It takes two to conceive. But the societal responsibility of preventing pregnancy largely falls on women.
This summer’s reversal of Roe v. Wade via the Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision brought conversations about birth control to the forefront. But more than 60 years after the first oral contraceptive for women was introduced, science has yet to develop an FDA-approved method of contraception for men beyond vasectomy and condoms.
One barrier: meeting the criteria. Meharry Medical College professor Anthony Archibong has been studying male birth control since the 1980s. He’s currently working on off-label use for one drug, and in the past has focused on antigen shots, which cause a man’s body to turn against his sperm.
But for the kinds of methods Archibong researches to be considered successful, he says they have to be reversible, cost-effective, accessible, dependable, easy to take, have few side effects and not reduce libido, he says — criteria that are largely not required of popular female birth control methods.
Another barrier for this research is lack of funding. According to the Male Contraceptive Initiative, the Durham, N.C., nonprofit is the largest funder of nonhormonal male contraception research. The organization has an operating budget of approximately $3 million a year and four employees. Since Roe was reversed, the MCI’s website traffic has doubled. There’s been an uptick in interest around participating in clinical trials and donations, according to spokesperson Kevin Shane.
“One individual who gives us millions of dollars each year, he is almost single-handedly making sure that this happens,” Shane says. “We’ve been saying that [a male contraceptive option] is 10 years away forever, because there’s no money and there’s no one doing this work.”
Shane says that with slightly more funding, a hormonal option will likely be first to hit the market. Most promising is Nesterone/Testosterone (NES/T), a gel that’s applied on the shoulders daily. It’s been tested on committed heterosexual partnerships in which the female stops birth control entirely, to success. It’s heading to stage 3 trials, which, according to Shane, means it could be on the market within a few years.
According to a 2019 study led by the Male Contraceptive Initiative, men are twice as likely to opt for a nonhormonal method (80 percent) as a hormonal method (40 percent), though Shane predicts it will be five to 10 years before one hits the market.
The most promising MCI-funded study involves triptonide, an herbal extract used in Chinese medicine that alters the sperm so it can’t penetrate the egg. Another grant recipient, Contraline, is beginning clinical trials for a hydrogel that’s injected into the vas deferens.
Until more options come to the market, one effective option — vasectomies — is seeing an uptick in public awareness. Urologist Matthew Pollard, who performs three to five vasectomies a week, has noticed younger patients who often haven’t already had children in his consultations — and a growing wait list. The majority of the time, a vasectomy is covered by insurance.
Pollard emphasizes that a person should not depend on a vasectomy being reversible, however. He estimates that 80 to 95 percent of the time, a reversal can get sperm back into the ejaculate, though the sperm count and quality is often lower. He recommends that his patients freeze sperm before the procedure for this reason.
“There’s lots of factors, but there is a significant portion of patients who — even though they do get a great reversal and everything went really well and the reconstruction was excellent — they still have to do something additional to get pregnant,” Pollard says.
The procedure typically takes 20 minutes under local anesthesia, and requires one day on the couch, icing the surgical site. The next day the patient will be sore and sensitive, but should be up and doing their normal activities. By the end of the week, they’re totally back to normal.
Still, the most common question Pollard gets around the procedure: Will it affect my sexual function?
“Men who have vasectomies, essentially, the vast majority of time don’t notice any significant change before and after vasectomy as far as their sex life goes,” he says.
Perhaps the largest barrier to getting new male contraceptives on the market is simply the will.
“A lot of people would say, ‘It’s easier to stop an egg a month — the menstrual process — than it is to try and stop this incredible sperm production,’ ” Shane says. “We don’t put too much stock in that because, yes, the science might be complicated, but hey, we’ve been able to put people on the moon for God’s sake. I think we can figure it out.”
