Why doesn’t a male contraceptive pill exist yet?

In 1962 women started taking contraceptive pills to prevent unwanted pregnancy. But nearly sixty years later, there still isn’t a male contraceptive pill available, even though more than fourty percent of all pregnancies worldwide are unplanned. So why doesn’t a male contraceptive pill exist yet?

What is a male pill?

If we say ‘male pill’, we are talking about a contraception method for men that prevents the female partner from getting pregnant. Out of all the available contraception methods, there is only one (temporary) option for men: condoms. Other contraception methods, like the IUD, contraceptive pill, injection, diaphragm, vaginal ring, female condom, and patch are all used by women. The female partner is therefore usually the one bearing the responsibility (and costs) of preventing unwanted pregnancy.

”Out of all the available contraception methods, there is only one (temporary) option for men: condoms.”

In order not to get their partner pregnant, men can use the pull-out method, also known as coitus interruptus, which isn’t exacly reliable, or they can go for sterilisation, which is a permanent solution. Therefore it isn’t surprising that there is a demand for a male pill, because it’s an easy and reliable way to prevent pregnancy. So why isn’t it available yet?

Also read: Contraception methods for women

A short history of the pill

The pill was initially intended for men. However, doctors felt that the side effects were too severe. By using progesteron to stop the production of sperm cells, testosterone levels in the body decreased as well. This would have to be compensated with testosterone injections. The male pill was also not as reliable as the contraceptive pill for women. In short, it came down to the fact that women were better equipped to deal with the unpleasant side effects caused by the hormones in the pill than men, so voilà: the contraceptive pill for women was here to stay.

The male pill does exist

The answer to the question when a male pill will be created might surprise you: it already exists. The pill has already been tested and it works very well. In fact, there are two different pills in development at the moment.

DMAU male pill

About two years ago, the results of a study by the University of Washington and LA BioMed were presented. During this study, 83 healthy men took the DMAU (dimethandrolone undecanoate) pill once every day for months. “DMAU is a huge step forward in the development of a ‘male pill’,” says dr. Stephanie Page, professor of Medicine at the University of Washington, one of the senior researchers. “Many men say that they’d rather take a pill every day than go for longer-lasting injections or gels, which are also currently in development.” In contrast to the pill that was created many years ago, as yet DMAU doesn’t negatively affect testosterone levels. Read the results of the study here.

11-beta-MNTDC

The male pill 11-beta-MNTDC (11-beta-methyl-19-nortestosterone dodecylcarbonate) is also currently being developed by a team of the University of Washington and LA BioMed. A group of fourty men participated in a study where they took the pill every day for 28 days. The results are positive: the men who took the pill showed a reduced sperm production. There also weren’t many side effects. More research has to be done however, because at the moment, it takes at least two to three months before the production of sperm cells completely stops.

Other new male contraception methods

We mentioned them before: gels and injections are being developed as contraception methods for men.

Hormone gel

Hormone gel is applied to the shoulders and upper arms. Progestagen stops the production of testosterone, which also stops the production of sperm cells. The gel contains an artificial version of testosterone, so that it doesn’t affect sex drive. When a man forgets to apply the gel, there’s no harm done: it takes 72 hours before sperm cells are present in his semen again. The advantage of hormone gel is that it directly enters the blood stream through the skin, while the pill has to be taken orally and is quickly broken down by the liver.

Hormone gel is currently going through a testing process in the aforementioned institutes, but also in universities in Sweden, Scotland, England, Italy, Kenya, and Chile. We won’t know if hormone gel is safe for use until the end of 2021. Researchers will then be able to determine if it reliably prevents pregnancy and if there are any side effects.

Injections

Senior researcher Christina Wang from LA BioMed says: “As far as we know now, we don’t have to use as much of the medicine if we inject it.” This is true for both 11-beta-MNTDC and the DMAU. “But because it’s injected and remains in the body for a longer period of time, the testing process is slower. Every time that we increase the dose, we have to discuss it first before we can move on.”

Why aren’t these products available to the public yet?

The researchers at the University of Washington and LA BioMed say that it could take another ten years before the first male pill is available to the public. They believe there is a market for male contraception methods. “If we ask men about hormonal contraception, 50% of them is willing to try it. And if you ask their partners, that percentage is even higher,” says dr. Page.

The pharmaceutical industry is not that keen on it however. Dr. Page: “In the eighties and nineties, the pharmaceutical industry was interested in it, but that changed in recent years. I suspect they think that there isn’t a huge market for male contraceptive methods.” It also costs a lot of time and money to develop and test the products. If the pharmaceutical industry doesn’t believe it will be profitable, their interest in it decreases considerably. This is why the development of both male pills isn’t sponsored by the pharmaceutical industry, but by The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).