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Where in the world is birth control for men?

Birth control for guys—urban legend, or reality?

by Grace Shih, MD, MAS

Last updated on November 11, 2014.

Picture this: a couple is in a committed relationship and they’ve agreed they’re not ready for kids. They talk to each other about birth control and maybe he helps her remember to take her pill. Maybe he’d like to take even more responsibility for birth control…but he’s got scant options.

But wait, aren’t there stories about new methods of birth control for guys all the time? There was Wired’s “Revolutionary New Birth Control Method for Men” and Fast Company’s “Indonesia Introducing a Male Pill Contraceptive,” to name a couple. Well, where do we sign up? In fact, the question is not just where, but when. Guys in China and India will have more choices at least a decade before guys in the United States do.

Dude, Hormones?

Several male equivalents of women’s hormonal contraceptives are in the works. Just like the women’s versions, they contain different mixes of hormones. All have some form of testosterone, and some also contain a progestin. Right now, there is no testosterone that men can take as a pill—the digestive tract changes it so the body doesn’t recognize it as testosterone. Drug companies are working on developing a testosterone that can be taken orally, but for now there are shots, gels, and implants.

All hormonal methods for men protect against pregnancy by stopping a guy’s body from making new sperm. Sperm account for about 1% of semen, so there’s no noticeable change in the ejaculate. It takes about 3 months for these birth control methods to become effective since that’s how long it takes for the last sperm made to travel through the long tubes in the testes and epididymis. When a man stops taking a hormonal contraceptive, it takes about 4 months for his sperm count to return to original levels for the same reason.

Men in China may be the first to have a hormonal contraceptive. Researchers there completed the rigorous tests needed to approve a new drug in 2009. They tested an injection of one type of testosterone (testosterone undecanoate, or TU) every 4 weeks. It was 98.9% effective, and the majority of guys who participated in the clinical trial said they liked it. (For comparison, the average effectiveness of the shot for women is 97%.) The most frequent complaint was soreness at the site of the injection that lasted 1-2 days. When asked about their libido, guys reported various effects, mostly increased sex drive.

It will be a while before guys in the U.S. are able to get hormonal birth control. In other tests of hormonal contraceptives for men, about 1 in 10 guys’ bodies didn’t stop making new sperm. Recent research shows that this may be a question of getting the dose just right—men who weigh more need more testosterone to have an effective contraceptive. That means more frequent or larger injections, and researchers will have to do more tests to prove this works.

A Sperm Blockade?

RISUG is a method of contraception that’s being tested in India. A doctor injects a tiny amount of this gel into the vas deferens, the tube that carries sperm from the testes to the penis. The gel coats the walls of the tube, partially blocking the sperm. Sperm that do get past the gel can’t swim. Studies have shown that the method is 100% effective and provides protection within a week. The most common side effect is swelling of the testes that goes away within 2 weeks. Some men have been using the method for over 15 years now, with no long-term problems reported.

The big question about both RISUG and Vasalgel is whether they're reversible. This hasn’t been studied in humans yet, but researchers have shown they can reverse RISUG in monkeys. An injection of sodium bicarbonate with water dissolves the gel. In the monkey studies, they injected the gel, waited a year and a half, removed it, and found that sperm counts returned to normal within 3 months. They need to show that it can be reversed in men who have used it for many years before RISUG—or Vasalgel—can be touted as a reversible contraceptive option.

In 2010, a non-profit organization that sees great promise in this method completed an agreement with the Indian government to make and test the gel in the U.S. They’re calling it Vasalgel, and they’re producing the gel in a way that should pass muster at the U.S. Food and Drug Administration (FDA). They’ve made the first batches and completed studies in animals. The team hopes to begin clinical trials in men by 2015. It will require several more years of studies and substantial financial support from foundations or the pharmaceutical industry to bring Vasalgel to men in the U.S.

Is That All?

These two methods are the ones likely to be available first in the U.S. There are a dozen other birth control options for men in development around the world. But, until these new options are available, guys in the U.S. will have trusty old condoms, high-discipline pulling out, or irreversible vasectomy.

For guys whose lady friends are using some other method of birth control, they may be able to help make the methods more effective with support. Studies have shown that women whose partners support their use of birth control use their method better. Guys can lend their support by learning about the method their partner is using, providing moral support and reminders as appropriate, and maybe even chipping in for costs.

Grace Shih, MD, MAS is a family practice physician in Seattle, WA. She completed her family medicine residency at Brown University and her family planning fellowship at University of California, San Francisco. When she's not seeing patients, you can find her cooking, hiking, or salsa dancing.

I think this is a great idea.  Men should have a right to choose when they want to have children instead of giving all of that control to the woman.  I hope this doesn't encourage more promiscuity and spreading of diseases.  That would be my worry.

2011-06-09 13:53:27 UTC

MediaGrump

why are people in india and china being treated as guinea pigs? why cant American doctors try this on their own people? Isnt every medicine supposed to be first in the US?

2011-06-10 12:42:39 UTC

Sujal_raj4u

From what I understand, the Vasalgel was invented in India, by an Indian doctor, and thus is being tested there because it's a local, homegrown product. US drug companies are highly unlikely to adopt it because there's no huge profit to be made from the cheap materials and one-time-only administration. (Though the IUD is a one-time-only thing and a profit is made by heavily marking up the cost of the IUD and then charging $$ for the understandably skilled insertion.) Source: That Wired article, linked above.

2011-07-31 20:35:19 UTC

superdaisy

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