What’s the Hold-Up on Male Birth Control? 

The reason there's still no male birth control pill? The same reason the female birth control pill isn't better than it is: a lack of research, development—and priority.

It takes two to tango, so why aren’t there more contraceptive options for men beyond condoms and vasectomies? According to Brian Nguyen, assistant professor of obstetrics and gynecology at the University of Southern California, it’s structural challenges (not biological ones) that have made developing a male birth control pill difficult.

“We know which compounds can bring men’s sperm count down to zero and we know how to reverse it and its safety profile and side effects,” explains Nguyen, who is part of a team working on the development of NES/T, a male contraceptive that’s currently in the second phase of clinical trials. “What’s stopping us is the lack of funding, time, and investment.”

Namely, Nguyen points to perpetuated societal narratives around who contraceptives are for as a major barrier research and development. Generally, society views birth control as the responsibility of the birthing partner—if you don’t want to have a baby, the partner who gets pregnant should be the one who takes care of contraceptives. But why should only one partner shoulder the burden? “It’s problematic when we continue to cast negative narratives about not being able to trust men with contraceptives,” says Nguyen. “In healthy relationships, the decision making and planning is shared.”

NES/T, the contraceptive Nguyen is working on, is a gel that’s applied on the shoulders daily. Funded by the National Institute of Child Health and Human Development in the U.S., NES/T is a combination of Nestorone (which is a proprietary progesterone) and testosterone that, when applied, “results in a drop in sperm to levels that are incompatible with getting someone pregnant,” explains Nguyen. There are some side mild side effects, namely acne, changes in libido, weight changes, and mood changes, but participants in clinical trials are tolerating these side effects, and the motivations for using NES/T outweigh the cons, Nguyen says. Unfortunately, there’s no timeline yet for when NES/T will be available on the market—Nguyen says that, at current funding levels, the projection is about 10 years—but an infusion of funding and human capital could speed things up, just like how the COVID vaccine was prioritized.

There’s also a birth control pill for men currently being tested. Dimethandronlone undecanoate (DMAU) works by suppressing hormones to decrease the production of testosterone and sperm without causing the negative effects of low testosterone (namely a diminished libido, erectile dysfunction, depression, fatigue, and loss of muscular strength). There’s also YCT529, a non-hormonal pill that reduces sperm counts by targeting a form of vitamin A that plays an important role in sperm formation. “These options are very promising but much earlier in terms of their progress down the concept development pipeline,” explains Nguyen.

Then there are the less…serious options being talked about. In 2021, a “testicle bath” won Germany’s coveted Dyson award for design. Coso, the conceptual ball jacuzzi in question, uses ultrasound and heat to temporarily halt sperm mobility, making it more difficult for it to fertilize an egg. Though, it should be noted that Coso was developed for a design challenge—not as a medical product or trial. “I love that it’s done a lot of press, because it shows that there’s a huge interest in male contraception—particularly non-invasive methods,” says Nguyen.

Despite the innovations that have been made in the field, it’s unlikely that an effective male contraceptive will be available any time soon. “The number of researchers who do this work—like, the number of high-level researchers—is less than what I can count on two hands,” he says. “So, how can we bring in more researchers? It’s by ensuring that there’s funding and making sure scientists are interested and trained.”

Next: The Pill Is Good. Why Isn’t It Better?

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Originally Published in Best Health Canada