Is Male Birth Control Finally Coming?

Por Julia Lurie — Mother Jones Magazine

The summer of 2021 was supposed to be a joyful season of life for Mattie Quinlan: She had just gotten married and was settling down with her husband, Ryan, in Provo, Utah. The young couple, who had met during their mission trips with the Mormon church, wanted a big family—just not right away, which is why Mattie was on birth control.

About a month into their marriage, though, she stopped taking the pill. “I was like, I can’t do this anymore,” she says. “I was just not feeling like myself, and I was pretty depressed.”

Her experience isn’t particularly unique: Roughly a fifth of women stop using birth control or change methods within the first six months, often because of mood-related side effects.

But then Ryan saw something on Instagram that caught his eye: an advertisement recruiting participants to a clinical trial for a new contraceptive for men. Ryan didn’t mind condoms, but wanted a better option—one that they didn’t have to think about in the moment and didn’t come with side effects for his wife. Mattie was on board, especially after learning that dozens of couples had already participated in the study. “I was like, I don’t have to do anything? Great,” she says. “Beautiful.”

Ryan and Mattie were among the 462 couples between 2018 and 2024 who took part in a clinical trial for NES/T, a hormonal gel that decreases sperm count while maintaining testosterone levels. Each morning, for a little over a year, Ryan applied the gel to his shoulders after he got out of the shower. Every month, he drove to Salt Lake City, where researchers checked his sperm count, vitals, and mood. A few weeks in, when Ryan’s sperm count was low enough, the couple stopped using condoms.

Data from the study hasn’t been released yet, but Dr. Brian Nguyen, an investigator for the trial and an assistant professor of obstetrics and gynecology at the University of Southern California, says there were no serious adverse events, and the rate of unplanned pregnancies was in line with other hormonal contraceptives. Some participants, he added, experienced “very minor” side effects, including weight changes, mood changes, acne, and increased libido.

For Ryan and Mattie, the gel was ideal: He didn’t experience side effects, and she didn’t get pregnant. Ryan’s sperm count quickly returned to normal after he stopped using the gel, at which point the couple decided they were ready for kids. After trying for just a month, Mattie got pregnant.

For decades, women considering birth control have had myriad options: pills, shots, patches, rings, implants, intrauterine devices, and more. Those options have their flaws, to be sure, but they exist. Men, however, have two choices: condoms, which have a user failure rate of up to 16 percent, or vasectomies, a surgical procedure that, while often reversible, can feel too permanent, particularly for younger men.

“Contraception has been completely associated with not just women, but women’s empowerment as well as women’s burden,” says Heather Vahdat, director of the Male Contraceptive Initiative, which funds research and development of male birth control options. “Men haven’t been asked to come to the table.”

Thanks to a new wave of research and development, the tide may be turning. NES/T will enter late-stage clinical trials early next year, which will involve hundreds more couples. Contraline, the company developing NES/T, is also working on a nonhormonal implant called ADAM, which is inserted into the vas deferens in an outpatient procedure with a similar effect to a temporary vasectomy. It has been shown to be effective for up to 24 months, and finished a 25-person safety trial this spring. Meanwhile, YourChoice Therapeutics is developing a nonhormonal daily pill currently undergoing an 88-person safety trial.

For Ryan and Mattie, sharing the responsibility—and potential side effects—of birth control felt simultaneously revelatory and long overdue.

“Thank goodness that this is happening now,” Mattie says, “but why is it only now happening?”

Subscribe to Mother Jones podcasts on Apple Podcasts or your favorite podcast app.

In the late 1950s, around the same time that the first oral contraceptive was being tested on women, another contraceptive pill was being developed—for men.

Like the pill for women, which was tested on low-income women in Puerto Rico, the pill for men was studied in circumstances that wouldn’t fly today. Male inmates in a prison near Salem, Oregon, took the pill for months. At first, it seemed like a miracle drug. The men didn’t have serious side effects, and their sperm counts dropped. When they stopped taking the pill, their sperm counts shot back up to normal levels.

But when a participant drank contraband Scotch, he became violently ill. As it turns out, in addition to blocking an enzyme that leads to sperm production, the pill also blocked an enzyme that metabolizes alcohol. After scientists discovered that men taking the pill wouldn’t be able to drink, research into the pill was abandoned.

There’s a joke in the world of male contraceptives: They’ve been five years away for the past 50 years. Again and again, promising new treatments have been halted by critical setbacks. The cycle played out again from 2008 to 2012, when hundreds of men participated in study of a new hormonal injection. The men seemed to like the product—more than 4 out of 5 participants said they’d use it if it were available. But the injection caused side effects, like acne, muscle pain, and mood changes. Three percent of participants reported depression. One man attempted suicide. After that, the scientific review panel cut the study short, determining that the risks outweighed the benefits.

Some experts say the failed male contraceptive trials underscore a double standard. For women, side effects from contraceptives are an expected burden, while for men, they are deemed intolerable. More than six percent of users of the Mirena, the nation’s leading intrauterine device, experience depression as a side effect—double that of what the men experienced in the trial.

Related

Me, Myself, and IUDs

For decades, the pervading assumption was that men simply weren’t interested in male contraceptives, but recent research suggests otherwise. An international survey in 2021 and 2022 found that 61 percent of men were interested in trying new male contraceptives. In the United States, only 39 percent of men were interested—a number that jumped to 49 percent when the researchers administered the survey again in 2023, after the Dobbs decision overturned the federal right to abortions.

In the absence of a product on the market, there’s no shortage of men interested in participating in clinical trials. More than 23,000 men have signed up on Contraline’s online registry for future trial enrollment.

“We have men email us all the time,” Vahdat says. “Ninety-five percent of them are things like, ‘I have a partner that can’t use contraception,’” she adds. “It’s mostly men desperately trying to be a good partner, trying to offer something.”

Vahdat recalled men she’d talked to over the years: the husband in a Delhi slum who wished he could take a pill so his wife wouldn’t have to; the Bay Area high schooler who wanted something to shield himself from the fallout of an unintended pregnancy; the man in the Frankfurt airport who spotted her “Male Birth Control Now” shirt and hugged her.

Despite the widespread interest, big pharmaceutical companies have been notably absent from the race for the new male contraceptive. That’s partly because developing new forms of birth control, for men or women, comes with unique liability. Unlike most drugs, contraceptives don’t necessarily treat an illness. Rather, they suspend a critical function in healthy people—reproductive ability—and guarantee that it will return. Pharmaceutical representatives have told Vahdat that they’re interested, but at this stage, there’s still too much risk attached to the products.

Plus, from a business perspective, there’s no sign that there’s a problem to solve: Use of contraceptives among women remains high. “There’s this sense of, ‘We have good enough products,’” Vahdat says. “That’s where the misogyny starts to eke in a little bit.’”

Whether the first new male contraceptive is a gel, an implant, a pill, or something else entirely, it will have to contend with the challenges of being the first. The Food and Drug Administration’s review process will likely be lengthy, since male contraceptives are a new product category. It’s unclear what the guidelines for the products will be, and how much tolerance regulators will have for side effects. And the products will almost certainly face cultural backlash, too—particularly in a world of politicians and influencers laser-focused on testosterone levels and virility.

Kevin Eisenfrats, the Contraline CEO, says the company plans to roll out NES/T by 2030 as the “gateway to the male contraception world”—easy to use, delivered on a monthly subscription basis. He analogizes ADAM, the implant like a temporary vasectomy, to long-term contraceptives like IUDs. Just as the pill for women came before the IUD, Contraline plans to introduce NES/T before ADAM. “We have to get people excited about male birth control,” he says, “and then they can be like, ‘Well, I’m already doing this thing every day—maybe I’ll go get this 10-minute procedure, and then I don’t have to think about it every day.”

Mattie and Ryan Quinlan, for their part, hope their daughters will grow up in a world in which male contraceptives are so common that they’re unremarkable.

“I don’t think it should be any one person’s job to do it,” Ryan says. “I don’t think it should necessarily sway and be only the man’s responsibility. I just think there should be like equal options for men and women.”

Fonte: Mother Jones Magazine