Why Male Contraception?
After being embedded in reproductive health work for 15+ years, I’ve found myself intrigued by the novelty of male contraception. I accepted a position on the Board of Male Contraception Initiative (MCI) two years ago, and then stepped in during a leadership gap as Interim Executive Director at the end of 2017.
The time has come for innovation in the contraception space. Don’t get me wrong—I love the Pill and LARCs, but they all rely on interrupting female hormonal cycles. And think about it: There has been little to no innovation in contraception since the ‘50s, and it’s 2018.
After the Pill hit the market and sparked a virtual revolution in women’s lives, researchers invented new ways to deliver hormones, including injectables, implants, patches, and hormonal IUDs. Women now have an array of hormonal contraceptive choices with the ensuing side effects. Because this method of action—the interruption of the menstrual cycle using hormones—is so effective, there has been little research on non-hormonal contraception with fewer side effects for either men or women to date.
Why Male Methods?
Men don’t have any cycles directing sperm production: the testes produce sperm continuously. Researchers have discovered that giving men progesterone—primarily a female hormone—plus testosterone can stop sperm production in most men. There are several problems with using hormonal contraception in men, including side effects that may occur among women, in particular mood changes such as depression. While research is ongoing, no male hormonal contraceptive is close to being approved by the FDA.
This leaves men today with just two choices—condoms and vasectomy—or three, if you count withdrawal with its low efficacy rate. We need new non-hormonal approaches.
Researchers of new male contraceptive methods have faced a number of challenges to date.
Scientific: Most earlier research on male contraception has focused on a complete but reversible halt to sperm production. All compounds under study had some fatal flaw, such as severe side effects or not being reversible in all men.
In recent years, more researchers are beginning to focus on affecting sperm function rather than halting sperm production (think yellow light rather than red). Examples of functional changes can include preventing sperm from swimming or from being able to fertilize an egg, or even muscle inhibitors in the vas that allow men to orgasm but stop ejaculation.
Acceptability: Until today, there has only been conjecture about the feasibility and acceptability of a new male contraceptive. MCI has new market research data that shows that most men in the U.S. want equity in contraception, and would use a new, reversible, effective non-hormonal method once one is on the market.
Policies: Since the Pill was brought to market more than 50 years ago, funding has continued to be focused on hormonal female methods (specifically LARCs) and global access. These are incredibly important policy foci. And there needs to be a significant shift to more research funding for non-hormonal methods for both men and women, bringing the field of reproductive technology into the 21st century.
It’s not going to happen tomorrow; but there’s a movement afoot. Won’t you be part of the change? Join us at Male Contraception Initiative!
This blog series is a collaboration with FHI 360 and can also be found on the CTI Exchange.