tag:theconversation.com,2011:/us/topics/male-pill-29770/articlesmale pill – The Conversation2018-05-21T19:49:16Ztag:theconversation.com,2011:article/925092018-05-21T19:49:16Z2018-05-21T19:49:16ZHere’s what’s on the horizon for a male contraceptive pill – but don’t hold your breath<figure><img src="https://images.theconversation.com/files/217427/original/file-20180503-153914-16y2xw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Men currently only have two contraceptive options: condoms or a vasectomy.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/ZbWuFoNau98">Javier Canales</a></span></figcaption></figure><p><em>ON THE PILL: In this <a href="https://theconversation.com/au/topics/pill-series-52834">seven-part series</a> we explore the history, myths, side-effects and alternatives of the pill, and why it’s the most popular form of contraception in Australia.</em></p>
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<p>The female contraceptive pill has helped millions of women take control of their fertility and reproductive health since it <a href="https://peopleshistorynhs.org/encyclopaedia/birth-control-on-the-nhs/">became available in 1961</a>. Yet a male equivalent has yet to be fully developed. This effectively leaves men with only two viable contraceptive options: condoms or a vasectomy. </p>
<p>The idea of creating a male contraceptive has been around almost as long as the female contraceptive. In theory, targeting the production of sperm should be a simple process. The <a href="http://www.open.edu/openlearn/body-mind/health/health-sciences/the-science-sperm">biology of sperm production</a> and how they swim towards the egg are well understood. </p>
<p>Yet, studies aimed at developing an effective male pill have been dogged by issues such as severe side effects. Most recently, a <a href="http://press.endocrine.org/doi/10.1210/jc.2016-2141?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&">study</a> that injected men with the hormones testosterone and progestogen – similar to hormones found in the female pill – had to be stopped early. </p>
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<a href="https://theconversation.com/why-the-male-pill-is-still-so-hard-to-swallow-68133">Why the male 'pill' is still so hard to swallow</a>
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<p>The study, from 2016, showed pregnancy rates for female partners of men receiving the injections fell below that typically seen for women on the pill. </p>
<p>But the study was cut short due to reports of adverse side effects including acne, mood disorders and raised libido. For the men taking part, these side effects proved too severe for them to continue, despite the desired drop in sperm production. </p>
<p>However, many people <a href="https://www.nhs.uk/conditions/contraception/combined-contraceptive-pill/#Advantages%22%22">may see these side effects as relatively minor</a> compared to those suffered by women on the pill, which include anxiety, weight gain, nausea, headaches, reduced libido and blood clots.</p>
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<img alt="" src="https://images.theconversation.com/files/217434/original/file-20180503-153878-17uazz7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/217434/original/file-20180503-153878-17uazz7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/217434/original/file-20180503-153878-17uazz7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/217434/original/file-20180503-153878-17uazz7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/217434/original/file-20180503-153878-17uazz7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/217434/original/file-20180503-153878-17uazz7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/217434/original/file-20180503-153878-17uazz7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">No human trials of the male pill have successfully provided contraception with tolerable side-effects.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/oral-contraceptive-pill-on-pharmacy-counter-660070825">Areeya_ann/Shutterstock</a></span>
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<p>Male contraceptives have been under development for at least 50 years. However, the drive to bring a male contraceptive onto the market has stalled for two main reasons. </p>
<p>First, there is a general pessimism of men towards taking a contraceptive pill, especially <a href="https://www.thenewsminute.com/article/contraceptive-cruelty-how-patriarchy-determines-birth-control-use-india-55850">in countries such as India</a>. </p>
<p>Second, the global <a href="http://www.independent.co.uk/news/business/news/male-contraceptive-block-drug-companies-examples-female-pill-injection-india-startup-big-pharma-a7665511.html">success of the female pill</a> provides little incentive for pharmaceuticals to invest in a male pill. Globally, the female pill is the <a href="https://onlinedoctor.superdrug.com/birth-control-around-the-world/">third most-used form of contraception</a>, with a projected market value of nearly <a href="https://www.thepharmaletter.com/article/oral-contraceptive-pills-market-to-reach-22-9-billion-by-2023-study">US$23 billion by 2023</a>.</p>
<p>Despite these setbacks, a new way of thinking about male contraception is taking shape. Here, the focus has shifted from stopping sperm production to stopping the sperm being able to fertilise the egg. </p>
<h2>The clean sheet pill</h2>
<p>The <a href="https://www.parsemus.org/projects/clean-sheets-pill/">clean sheet pill</a> effectively works as its name suggests: preventing the release of sperm. </p>
<p>The clean sheet pill has two main selling points. First, by preventing the release of sperm and the fluid they are carried in, the clean sheet pill simultaneously prevents unwanted pregnancy and the spread of sexually-transmitted infections. </p>
<p>Second, because the pill does not affect the feeling of orgasm, there is no reduction in male sexual pleasure. </p>
<p>Unfortunately, the clean sheet pill has so far only been tested in animals. As such, a version for human use is probably ten years away from being developed.</p>
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<span class="caption">The clean sheet pill is good idea but is still in the early stages of development.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/YYHWa4He1JM">Madi Doell</a></span>
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<h2>Vasalgel</h2>
<p>One of the downsides of a vasectomy is that it can render a man permanently sterile. However, the recent development of a product call <a href="https://www.parsemus.org/projects/vasalgel/">Vasalgel</a> may offer men a serious alternative to a vasectomy. </p>
<p>Vasalgel is a long-term, non-hormonal yet reversible form of contraception. This offers benefits over both hormonal contraceptives with their side effects as well as the permanency of a vasectomy. </p>
<p>Vasalgel is polymer that is injected into the <a href="https://en.wikipedia.org/wiki/Vas_deferens">vas deferens</a>, the tube that carries sperm from the testes. This allows the movement of fluid, but stops the passage of sperm. </p>
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Read more:
<a href="https://theconversation.com/a-new-male-contraceptive-could-help-men-bear-the-family-planning-burden-62790">A new male contraceptive could help men bear the family planning burden</a>
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<p>In a <a href="https://bacandrology.biomedcentral.com/articles/10.1186/s12610-017-0048-9">trial in monkeys</a>, Vasagel was found to be 100% effective at preventing conception. In <a href="https://bacandrology.biomedcentral.com/articles/10.1186/s12610-017-0051-1">separate studies in animals</a>, the effect of Vasagel was easily reversed with a simple second injection to dissolve the polymer. </p>
<p>If these effects are replicated in men, this could offer a low-cost, minimally invasive and effective contraceptive that is also reversible. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/PtUJj_QRvFg?wmode=transparent&start=4" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">If the success of animal trials can be replicated in humans, here’s how Vasagel would work in humans.</span></figcaption>
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<h2>Heart-stopping poisons</h2>
<p>A deadly, heart-stopping poison might not sound like a good starting point for a new male contraceptive. However, researchers have shown that a toxic compound call <a href="https://en.wikipedia.org/wiki/Ouabain">oubain</a> can be be used to slow down the swimming of sperm. </p>
<p>Researchers already knew that oubain <a href="https://link.springer.com/article/10.1007/s11596-014-1236-x">could affect male fertility</a>. But the cardio toxic effects of oubain prevented scientists from exploring its effects on male reproduction in any detail. </p>
<p>By modifying the structure of the oubain molecule, <a href="https://pubs.acs.org/doi/10.1021/acs.jmedchem.7b00925">researchers showed</a> it can be used to reduce the motility (ability to swim) of rat sperm while being non-toxic to the heart. </p>
<h2>Research and development</h2>
<p>While research into male contraceptives have been ongoing for nearly 50 years, we still seem to be at least “five to ten years away” from an effective male pill. </p>
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Read more:
<a href="https://theconversation.com/we-wont-have-a-male-contraceptive-until-we-change-our-understanding-of-risk-68375">We won't have a male contraceptive until we change our understanding of risk</a>
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<p>Potential new targets for male contraceptives are being developed and tested scientifically all the time. However, without the significant input and push from big pharmaceutical companies, these discoveries may never see the light of day. </p>
<p>With the cost of developing a new drug to market estimated at <a href="https://cen.acs.org/articles/92/web/2014/11/Tufts-Study-Finds-Big-Rise.html">US$2.6 billion</a>, the burden of family planning looks to remain firmly on the shoulders of women for now.</p><img src="https://counter.theconversation.com/content/92509/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Watkins receives funding from the Biotechnology and Biological Sciences Research Council (BBSRC) under grant number BB/R003556/1. </span></em></p>Male contraceptives have been under development for at least the past 50 years, because of the success of the female pill and pessimism about men taking a pill.Adam Watkins, Assistant Professor, University of NottinghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/681332016-11-05T12:31:22Z2016-11-05T12:31:22ZWhy the male ‘pill’ is still so hard to swallow<figure><img src="https://images.theconversation.com/files/144437/original/image-20161103-25329-1g8fa8t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Okay for women, but what about men?</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/dl2_lim.mhtml?src=HdRlUOkWprnSWU_oY-gDMA-1-6&id=160288271&size=medium_jpg">Shutterstock</a></span></figcaption></figure><p>A recent study looking at the effectiveness of a male contraceptive injection was abandoned after the men taking part reported <a href="http://press.endocrine.org/doi/10.1210/jc.2016-2141?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed">increased incidences</a> of acne (nearly half), mood disorders (over a fifth) and raised libido (over a third). In fact, there were 320 men in the study – and a total of 1,491 adverse events were reported. For those overseeing the trial these side effects were viewed as being more significant than the fact that the contraceptive injection appeared to work well in reducing the production of sperm – and the evidence does appear to support their concerns?</p>
<p>Nevertheless, many women will feel these side effects seem minor when compared with those of the female contraceptive pill – and they’d have a point, too. These include <a href="http://www.nhs.uk/conditions/contraception-guide/pages/combined-contraceptive-pill.aspx#Advantages%22%22">anxiety, weight gain, nausea, headaches, reduced libido and blood clots</a>. Which raises the question: why is it so hard to make a male contraceptive? And if the plug has been pulled on this one because of side effects, would the female contraceptive pill make it to market if it were released today? </p>
<p>On the face of it, regulating fertility in men should be the more obvious choice. Sperm are produced on a constant basis and not in cycles like eggs are in women. This means that, barring any underlying health problems, men are always fertile. In addition, as the biology of sperm production is <a href="http://www.open.edu/openlearn/body-mind/health/health-sciences/the-science-sperm">well-known</a>, the mechanisms of how to block it are also well-known. </p>
<p>Indeed, the current study was exploiting the well-established relationship between testosterone – the hormone that gives men their male characteristics – and sperm production. By giving men synthetic testosterone in combination with a hormone called progestogen – similar to the hormones usually found in the pill – sperm production in the testes is reduced dramatically. </p>
<p>Before the study was halted, the researchers from Martin Luther University, Germany, observed that pregnancy rates for the men on their trial fell to an equivalent of just <a href="http://press.endocrine.org/doi/10.1210/jc.2016-2141?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed">1.5 babies conceived per 100 couples</a>. Compare this with the pregnancy rate of nine babies per 100 couples for <a href="http://www.arhp.org/Publications-and-Resources/Quick-Reference-Guide-for-Clinicians/choosing/failure-rates-table">women using the combined pill</a>, and the development of such a male contraceptive seems like a no-brainer.</p>
<h2>So what’s going on?</h2>
<p>Yet, here we are at the end of another study – without being any closer to the development of a viable male contraceptive. As such, women are left once again placed solely in charge of their fertility as well as bearing the brunt of the side effects. Many women may view the side effects as the lesser evil when compared with an unplanned pregnancy, and many <a href="https://www.theguardian.com/commentisfree/2016/oct/30/will-we-believe-a-man-who-says-he-is-on-the-pill">may also question</a> whether leaving the responsibility of contraception in the hands of men will work. </p>
<p>But the side effects of the male pill could actually have been an unlikely beneficial factor. With both partners actively taking contraceptives – and sharing an understanding of the side effects – a joint sense of responsibility for the couple’s fertility would be established. Also, if one partner needed to take a break from their contraceptive, the other could start taking theirs, sharing the impact of those side effects.</p>
<p>So why has it been so difficult to develop an effective male contraceptive when women have been taking the pill, and enduring the side effects, since the early 1960s? In fact, looking at the original trial results from 1956, it’s hard to see how the contraceptive pill ever actually made it to market.</p>
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<span class="caption">Well, there’s always these.</span>
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<p>The <a href="http://pdf.usaid.gov/pdf_docs/PNAAV359.pdf">first large-scale human trial</a> was conducted in Rio Piédras, a Puerto Rican housing project. The women taking part received little information about the product they were receiving, partly because there was little to give and partly, perhaps, because none of the people running the trial felt it necessary. Such were clinical trials in the 1950s. </p>
<p>While women even then reported side effects including headaches, dizziness, nausea and blood clots, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520685/pdf/058e757.pdf">these were largely dismissed</a>. Thankfully, since then, the pill has undergone constant refinement and modification, becoming a form of contraception now taken by an estimated <a href="http://www.un.org/en/development/desa/population/publications/pdf/family/trendsContraceptiveUse2015Report.pdf">225m women world-wide</a>. </p>
<p>The pill has unquestionably <a href="http://www.albertmohler.com/2010/04/26/the-pill-turns-50-time-considers-the-contraceptive-revolution/">changed female sexual freedom</a>, allowing women <a href="http://www.bbc.co.uk/news/uk-15984258">greater control over when to have children</a>. Indeed, in 2012, UK women voted the pill their favourite invention of the last century – ahead of leisure devices such as the <a href="http://www.thescottishsun.co.uk/scotsol/homepage/news/4239571/Women-say-the-Pill-is-their-favourite-invention.html">internet and the television</a>. </p>
<p>Consequently, it is strange that more resources haven’t been ploughed by big pharmaceutical into a male pill. Part of the problem appears to be the very success of female contraceptives. As many pharmaceutical companies make <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464843/pdf/AJPH.2012.300706.pdf">big profits from female contraceptives</a>, there is little desire to take focus away from them. </p>
<p>It also appears that there isn’t a universal desire by men for such a form of contraception. Indeed, a <a href="http://humrep.oxfordjournals.org/content/20/2/549.full.pdf+html">2005 study</a> surveyed more than 9,000 men across nine countries about their willingness to take a male pill. While approximately 70% of men in Spain and Germany stated they would be happy to take it, less than 30% of men in Indonesia displayed a positive attitude towards it.</p>
<h2>Shared responsibility?</h2>
<p>In the meantime, it seems that until there’s more demand from men for a “pill” of their own, the responsibility will be left to women. This means that the need for such a powerful regulator of fertility as the female contraceptive pill is still needed today as much as ever. </p>
<p>It should be remembered that many women take the pill for its additional benefits such a relieving heavy menstrual bleeding and pain, reducing acne and helping with <a href="http://www.nhs.uk/Conditions/Premenstrual-syndrome/Pages/Symptoms.aspx">premenstrual dysphoric disorder</a>. With the development of new and improved contraceptive pills that contain lower hormone doses, the negative side effects of the pill also appear to be reducing.</p>
<p>Indeed, in light of the enormous benefits that the contraceptive pill has brought to women and their sexual health, it would be hard to imagine a world without it. But perhaps we should also be asking why, even in the 21st century, the idea of a man taking a contraceptive “pill” remains such a big deal.</p><img src="https://counter.theconversation.com/content/68133/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Watkins does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Side effects have led to the plug being pulled on the male contraceptive injection. But what about those experienced by women on the pill?Adam Watkins, Research fellow, Cell & Tissue Biomedicine, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/627902016-07-29T05:56:13Z2016-07-29T05:56:13ZA new male contraceptive could help men bear the family planning burden<figure><img src="https://images.theconversation.com/files/132170/original/image-20160727-5660-1pyf96r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>A new method of male contraception that is as effective as a vasectomy but entirely reversible with little to no side-effects is being tested and is showing promising results in <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4812607/">animal trials</a>.</p>
<p>If it is successful, it could drastically change the field of contraception. It would give men the power to prevent a pregnancy without any input from women using a method that is not permanent, such as the vasectomy.</p>
<p>The vasectomy is currently the only reliable contraceptive option available to men. It is a minor surgical procedure where the the duct that conveys sperm from the testicle to the urethra is tied or cut. The challenge is that it is not reversible.</p>
<p>The new contraceptive – <a href="https://www.parsemusfoundation.org/projects/vasalgel/">Vasalgel</a> – is a type of no-scalpel vasectomy. It has no hormonal effects or other side-effects, and can be reversed when the man wants to start a family.</p>
<p>In the same way that a vasectomy would, Vasalgel blocks the flow of sperm from the testicles to the penis. But it does not require any surgery. Instead of severing the tube that carries sperm – called the vas deferens – a gel is injected into the tube, forming a barrier that blocks sperm but allows other fluids to pass through.</p>
<h2>Low uptake of vasectomies</h2>
<p>Vasectomies are usually quick and straightforward procedures that carry minor risks like bleeding or infection. There is also a small chance that a man might experience post-vasectomy pain due to pressure build-up in the testicles. </p>
<p>Although very few vasectomies fail or go wrong, globally there has been a low uptake of this procedure. </p>
<p>In 2013 only <a href="http://www.un.org/en/development/desa/population/publications/pdf/family/worldContraceptivePatternsWallChart2013.pdf">2.2% of men globally</a> had vasectomies. This compares to 18.9% of women who underwent female sterilisation. Although some countries like Canada have higher rates of men who have undergone a vasectomy (22%), in Africa only <a href="http://www.fhi360.org/sites/default/files/media/documents/no-scalpel-vasectomy-rwanda.pdf">0.1% of men</a> have undergone vasectomies.</p>
<p>On the continent, vasectomies could be one of the most effective male birth control methods because they are inexpensive and could therefore have a major impact on sustainable development and population growth. But the procedure is misunderstood and, as a result, is poorly used.</p>
<h2>A second attempt</h2>
<p>The new contraceptive is not the first time a male contraceptive has been introduced. Several years ago, the idea of the “male pill” was abandoned and more recent <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4023373/">research efforts</a> have been focusing on intra-vas devices, including Vasalgel.</p>
<p>Previous efforts to develop a male contraceptive focused on hormonal manipulation, which is how the contraceptive “pill” for women works. A man would basically be given hormones (like testosterone and progesterone) and these hormones would then interfere with certain processes in the body and cause the testicles to stop producing sperm.</p>
<p>The male hormone testosterone is linked to sperm production and by lowering the testosterone level in a man’s testicles you can prevent the production of sperm. But to lower testosterone in the testicles, you have to increase testosterone levels in the blood. Several studies have shown that there are too many unpleasant side-effects to this. These include aggression, depression, fatigue, low libido, high blood pressure and an increase in cholesterol levels.</p>
<p>Researchers have also tried to tweak the method of hormonal male contraception by adding other hormones, like the female hormone progesterone. But it still had too many side-effects and wasn’t effective enough. </p>
<h2>Final steps</h2>
<p>Vasalgel is currently being tested in humans but its reversability has only been shown in animal studies. These studies have shown rapid restoration of sperm flow.</p>
<p>For the reversal to happen, the man gets an injection of a bicarbonate solution into the duct that conveys sperm from the testicle to the urethra. This bicarbonate solution will dissolve the Vasalgel and it is flushed from the duct.</p>
<p>The challenge with Vasalgel is that although it blocks the flow of sperm, it does not offer any protection against the transmission of sexually-transmitted infections such as HIV.</p>
<p>Family planning is still considered a woman’s responsibility in many parts of the world. This has prevented men from being more involved in family decisions about fertility. It has also limited their access to family planning services targeted at them. The new method could be the first step to change this.</p><img src="https://counter.theconversation.com/content/62790/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amir Zarrabi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The vasectomy is currently the only reliable contraceptive available to men. But a new option could give men more family planning power.Amir Zarrabi, Urologist and Lecturer, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.