the furthest along in development, followed by a hormonal pill contraceptive and a nonsurgical vasectomy. However, we are at least a decade away from the product that is furthest along.
Biology is one of the biggest roadblocks to developing male birth control. In women, hormonal birth control prevents ovulation. While women produce one or two eggs a month, men produce hundreds of millions of sperm a day, with about 250 million sperm per ejaculate. Shutting down the male reproductive system is much more difficult on a simple numbers basis. Using hormones to prevent sperm creation requires very high doses, which cause intense side effects. Since male contraceptives need to be at least as safe and effective as the options available for women, pharmaceutical companies have pretty much abandoned development of male birth control, leaving the research and its funding to governments and nonprofits.
Side effects actually are worse for men than for women
You may remember a male birth control trial in 2016, when headlines suggested that the men dropped out because they couldn’t handle the side effects that women on hormonal birth control face every day. Although this angle was honestly pretty funny, it was actually misleading — the study was halted because one of the two independent monitoring committees was concerned about the high number of adverse reactions reported. The hormonal contraceptive injection was found to be 96% effective, but it was associated with a number of side effects, including pain, depression, acne, and altered libido. The rate of side effects was higher than what women typically experience using hormonal birth control.
However, the hormonal side effects in men are much less than they were for women when the birth control pill was introduced. “It’s just that the bar for what people are willing to tolerate is a lot different,” said Dr. Stephanie Page, a lead author of this year’s University of Washington study. “It’s really a matter of who’s going to benefit. Pregnancy, in theory, is still a life-threatening condition for a woman. Preventing a pregnancy is important to a man for a lot of reasons, but not for his personal health.”
When the first contraceptive pill was being tested on female subjects, scientists could not find women willing to endure the side effects, so they forced women to participate without telling them what the pill was for. These trials took place largely in Puerto Rico, where contraception and abortion were legal (eventually these trials led directly to the informed consent procedures that medical studies must adhere to today). When the first version of the contraceptive pill, Enovid, debuted in 1960, it contained ten times the amount of hormones needed to prevent pregnancy, and could cause weight gain, nausea, dizziness, breast tenderness, headaches, and vomiting. It took a decade for scientists to reformulate the pill with a lower dose of hormones. But at a time when abortion was illegal or difficult to obtain, women were willing to take on the accompanying risks and side effects.
The positives of male birth control
Besides sharing the burden of side effects with women, male birth control would have many positive consequences: a reduction in accidental pregnancy, and an increase in male responsibility, awareness, and understanding of birth control. With male contraception, men would be forced to plan beyond just carrying condoms. They would have to make doctor appointments, try different methods, talk to their health insurance company about coverage, and get regular checkups. When an accidental pregnancy happens, they will be asked why they weren’t taking birth control. If men were equally responsible for contraception, birth control would be more normalized, and our society’s understanding of sex and reproductive rights would progress. For the many women who cannot take hormonal birth control for health reasons, it would be a huge game-changer.
The negatives of male birth control
While it would be great for women to be able to rely on their partner for contraception, how many women would actually trust their partner to take a pill on time every day if they aren’t the ones who would actually get pregnant? Among women, the typical failure rate for oral contraceptives hovers around 9% due to noncompliance and imperfect use. I’m willing to bet that number would be higher for men since they are not the ones at risk for unplanned pregnancy. What about men who would use “I’m on the pill” as an excuse to have unprotected sex? Best case scenario they are putting themselves and their partner at risk for STIs, and worse case scenario they are putting their partner at risk of pregnancy as well.
Most importantly, what motivation do men have to take birth control? They can already avoid unwanted pregnancies if their partner is on birth control; with male contraception, they get the same advantages, except now they might get some pretty unpleasant side effects. And since men are fertile for decades longer than women, they are looking at a lifetime of them. Take vasectomies, for example: vasectomies account for only 5% of contraception, despite being 100% effective. Only 5% of American men have had a vasectomy, but 15% of American women have had a tubal ligation. Vasectomy is the safest and most effective option, yet we still cannot get all eligible men to have one.
Alternative (better?) options to male birth control
What if, instead of putting (mainly government) money towards developing male contraception, we focused on making female birth control options cheaper — or free. Free would be ideal. If birth control were safer and more accessible, women would be more likely to use it. A study at the University of Utah Health revealed that women were as much as two and a half times more likely to use more effective contraceptives when cost wasn’t an issue. Besides the financial burden, many women are not satisfied with the existing options. A report by the Center for Disease Control in 2013 showed that almost half the women surveyed had discontinued a form of contraception because they disliked it or were concerned about side effects, and a third of the women had tried five or more types of birth control.
The truth: developing new female contraceptives is too risky for pharma companies
Most new contraceptive options are just adaptations of birth control developed in the 60s and 70s — for example, pills with lower doses or different formulations of hormones. There have been some new developments, such as contraceptive implants, patches, and vaginal rings, like the NuvaRing. Not only is new drug research extremely expensive, but in the case of birth control, the products are especially prone to lawsuits since unlike other medication users, women who take contraception do not necessarily have a health problem. For example, in the 70s the pharmaceutical company behind the Dalkon Shield IUD pushed the product even as users reported miscarriages caused by severe pelvic infections and emergency hysterectomies. The Dalkon Shield was pulled from the market in 1974, and by 1985 the company had received hundreds of thousands of lawsuits. In recent years, women using the Mirena IUD served Bayer with nearly 1,300 lawsuits, while thousands of women using the NuvaRing won a settlement against Merck for $100 million. Without the funding to make research worthwhile, pharmaceutical companies don’t want to take the risk to develop new female contraceptive options.
No matter what gender, birth control is a huge responsibility: taking a pill every day, or getting a shot every month, or changing an IUD every few years takes planning, access to medical care, and financial resources. I don’t wish a birth control product on anyone that is anything less than optimal. If contraception is going to progress though, it makes sense to build on the decades of research already available on female birth control rather than start from scratch with a male option. At the very least, more work needs to be done to improve access to existing options before focusing on developing new ones.
Cover image source: Tony Futura