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Will we ever have a male birth control pill?

Will we ever have a male birth control pill?

Over the years, I’ve wondered (and grumbled) about the lack of birth control options for men. Other than using a condom or getting his tubes tied, there’s really not much a man can do to keep his partner from getting pregnant. Which means that women almost always bear the burden of preventing pregnancy… and the downsides that come with using birth control.

The costs of taking birth control are real, and we’re not just talking co-pays. Women have to deal with side effects, like mood changes and weight gain (hello, birth control pill) and heavier periods (that’s you, copper IUD). And, as with any medication, many forms come with their own uncommon, but nevertheless serious health risks, which are, again, borne by women.

Adding to that, women are also responsible for going to doctor’s visits, filling birth control prescriptions, and then, of course, paying for it. Plus, for those of us on the pill, remembering to take your daily dose of birth control can be a small but annoying task that no man has to deal with.

I’m sure I’m not alone in thinking: it would be so much easier if our male partners could share in this responsibility, or at least have the option to do so.

Well, there’s some goods news: researchers have finally tested a male birth control shot in a trial commissioned by the World Health Organization, because, yes, this is a global issue! The trial was the culmination of four decades of research, and, the outcome was promising. Dr. Mario Festin, who carried out the study, reported that “The study found it is possible to have a hormonal contraceptive for men that reduces the risk of unplanned pregnancies in the partners of men who use it.”

If you’re wondering why it took so long to get here, that’s a great question.

If you’re wondering why it took so long to get here, that’s a great question. The main reason is that it’s simply harder to create a birth control pill for men. Whereas women release one egg per month, a male birth control pill has to contend with the millions of sperm that a healthy man produces on a monthly basis. Another difference is that it takes a relatively low dose of birth control to make a women stop ovulating, particularly because the window of ovulation is so short. By contrast, men are constantly producing sperm, so male birth control requires much higher doses of hormones, and therefore an increased risk of side effects.

In the WHO’s trial, researchers gave 320 men with a normal sperm count a contraceptive shot every 8 weeks. The shot contained two hormones, progesterone and testosterone, designed to suppress the testes’ ability to produce healthy sperm. By injecting the men with these hormones, researchers were looking to “trick the brain” into thinking the body was already making enough of them, thereby shutting down the testicles’ own production of progesterone and testosterone.

To determine effectiveness, participants provided semen samples so that researchers could measure the sperm count. Once the count dropped to under a million per milliliter (the magic number at which pregnancy is highly unlikely), the men were instructed to discontinue using other forms of contraception, while continuing to having intercourse.

The result? Pretty good.

The result? Pretty good. Researchers found that 274 participants hit and maintained that low sperm count within 24 weeks of receiving their first injection, and that the method was effective for 96% of continuing users, which is comparable to contraceptives used by women. (Only four pregnancies occurred during the trial).

However, reported side effects, particularly instances of depression and other mood disorders, but also muscle pain and acne, led 20 men to drop out of the trial. Concerned that the so-called “adverse events” associated with the injection were more severe and frequent than anticipated, a WHO review board decided to suspend the study. (In fact, the rate of depression experienced by the male participants, 2.8%, may be five times higher than what we see with women taking hormonal contraception, which one study found to be 0.5%.)

Another issue was that most of the complaints came from one test site, suggesting either that study was being conducted improperly at that location, or, again, that the drug was riskier than previously assumed. A final problem surfaced after the suspension: although most of the participants returned to fertility within 6 months, 8 men still weren’t fertile 52 weeks after taking the injections. Which, of course, is bad news.

So what’s next? Researchers are exploring how they can combine different levels of the same hormones used in the trial, as well as different methods of delivery, such as gels, to address the problems encountered in the study. At this point, we’ll probably have to wait a while longer (perhaps even a decade) until a male form of birth control is approved for market.

Disappointing? Yes. But let me leave you with at least one development that may make you happy. At the conclusion of the study, 75% of participants reported that they would use this method of contraception, despite the side effects. Which means that a solid proportion of men are willing to share the burden of taking birth control. Fingers crossed that researchers work out the kinks soon.