How far are we from the male contraceptive?

The professor at the forefront of male contraceptive science explains

27th February 2018

“It’s weird not knowing what I’m like without the pill.”

Lara’s 22, and has been taking oral contraception for five years. But she’s fed up; of playing “pill roulette”, of being solely responsible for contraception in her relationship; and, most significantly, of the side effects.

“The first pill I took made me a bit crazy – I was so anxious and down. I wouldn’t get on trains or buses that I ‘had a bad feeling about,’ and was certain I was going to die every time I got into a car. I was generally a miserable ball of nerves.” 

“Things have got better, but I still suffer quite badly; I often feel really down. I’m taking a six-month break to find out whether I’m just anxious, or if the pill is making it worse.”

Lara’s story isn’t unique; 81% of women aged 16-49 in the UK take some form of contraception, and the side effects are well documented. Mood swings, acne and nausea are just some of the countless adverse reactions most women tolerate.

Yet, in 2016 the World Health Organisation (WHO) suspended a clinical trial testing male contraception when 20 men dropped out due to negative side effects, including acne, depression and increased libido. The trial was testing a hormone injection to suppress sperm production, and was 96% effective in the 350 participating men. 

So is this an example of double standards? 

Richard Anderson, the Professor at Edinburgh University who led the trial, doesn’t think so. He’s been working on developing contraception options for the best part of 25 years. The only double standard, he says, is the “inherent sexism” in men’s “lazy attitude towards taking responsibility for contraception” – there’s no systemic industry bias.

I think it was a rash decision. It means that people are aware that trials have stopped because of side effects, and that sounds terrible

But he is “disappointed” by the WHO’s judgement.

“I think it was a rash decision. It means that people are aware that trials have stopped because of side effects, and that sounds terrible. There are an awful lot of trials that have been conducted, and very few of them have been stopped prematurely.”

Anderson’s research tested a hormonal approach, giving men an injection of progestogen and testosterone. The injection is more effective than a pill, which has been largely ruled out because of how male hormones are metabolised. The progestogen in the contraceptive works to prevent the cells in testicles producing sperm, but this also reduces the production of testosterone. Therefore, the injection includes testosterone supplements to prevent side effects such as muscle weakening or a reduced sex drive. 

Although developing male contraception is difficult — “you’re trying to stop all sperm production 24 hours a day 7 days a week, which is a slightly more challenging thing to do than interfere with ovulation” —  Anderson thinks funding is the main cause of delays.

The lack of industry involvement in funding and research is, I think, in part because there’s a reluctance to enter a brand new market

The contraceptive market is expected to surpass $33 billion by 2023, but the major pharmaceutical companies remain unwilling to devote significant money towards developing a viable drug. 

“The lack of industry involvement in funding and research is, I think, in part because there’s a reluctance to enter a brand new market.” 

Could this reluctance be due to a lack of demand? 

Well, certainly not on the part of women. 

“I suffer from migraines so I can’t use the combined pill, and when I was on the progestin pill I just felt depressed and tired all the time.” Ellie, 23, says. 

“I’ve tried other options, but they had side effects like two month long periods. I have migraines and anaemia when I’m on my period, so that really wasn’t good. It feels like, fundamentally, I don’t have any choice except using condoms, which aren’t always reliable.” 

“A male contraception would give me more options and take the responsibility off me. It would reduce the guilt of not wanting to take the pill.” 

Anderson agrees. “A lot of women feel pretty fed up if they take the pill for 15 years, have a couple of babies, and are then expected to take the pill again. They think, well actually, there’s two of us and a little bit of sharing would go a long way.”

Back in 2002, a German study asked 9,000 men in nine different countries if they’d be willing to take a new form of contraception; 55% said they’d try it.

But Louis, a junior doctor, thinks the possibility still isn’t discussed enough. 

“I don’t think the demand is enough at the moment for pharmaceutical companies to invest in research. Part of that is because men are comfortable with the status quo. It’s clearly unfair, but it’s much easier to leave the responsibility to women and avoid the side effects – the cancer risks, the pain, the inconvenience.”

And men are clearly worried about the side effects – perhaps unsurprisingly considering that women’s issues have been so widely discussed. 

 “If I had the option and knew all the potential risks were minimal I wouldn’t have a problem,” says Angus, 23. “It would certainly just remove any worry or doubt that a sexual partner wasn’t on contraception.”

I feel it would be safer as you wouldn’t have to rely on condoms, but if I reacted really badly then I’d definitely think twice about continuing

Similarly Michael, 25, thinks: “As long as the side effects weren’t massive I would take contraception. I feel it would be safer as you wouldn’t have to rely on condoms, but if I reacted really badly then I’d definitely think twice about continuing.” 

But, in reality, it’s difficult to say whether men would take contraception until the option is widely available. 

Later this year, Anderson will be contributing to a new trial, funded and organised in the US, to experiment with using a gel to administer hormones. The idea is to provide men with an option that doesn’t involve going to a clinic for an injection every few weeks.

So will a widely available male contraception option, that’s not sterilisation or a condom, be available soon? Sadly, Anderson thinks not. 

“I think it’s completely unrealistic in five years.

“Beyond that it’s anyone’s guess.”

27th February 2018