Following the overturning of Roe v. Wade, developing more birth control options for everyone becomes even more important.
Women and people who can become pregnant have a number of effective contraceptive methods available, including oral pills, patches, injections, implants, vaginal rings, IUDs, and sterilization. But for men and people who produce sperm, the options are limited. Two options, weaning and condoms, both have high failure rates. Withdrawal has a failure rate of around 20%. Condoms have a failure rate of only 2% when used correctly, but that rate goes up to 13% depending on how people typically use them. Vasectomies have a failure rate of less than 1%, but they require minimally invasive surgery and are considered a permanent method of birth control. Neither vasectomies nor withdrawal protect against sexually transmitted infections.
There has not been a new form of male contraception since the introduction of the “no-scalpel vasectomy” In the 1980’s. me, with my teamhave been developing methods of male contraception since the 1970s. I believe that new, safe, reversible, and affordable contraceptive options can help men participate in and share responsibility for contraception with their partners, and reduce the rate of unwanted pregnancies.
Take responsibility for family planning
A 2017 survey of 1,500 men aged 18-44 found that more than 80% wanted to prevent their partner from getting pregnant and felt they had shared or sole responsibility for birth control.
Men who are dissatisfied with condoms are more likely to use withdrawal as a form of birth control or to never use contraception. However, among those dissatisfied with condoms, 87% are interested in new methods of male contraception. This results in an estimate 17 million men in the United States who are looking for new methods of contraception to prevent unwanted pregnancies.
Similarly, a 2002 survey of more than 9,000 men in nine countries on four continents found that more than 55% would be willing to use a new method of male contraception. Importantly, a survey conducted in 2000 on three continents revealed that 98% women would trust their partner to use a male contraceptive method.
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Barriers to male contraception
The intense interest in a new male contraceptive raises the question of why there haven’t been new methods of male birth control since the 1980s.
The development of male contraception has been supported primarily by governmental and non-governmental organizations, including the World Health Organization work with academic medical centers. However, these organizations often do not have drug development infrastructure comparable to pharmaceutical companies, with programs typically run by a handful of staff assisted by clinical research organizations. Limited financial resources further slow down development.
Lack of interest from pharmaceutical companies may also play a role in deterring the development of male contraception, and there are a number of possible reasons why the pharmaceutical industry avoids male birth control. One reason is to weigh the cost of development against the uncertainties about the potential market. Other reasons include uncertainties about who would dispense these drugs and the lack of clarity regulatory requirements for male contraceptive methods to receive FDA approval. Companies may also be concerned about liability in the event of pregnancy.
New methods currently in development
Researchers are currently studying several different methods of male contraception.
Hormonal methods are usually taken as a gel applied to the skin, an injection into the muscle, or an oral pill. These methods usually contain testosterone and a progestin. Progestin suppresses two pituitary hormones that control the testicles, the organs that produce sperm. While the testicles require high concentrations of testosterone to produce sperm, testosterone is usually included in hormonal methods to ensure that there is an adequate level of the hormone for other bodily functions. Counterintuitively, taking testosterone can also help suppress sperm production, because increasing circulating testosterone levels above a certain level suppresses the same two pituitary hormones. The addition of a progestogen further enhances the suppression of sperm production.
The most advanced hormonal contraceptive candidate in development is currently underway second stage clinical study which has recruited more than 400 couples on four continents. I was the principal investigator of this trial at the Lundquist Institute. The results of the study, sponsored by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the population councilhave so far shown promise with minimal side effects, and couples have found the gel acceptable to use.
My team and I are also developing drugs that work like both testosterone and progestin, but in a single compound. These drugs are currently in early human testing as a daily oral pill or long-acting injection.
Non-hormonal methods usually involve drugs that specifically target sperm-producing organs to decrease sperm concentration or function. Non-hormonal drugs show efficacy in animal models, but preclinical toxicology results are needed before clinical studies to demonstrate safety, tolerability, and efficacy in humans can begin. Some of these methods are working toward first-stage clinical trials.
Another non-hormonal method is to reversibly block the vas deferens, an organ that carries sperm for ejaculation. Studies sponsored by the Male Contraception Initiative and Parsemus Foundation test hydrogelsa type of polymer that retains water, which prevents sperm from passing through the vas deferens.
People are ready for new contraceptive methods. I believe that collaboration between the academic, government, nonprofit, and pharmaceutical sectors can help provide new methods of contraception that are safe, reversible, acceptable, and accessible to everyone.