What The Hell Is Going On With Male Birth Control

Heather Vahdat gets how frustrated people are to read breathless headlines about research on birth control for men, proclaiming it’s coming soon, when it is still not even close to going on the market. She still remembers an email she received from a person who said he got a vasectomy “because you guys are just taking too damn long.”

Vahdat is the executive director of the Male Contraceptive Initiative (MCI), which supports the development of non-hormonal methods for men and anyone with a penis. Data shows that men are interested in options beyond vasectomies and condoms, contradicting some well-worn narratives, but they’re tired of waiting for the clinical trials process to run its course. Women are obviously also tired. As a March 2018 Jezebel headline read: “The Male Birth Control Pill Is Right Around The Corner, We Swear, We Can Almost See It, Just Keep Taking Your Pills, Ladies.” Vahdat works in this space as someone who’s had “really crummy side effects from contraception my whole life,” she told Jezebel.

Time is of the essence for many people who want better reversible options to prevent pregnancy. In the three to four years since the last round of overly optimistic coverage of progress in male birth control, more states have moved to ban abortion, and the Supreme Court now looks poised to drastically weaken or overturn Roe v. Wade.

We need contraceptive options now more than ever, but research is slow because pharma companies aren’t interested—it’s the US government, non-profits, and private donors funding their development. We’re still about 10 years away from anything hitting the market—maybe five if the stars align. (As a reminder, emergency contraception is available for about $8 per dose online, and people in all 50 states can order abortion pills before they’re pregnant so they can have it on hand just in case.)

The two male birth control options furthest along are a hormonal gel men apply to their shoulders that reduces sperm production and a non-hormonal injection into the tube that sperm travels through so it can’t exit the body. The injected substance either biodegrades or is flushed out, making it like a truly reversible vasectomy or an “IUD for men.” Yes, vasectomies can technically be reversed, but it’s not a sure thing and it’s expensive, so no one should get snipped thinking they’ll just “undo” it later if they change their mind.

Christina Wang, MD, an expert on contraceptives at The Lundquist Institute at Harbor-UCLA Medical Center, is the lead investigator on the clinical trials for the hormonal gel. The shorthand name is NES/T, as it’s a combination of nesterone to block the production of natural testosterone in the testes and bring down sperm count low enough to prevent pregnancy, and replacement testosterone to maintain sex drive. “It is a big relief for the women, [especially] for those that have tried one, two, three or four different types of contraception,” she told Jezebel. Dr. Wang said there have been no pregnancies so far and some couples like the gel so much they wanted to know where they could get it. The answer is nowhere, yet, and they can’t be re-enrolled in the trials either.

The phase two trial of 420 couples started in the fall of 2018, and a phase three will follow, which will take three to four years. Then researchers have to seek FDA approval, so we won’t see contraceptive gel on the market for another five to 10 years from now, Dr. Wang said. Other options further behind the gel in development include a daily pill and an injection.

Dr. Wang said pharmaceutical companies haven’t been interested in developing male birth control for several reasons, including the cost of R&D, fear of lawsuits if people get pregnant or men are harmed by the drugs, and the idea that it would cut into the market for female contraceptives. She thinks the latter is particularly false, because “people try many methods and want to try a new thing.”

MCI is the second largest funder of male contraceptive research behind the National Institutes of Health, but at $1 million to $1.5 million a year, it’s comparable to “a rounding error” for overall drug development, Vahdat said. MCI is supporting Contraline, the company developing a reversible sperm-blocking injection in the US that’s known as ADAM, Vahdat said. The company behind it, Contraline, is preparing to start “first-in-human” trials early this year, which are an initial foray into safety before they can move on to the bigger studies necessary for FDA approval, she said.

It will take five to 10 years from when that study starts. “Contraline might be five if we’re lucky. There’s a million asterisks after that, but in a perfect world, there is a scenario where that could happen,” she said. “But I would say our best ranges are five to 10 [years].” Other options MCI is supporting include non-hormonal compounds that target the development or movement of sperm or the ability of sperm to fertilize an egg, but these methods aren’t as far along in the development process as ADAM. Vahdat notes that non-hormonal methods could be important options for anyone taking-gender affirming hormones.

Men and people who produce sperm increasingly want to share the responsibility of preventing pregnancy, Vahdat said. “There’s a generational leap that’s taken place,” she told me. “I was talking to a couple in Delhi and the man said, ‘I just wish there was something I could take so that she didn’t have to deal with side effects.’” MCI also talks to young people who are “shocked” there isn’t male birth control yet. “It’s like, ‘What do you mean? I just assume that you’re gonna provide this for me,’” she said.

Attitudes about how to ethically study male birth control are changing, too. A few years ago, experts and writers talked about male birth control as having to meet the high bar of having fewer side effects and risks than the already existing options for women—after all, cisgender men don’t face any health risks from pregnancy. But there’s a growing recognition that the ejaculations of cisgender men are what cause those pregnancies and all the attendant health risks. They are involved in this biological process, and any maternal complications and deaths that result, and should share responsibility for any contraceptive risks.

“We also have to stop looking at contraception as being female versus male,” Vahdat said. “This is an evolution, because women will benefit from male contraception as well. Sometimes the best option for a woman will be for her partner that she trusts to use contraception.”