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Tuesday, November 29, 2022
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Male contraception: Why is there still no pill for men?

While modern birth control has existed since the 1950s, researchers are still searching for a male equivalent.

 

The topic of contraception is often seen as a "women's issue" because women are often the ones who bear the burden of pregnancy. However, there is another side to the equation — the development of a male birth control pill has a rocky past, but a hopeful future.

One of the best-known contraceptives on the market is the birth control pill, colloquially known as “the pill.” It is reasonably affordable, very easy to use and very effective. What most people don't know is that the female contraceptive pill was launched in 1957 under the name "Enovit" in the United States. At first, the Food and Drug Administration (FDA) approved the pill for a completely different purpose, namely, to treat menstruation disorders such as irregular menstruation and premenstrual syndrome (PMS). A few years later, in 1960, the pill was available for purchase as a "contraceptive" for the first time. This sudden easy access to birth control was an enormous gain in freedom and peace for women of the 1960s. At the time, women in the U.S. did not have access or knowledge of birth control, and would often resort to dangerous or unreliable alternatives. The pill changed this situation significantly. 

Nurse and women's rights activist Margaret Sanger made a major contribution to the development of the pill. Around the 1920s, it was still almost universally forbidden to talk about contraceptives in the U.S. because of the Comstock Act — a federal law from 1873 to "suppress the trade in and distribution of obscene literature and articles with indecent content." Margaret Sanger fought against this law by making information about birth control and contraceptives available to women. She was arrested in 1916 for opening the first birth control clinic in the U.S. 

Much has happened since the first pill appeared on the market. There are now countless different birth control pills, all of which work in roughly the same way: the pill mainly contains the hormones "estrogen" and "progestin," which prevent ovulation. No ovulation means no egg can form with which the sperm could possibly combine. Thus, fertilization — and pregnancy — is prevented. 

The pill seems to be an all-too-perfect means of birth control — if it weren't for the countless and sometimes extremely severe side effects. The list is long: bleeding disorders, nausea, bloating, weight gain, psychological impairments such as depression, breast tenderness, headaches, dry vagina, cysts on the ovaries, reduced desire for sex, increased risk of thrombosis, deeper voice, more facial hair, acne and more — and about 88% of all women who take the pill suffer from at least one of these side effects.

Women are already taking on many side effects. But, why do we only talk about women in regard to this topic? It takes two people for a pregnancy, so we should also ask ourselves what birth control would be possible for men. Currently, there are only two methods of contraception for men: vasectomy and the condom. But what about a pill for men? 

The concept, which is being tinkered with, works in basically the same way as for women: By taking more testosterone, the hormonal balance in the man is altered so that he produces fewer sperm — so few, in fact, that it is no longer possible to father babies. The problem is that the male body, unlike the female body, immediately breaks down the excess testosterone, so it does not even reach the vas deferens. The testosterone would have to be injected directly into the vas deferens with a syringe, but this is unpleasant and not easy to handle. Likewise, men would have to get this injection from a doctor.

Some studies on male contraceptive methods started in the 1980s. The World Health Organization (WHO) has been researching a "gel" that contains testosterone and norethisterone, and is injected with the help of a syringe. 

Every eight weeks, subjects were given a dose of the hormone cocktail which made them infertile, and the effect lasted only until the injection was no longer taken. However, the study of the WHO was stopped in 2011. The reason: too many side effects, including depression, weakening of libido and weight gain. Does this sound familiar? Yes, these are exactly the same side effects as the ones from the female pill. Unfortunately, the following policy often applies in the pharmaceutical industry: “Never change a winning horse.” Since the current pill works and people buy it, the pharma industry does not see the need to fund studies in the field of male contraception. 

From the perspective of the medical industry, the question of the pill for men also comes with an ethical problem. By taking this pill, a perfectly healthy man would potentially suffer dangerous side effects for something that wouldn’t benefit him directly. From a medical point of view, the woman benefits more from the pill because she is the one who gets pregnant. Because of all the health risks that can come with a pregnancy, a woman in general is “in a riskier position” than the man. The pharmaceutical industry follows the policy: the greater the benefit of a medication, the more side effects can be expected. Since the woman derives a greater benefit from hormonal contraception — because she is the one who is exposed to a higher risk due to a possible pregnancy — she can also tolerate more side effects. Therefore, whether or not it is ok to expose men to similar side effects when they are technically not the ones directly at risk is a highly ethical question. 

The previously mentioned method of hormone injection for men has been further developed in recent years. The problem with the original method was that the enormous amount of testosterone caused too many side effects for patients. Dr. Stephanie Page from the University of Washington has been researching a pill for men with her team for 10 years. However, in contrast to previous research, she does not use testosterone, but androgens. Androgens are a group of hormones that are responsible for sperm formation, as well as hair growth, bone density and muscle development. 

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In clinical trials of Dr. Page’s androgen based birth control, there were only minor side effects in the form of headaches, acne and fatigue. It was also observed that the testosterone levels dropped sharply. Sperm production could therefore be reduced. Research will possibly continue now, as the initial trials in this small study were successful. But that will take at least another 10 years before we will see new results, according to forecasts.

However, research is currently being conducted into a completely different type of contraception method for men: The latest "male birth control" does not require any hormones at all. At the spring meeting of the American Chemical Society, researchers at the University of Minnesota presented a pill that prevents pregnancies without obvious side effects — at least in mice. The product will not be tested on humans until the middle of the year. 

The pill is designed to suppress sperm formation by blocking a protein in human cells. This protein, called retinoic acid receptor alpha, binds retinoic acid, a form of Vitamin A, in cells. It plays an important role in cell growth, embryonic development and cell differentiation — the latter including sperm formation.

Research is not idle in the field of male contraceptive methods. However, there is always something that gets in the way — be it the side effects or, often, the costs. There are already many different approaches, but a major hurdle is the pharmaceutical industry. They think, "There is a pill on the market that works. Why should we then pour money into research?" There are a substantial number of approaches, but the economic side of the debate is afraid the product might not be profitable enough. 

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