Why we need a male contraceptive pill

The introduction of modern contraceptive methods has been revolutionary, not only in terms of sexual freedom but also due to its impact on the very fabric of society. Suddenly, with condoms and the pill readily available, procreation was no longer the primary focus of intercourse.

However, despite tremendous progress, there is still much to do. In the United States, approximately 40% of pregnancies are unplanned.

A wanted child is a happy child. A happy and secure child more often than not grows into a well functioning and adjusted adult. This is why it’s so important that pregnancy is a choice, for both parents’ and children’s sake.

In order for this to happen, the burden of responsibility for pregnancy prevention needs to shift from women to family planning. This entails men playing a major role.

The problem is that, historically-speaking, contraception options for men are not very effective or optimal.

The most secure pregnancy prevention method for men is abstinence, something that’s so unfeasible most of you reading this article might simply laugh it off (as you should). Even so, there are many organizations in the United States that go to great lengths to preach abstinence until marriage, especially in schools where it sometimes replaces evidence-based sex education.

Condoms are actually great for both preventing unwanted pregnancies and STDs. When used perfectly, they are 98% effective at preventing pregnancies. But since people aren’t perfect, condoms are about 85% effective. Some couples find them very annoying so they just use unreliable and risky methods like the calendar method or the withdrawal method.

In contrast, vasectomies (basically male sterilization) are almost 100% effective at preventing pregnancy. However, it has the potential to remain permanent and many men are scared of having this kind of surgery.

More than 60 years since the oral contraceptive pill was first introduced for women, it is now time to make the leap and offer a similar option for men, too.

How a male birth control pill works

Researchers have experimented with a number of options in the past two decades but an effective oral contraceptive for men has always been difficult to produce due to the rapid metabolization rates of androgynous hormones by the male body. However, scientists are making progress.

At the moment, various research groups are working in parallel to find the male birth control pill that is the most effective and with the fewest side effects. Here are some of the most promising hormonal-based male contraceptives.

Dimethandrolone undecanoate (DMAU) is a pill that is taken daily and affects male fertility by suppressing two types of male hormones – follicle-stimulating hormone (FSH) and luteinizing hormone (LH). This hormonal inhibition decreases the production of testosterone and sperm count without causing symptoms of low testosterone.

In a 2018 study, 82 healthy men aged 15 to 50 received either a daily pill of DMAU in one of three doses for 28 days or a placebo. The study found that those who took the highest dosage (400 mg) had the lowest levels of testosterone, FSH, and LH.

“Dimethandrolone is a modified form of testosterone, which has been chemically modified to get rid of the problem of liver toxicity,” explained Stephanie Page, a researcher at the University of Washington in Seattle, and the study’s lead author.

“A long fatty acid chain has been added to another portion of the molecule to increase its absorption in the bloodstream, so we can get around the twice-a-day dosing. Dimethandrolone is different than testosterone in that it binds to both the progesterone receptor and the androgen receptor so we don’t need two different steroids in order to have an effective male contraceptive,” she added.

This study didn’t measure the effectiveness of DMAU as a birth control method due to many ethical constraints. Just imagine a doctor telling you using this pill might or might not result in pregnancy — “let’s just try it and see”.

Instead, the study’s main objective was that of assessing safety and tolerability. According to the results, there were “no clinically significant changes developed in safety laboratory parameters”, which supports further testing of DMAU in subsequent studies.

Longer trials are necessary because the body needs up to 90 days to produce sperm.

Male birth control pill side effects

The DMAU trial reported side effects such as:

• Acne
• Headaches
• Mild erectile dysfunction
• Reduced sex drive
• Tiredness
• Weight gain of 5 lbs. or less

“The men experienced no hot flashes and no mood changes, and no problems with sexual function compared with the placebo group,” Paige said. “There was no evidence of liver toxicity. We did see mild weight gain and an increase in cholesterol levels and that may require us to fine tune the dosing, but overall we are very encouraged about the safety profile of dimethandrolone.”

“Despite these incredibly low levels of testosterone, the men did not have symptoms of low testosterone. Because dimethandrolone is a modified form of testosterone, when we give the right dose of dimethandrolone, all those important secondary sexual characteristics in the man will be maintained in the body,” she added.

It’s a fairly established fact that the pill for women increases the risk of depression and forming blood clots. Long-term studies following male users over the years will be able to establish if there may be any similar effects.

If DMAU works like the pill developed for women, men will be able to stop taking it and resume sperm production when they feel ready to become fathers.

Ultimately, DMAU could be packed as an injectable version administered monthly so patients won’t have to remember to take a daily pill.

More serious side effects were reported by a 2016 study conducted by researchers affiliated with the World Health Organization in Geneva. Their birth control vaccine was administered to 270 monogamous men, aged 18 to 45, and was found to be 97% effective. However, the study had to be cut short due to significant side effects like acne and serious mood disorders. However, it’s worth noting that 75% of the men who enrolled in the trial said they’d be willing to use this contraceptive measure again. 

A 2019 study performed by scientists at the Los Angeles Biomed Research Institute (LA BioMed) in Torrance, California, experimented with a male oral contraceptive called 11-beta-methyl-19-nortestosterone dodecylcarbonate —  or 11-beta-MNTDC for short — which is a sister compound of DMAU. The study involved 40 healthy men, out of whom 10 received a placebo, 14 received a dose of 200 milligrams (mg), and 16 got a double dose of 400 mg. The pill was taken daily with food.

Like DMAU, 11-beta-MNTDC works by reducing circulating testosterone levels as well as two other hormones required for sperm production. Both doses of the pill were successful in reducing these hormones compared to the placebo, and the effects were reversible — after the treatment was stopped, normal levels were observed once again.

Compared to other male birth control pills, the side effects were pretty mild. Five men reported slightly decreased sex drive, and two men described mild erectile dysfunction. Overall, the participants maintained a healthy libido.

Other groups taken alternate routes. Instead of trying to suppress sperm production, researchers at Monash University in Australia have focused on halting sperm ejaculation altogether.

Sperm is produced inside the testicles and then stored in a coiled tube called the epididymis. During ejaculation, smooth muscles contract and propel the sperm out the epididymis through a tube called the vas deferens, then into the urethra from which it is finally expelled. Muscle contraction is signaled by certain hormones which attach themselves to two receptors: α1A-adrenoceptors and P2X1-purinoceptors.

A 2013 study on mice by the researchers at Monash found that genetic modifications blocking these two receptors prevented male mice from inseminating females. Because the vas deferens is located outside the blood-testicle barrier, this also means drugs that target these receptors could be administered orally.

While most groups are trying to find an oral contraceptive or vaccine, researchers at the University of Edinburgh have developed a hormone gel. A male user simply has to rub a bit of gel on the shoulder and pectoral area, leave it to dry for three to four seconds, then get dressed and go about his day.

The gel is a mixture of progesterone and testosterone. The progesterone switches off sperm production in the testes. Testosterone is added to compensate for the decrease caused by progesterone. Usually, artificial testosterone is rapidly metabolized by the body. By delivering testosterone in a gel form, the blood levels of the hormone will be adequate for a longer time, thanks to the slow transdermal absorption.

At the moment, the gel is being trialed by more than 450 couples around the world with preliminary results expected to appear by the end of 2020. Dr. John Reynolds-Wright, who is leading the study, hopes the gel will match the pill’s effectiveness rate of 97 to 99%.

When will a male birth control pill be released commercially?

According to Christina Wang from the Los Angeles Biomed Research Institute, a “safe, reversible hormonal male contraception should be available in about 10 years.” She goes on to add that 55% of men in stable relationships would at least try this type of contraceptive. That being said, you cannot buy male birth control pills and anyone claiming to sell them online is a scam.

Just like the female version, a male birth control pill will not protect users from STDs. This is why it is still important to use condoms in order to prevent sexually transmitted infections.