Male Birth Control: Are we ready to pop the pill?

Words By Rosie Marilyn Burgess

Imagine, for a moment, the bright lights of Kensington and the bustling shoppers of Carnaby Street. Adorning shop windows are images of the now-iconic Twiggy and Jean Shrimpton, teenage supermodels in the process of redefining fashion. Pouring out of radios and record players across the nation is a cacophony of “London-sounds”; The Beatles, The Kinks and The Who, each one changing irrevocably the face of British rock music. Post-war London is being transformed by experimentation of all kinds and the political activism of the anti-nuclear weapons movement, and sexual liberation is in full swing. This is, of course, Swinging London, a place and time which bore witness to seismic social change. While the debate then centred around the ethics of contraception, there are today new debates to be had on the topic of birth control and sexual health. One of which concerns birth control for men, rather than for women.

Informally known as “the pill”, Gregory Pincus and John Rock spearheaded the discovery of the oral contraceptive in the 1950s. Approved in 1961, it was and can still be made up of synthetic hormones progesterone and oestrogen. Combined oral contraceptive pills work by thinning the lining of the uterus which stop implantation. It also affects the hypothalamus and pituitary glands inhibiting ovulation. Nowadays, the pill boasts over 151 million female users globally and is now so developed that it has been refined into 23 different types. For some women, the pill can improve certain symptoms like lighter periods and a reduced risk of certain cancers. Even so, it still isn’t without its downsides. With a reported plethora of unwanted side effects: acne, depression, breast tenderness and weight gain to name just a few. In 2018, a survey of women on the pill conducted by the team from the documentary ‘The Contraceptive Pill: How Safe Is It?’ found that a quarter of respondents reported negative effects upon their mental health. And, even where women have been exempted from the burden of contraception thanks to non-hormonal contraceptive methods for men, still, a majority of the time women are involved in family planning. So, when it comes to contraception, why are we not levelling the playing field? 

However, male counterparts are now thankfully being developed. Research started in the ’70s and involved the artificial causation of a biological process known as azoospermia, which suppresses the body’s formation of sperm. This allows for the production of semen with little to no sperm content through the use of androgen hormones like testosterone. Ongoing research suggests there are clear advantages to this contraceptive method; it would reduce the risk of pregnancy to about 1% per year, the same rate as female hormonal birth control. However, as injectable testosterone isn’t so quickly excreted by the body, such a method may require between 3 and 4 months to take effect. While this method may not be instant, it may potentially be long-lasting; injectable testosterone can last longer in the body owing to its slower rate of excretion.

So, what is happening right now? In the last few years, the science community has seen a marked groundswell of new research into male hormonal birth control. So far, this interest has led to the development of a topical gel that combines progestin and testosterone, with reliable rates of azoospermia. Studies have found that the drug is reversible and that its side effects (decreased libido, increased risk of sunburn and dry, scaly rash at the site of application), are deemed acceptable by most participants. The study passed human safety trials and human clinical trials but has yet to be tested as a contraceptive.

A new method is being developed in China. This method involves using an injection of non-hormonal chemicals that block the vas deferens, the tube that transports sperm to the ejaculatory duct. This is the same tube that gets cut in a vasectomy to inhibit sperm motility.  Such an injection would also directly inhibit the ability of sperm to swim. Unfortunately, this has only been tested on rats.

Another prospective method involves Dimethandrolone Undecanoate or DMAU for short. DMAU is a once-daily pill that suppresses two male hormones, follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The result of this suppression is a decrease in the production of both testosterone and sperm, without causing symptoms of low testosterone. However, testing of this method has solely focused on safety so far.

Meanwhile, even traditional medicine has proved to be a promising endeavour. Gendarussa is a plant commonly used in South East Asia, namely in Indonesia and Papua New Guinea. Although further research has yet to be conducted, the key to Gendarussa’s effectiveness may be an active ingredient; specifically, flavonoids called Gendarusin A and B. 

There is no doubt that the female birth control pill changed the world. New contraception methods were developed such as IUDs, injections, patches and implants. It empowered women by giving them control of their bodies. Women could successfully delay childbearing, therefore gaining the freedom to forge their path in the pursuit of education or a career. However, great inequality remains because of how little research has been conducted in this area. Nearly 50% of pregnancies are unintended, and when 1 man can get 100 women pregnant but only 1 woman can get pregnant at a time there is a sense of urgency for another solution to come to the marketplace. Unfortunately, COVID-19 has delayed most studies but we can be hopeful that within the next decade men can say they are popping “the pill”.