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August 9, 2021

Male birth control


Birth control often ends up being the responsibility of the person who can get pregnant. Their options include birth control pills, an IUD, or another implant. The other half of the equation are currently limited to condoms (less effective, prone to breaking) and difficult-to-reverse vasectomies. This begs the question: Why don’t we have more male birth control options?

As of 2019, 40–45% of pregnancies worldwide were unplanned, indicating the need for available birth control for all sexes. Here, we explore current and potential future options for male birth control.

Takeaways:

  • Male birth control options are currently in research, but lack of funding and fear of side effects are slowing the process.
  • Possibilities include male birth control pills, injections, and gels, all of which would work to temporarily stop or decrease sperm production or block sperm from leaving the testes.
  • The only male-controlled contraceptives currently available are condoms and vasectomy (a permanent birth control option).

Will we ever have a reliable, reversible male birth control option?

A 2005 study found that more than 55% of men in several countries supported hormonal birth control for males. The main barriers to development have included funding and the potential for side effects. Still, research and clinical trials have been ongoing to find safe, effective, and accepted male birth control options.

According to research from 2019, at the current speed, it will likely take until at least 2030 for a new drug to be approved for male birth control.

How male birth control works

Several birth control options for men have been explored.

Some are still quite experimental. One example is “magnetic hyperthermia,” which involves injecting iron oxide nanoparticles into the testes and using magnets to cause the particles to heat up and temporarily stop sperm production. (A 2021 study of this technique only tested it in mice.)

Other methods are much further along in testing and development. Gels like Vasalgel could create the same effect as a vasectomy by blocking the vas deferens to stop sperm from getting through.

Birth control methods for men could also work by stopping the production of sperm, killing sperm, or preventing them from functioning. Most male birth control pills and hormonal gels aim to decrease sperm production by suppressing the hormones involved in sperm and testosterone production: luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Learn more about male fertility hormones.

Male birth control options currently in research

Three of the main contraception options currently being studied include male birth control pills, male birth control injections, and male birth control gel.

Male birth control pills

Recent research has examined pills containing dimethandrolone undecanoate (DMAU). DMAU is an androgen/anabolic steroid as well as a progestin, or a synthetic progesterone.

These pills suppress LH and FSH and lower testosterone, which should temporarily impair sperm production. The good news is that the pill did not cause symptoms of androgen deficiency (low testosterone) in the 28-day study. However, while these studies concluded that the medication affected hormone levels, they haven’t yet tested the impact on sperm count or quality. Longer and larger studies are needed to understand side effects and to confirm that sperm production falls sufficiently over time.

The same questions also need to be answered for another pill in research now, containing 11β-MNTDC. This medication, another androgen/anabolic steroid tested in 2019 and 2020 studies, is also intended to suppress spermatogenesis (sperm production) by decreasing levels of LH, FSH, and testosterone. Again, researchers found that there was no significant impact on mood — a concern when testosterone levels are lowered — but concluded that longer-term, larger studies are necessary to prove this pill can reliably lower sperm production and prevent pregnancy.

Male birth control injections

The same active ingredient in one of the male birth control pills — DMAU — is also being trialed as a long-acting injection.

However, it’s not the only injection that scientists have tried. In 2016, research examined the impact of injecting testosterone and progesterone simultaneously to temporarily stop sperm production. The study of 320 men found that the injection effectively reduced sperm production to fewer than 1 million sperm and prevented pregnancy in 96% of couples. It also found that the method was reversible, with over 94% of men regaining their full fertility less than one year after stopping the injections.

Unfortunately, the trial was discontinued due to some of the side effects: namely, mood disorder, such as emotional volatility, aggression, and depression. Interestingly, though, 75% of the men in the study still reported that they would be willing to use this method of birth control, and were satisfied with the medication. Hopefully, researchers can ameliorate some of the side effects in order to make this a real male birth control option in the future.

Male birth control gel

Two forms of gel are being studied for birth control. The first is a hormonal version that men rub onto their skin, a gel called NES/T that combines Nestorone, a progestin, and testosterone. This medication is undergoing a clinical trial to test whether daily application to a man’s back and shoulders successfully reduces testosterone and sperm levels, as well as prevents pregnancy, without undesirable side effects.

The other type of contraceptive gel under examination is a non-hormonal version that’s injected into the vas deferens, blocking the sperm — just as in a vasectomy, but without cutting the vas deferens. One version, Vasalgel, is currently in development as a multi-year form of birth control after a 2017 study in rhesus monkeys suggested that the gel seemed effective for preventing pregnancy. Further studies need to be done in humans, and to test the effectiveness of reversing the process by dissolving the gel.

Another version is known as ADAM, a similar injectable gel that's water-based. Scientists are currently recruiting for human clinical trials, which should begin in 2021.

Problems identified with these options

One challenge in developing men’s birth control is preventing sperm production while preserving healthy testosterone levels. Low testosterone could have impacts on sexual function (such as decreased libido or erectile dysfunction) or cause weight gain, while adding testosterone could contribute to mood swings, aggressiveness, and acne. 

Researchers are still exploring other potential and long-term side effects, and clinical trials are still ongoing.

Will male birth control affect male fertility long term?

Male birth control is intended to be temporary. Clinical trials of male birth control include analyses of participants’ sperm after they stop the treatment, checking to ensure that sperm production returns to normal. In the case of the testosterone/progesterone injection that was studied, sperm production returned to baseline within one year for 94% of subjects.

Research has also indicated that pregnancies and miscarriage rates following the cessation of male birth control matched the numbers seen in the general population. However, longer studies are needed to confirm any effects on fertility long term.

What are the current options for male birth control?

Until other methods are developed, we’re limited to two birth control options: condoms or vasectomies.

Condoms

For effective birth control, a condom must be placed over the penis every time you have sex. It will prevent pregnancy by keeping sperm from entering the female reproductive system, but only if stored and used correctly.

Condoms have a failure rate of 13% from people using them ineffectively. When using a condom, it’s important to:

  • check for any tears.
  • use it by the expiration date.
  • use each condom only once.
  • use just one condom at a time.
  • avoid using lotion or other oil-based lubricants with latex condoms to prevent tears.

A 2017 report found that about 24% of women and 34% of men in the U.S. used a condom the last time they had sex.

Vasectomy

During a vasectomy, a surgeon cuts each of the vas deferens, the tubes that transport sperm from the testicles to the urethra. The goal is to prevent sperm from entering the semen. (It may take up to three months for sperm to disappear completely from your semen, during which time you’ll still need to use another type of birth control.)

Overall, a vasectomy is a highly effective birth control method, with just 1 or 2 women per 1,000 getting pregnant within the year following their partner’s surgery.

A vasectomy is a permanent form of birth control. While reversal is an option, it is invasive, expensive —  your insurance may not cover the procedure — and not guaranteed.

After a reversal, it may also take between four months and one year for your partner to become pregnant. Pregnancy rates after vasectomy reversal may be as low as 30%. The reversal is more likely to restore your fertility the less time that’s passed since your vasectomy.

If you’re considering a vasectomy, you may consider freezing your sperm, just in case.


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