A Check-In on Current Landscape of Male Contraceptives
Safe and effective male contraceptives continue to elude the general public, and even with several new options in the research pipeline, it may be many years before men have access to birth control from the comfort of their physician’s office. In the meantime, physicians and scientists are working hard to empower men to take charge of their sexual health and contraceptives.
“The concept of male hormonal birth control isn’t any more complicated or risky than birth control for women. Ideally, a man and woman would feel equally invested in preventing an unplanned pregnancy, but that’s not how it works. Women are much more motivated to use contraception because the consequences of pregnancies are so much higher for them,” says Lauren Streicher, MD, associate clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine. For a variety of reasons, male birth control research moves at a different pace and with a different urgency than studies for women, but that doesn’t mean scientists aren’t still committed to the cause.
The most recent high-profile effort to develop birth control for men was an October 2016 clinical research trial. The trial tested the efficacy of an injectable hormonal contraceptive for men in 320 healthy participants between the ages of 18 and 45 with normal sperm counts. The research showed encouraging results by reducing sperm counts and preventing pregnancies in all but four participants and 75 percent of the participants reported that they would be willing to use the birth control method after the trial ended. (It was later reported that three of the four pregnancies occurred in the induction stage of the study before the contraceptive agent was fully effective.)
Despite the promising feedback, the trial itself was halted by an independent safety review board affiliated with the World Health Organization that determined the risks – which included reported cases of infertility, inability to return to normal sperm count and death at one of the facilities – outweighed the research. And while it’s true that 20 men dropped out of the study due to side effects typical of female birth control (libido, muscle pain, acne, migraines, depression and mood swings), those side effects and dropouts had minimal bearing on safety board’s decision. Dropouts are quite normal in clinical studies.The safety board was most concerned with a large number of men (63 of 65) at one study site that reported new symptoms of depression.
The abrupt end to this trial may seem disheartening, but scientists are still on the case for male options. The team behind the injectable hormonal contraceptive will revisit their research – again, adjustment and optimization is not unusual for Phase II clinical trials – while other groups are exploring different options.
One such option on the horizon is called Vasalgel and is a hydrogel that is injected into the vas deferns. (The vas deferns is the tube in the male reproductive system that carries the sperm and is what is cut during a vascetomy.) The gel would be injected during a quick outpatient procedure in a physician’s office and create a semi-permeable gel barrier that would block sperm while having no effect on sexual function. The side effects are reported to be minimal.
RISUG (Reversible Inhibition of Sperm Under Guidance) is a similar contraceptive to Vasalgel and it is closer to market. RISUG is being closely monitored by the FDA and is currently in advanced clinical trials only available to local men in India, whereas the team behind Vasalgel is preparing for their first clinical studies. Like Vasalgel, RISUG is an injectible compound that blocks sperm from the vas deferens duct. It is effective almost immediately and can be reversed with an injectable antidote. (The Vasalgel scientists are testing ‘flushing out’ the gel rather than an antidote.) RISUG has been monitored for 15 years and reports suggest it is highly effective.
Protection For Now
It could be years before any of these options make it to market and into your physician’s office and until then, there remains two primary options for men: condoms and vasectomies. Condoms are recommended across the board for sexually active men, particularly those whose lifestyle may put them at greater risk for sexually transmitted diseases. Vasectomies are more widely accepted among men ages 50 and older, with nearly 500,000 men getting “snipped” each year in the United States. Contrary to public belief, a vasectomy doesn’t affect a man’s sexual function, and may take up to three months to be effective. It is, however, not without its drawbacks.
“Reversing vasectomy is quite costly, and doesn’t always work, so it’s important to consider this as a final option,” says Nelson Bennett, MD, urologist with Northwestern Medical Group. “Because it is difficult to reverse, vasectomies are usually considered by couples who are done having children.”
The middle ground then – men in long-term, committed heterosexual relationships who, along with their partner, no longer wish to use condoms but are not at a lifestage to get a vascetomy – is exactly who can benefit from the male birth control options in development. The need is real.
And while Dr. Streicher doesn’t expect the number of birth control options to change for men any time soon, she does advise women about the potential changes to the contraceptive mandate in the Affordable Care Act, and the ways in which insurance plans cover the cost of birth control.
A strong relationship and open communication with your physician can help men and women alike maintain their sexual health and navigate the contraceptive methods available to them. While there may not be an option for men on par with the Pill, rings or IUDs, men can still be active and responsible participants when birth control is the goal.