In His Shorts: What Happened to Male Birth Control?

Cross-posted at On The Issues Magazine

By Laura Eldridge

While feminists in the 1960s and ’70s dreamed that a “male Pill” was close to happening, today it has become a joke that such a drug has been “five years away” for decades.

Despite huge advances in sexual equality, we still live in a world where contraception is largely the responsibility of women. Scientists, doctors and women have been talking about the possibility of a birth control pill for men since before there was one for women, but male contraceptive options remain the same as they have been for decades — condoms, withdrawal and sterilization.

Why, then, there is still no pill for men?

The answer is rooted in history. Attuned to the urgent unmet needs of women in the first half of the 20th century, the women most responsible for the Pill, Margaret Sanger and Katherine Dexter McCormick, chose to focus on hormonal drugs for women instead of other possible approaches that were in the air by the early the 1950s. The vast amount of research on the female pill that has taken place since then has given scientists time to find solutions to efficacy and safety issues that have arisen over the years. Equivalent limitations posed by hormonal compounds for men, however, have yet to be thoroughly studied and overcome. Scientists are still struggling to find compounds strong enough to last in the body without impractically frequent administration or unacceptable side effects, and also to find a distribution system (a pill, implant or shot) by which to get these chemicals into the body efficiently.

Another significant hurdle to male contraceptive development has been a lack of scientific infrastructure through which to conduct trials. No neat analogue of gynecology exists for men, and the same is true with public health clinics, another place where trial subjects have been found. Doctors have been consistently reluctant to refer patients for trials. When men do agree to participate, it is their female partners who must deal with the consequences if a given method fails to work — and if a method does work, men must bear the side effects without reaping many of the benefits found in preventing unwanted pregnancy.

But not all problems have been technical or scientific: outdated stereotypes about sex and gender have always lingered in the foreground of this issue. Doctors, scientists and pharmaceutical companies claim that male contraception is a doomed project because men (unlike women, of course) don’t want to do anything that would mess with their reproductive systems; that they (in particular, those who are low-income or live in the developing world) have no interest in family limitation considering big families to be status symbols; and that they are unreliable and untrustworthy.

In fact, research shows that men would be willing to try new methods, and that on the whole, female partners would trust them to do so. When it comes to contraceptive development, stereotypical assumptions aren’t helpful to women and should be insulting to men.

Thanks to these scientific, technical, and social obstacles, most new methods of male birth control live somewhere between the realm of science fiction and the reality of an actual, FDA approved drug. Farthest along are hormone drugs meant to eliminate or reduce sperm.

Non-hormonal alternatives, although much further behind scientifically, provide opportunities for scientists to think in innovative ways about reproduction. These methods range from botanical compounds that would kill sperm, to compounds that would inhibit sperm motility or block calcium channels on the tails of sperm, to contraceptive vaccines and even underwear that would inhibit sperm production. However, most of these proposed methods are so far away from being tested, efficacious, safe drugs that they live much closer to the realm of fantasy.

A friend recently asked me whether I thought a male pill was visible on the horizon. “Yes,” I said, and I do.

And when an effective pill is finally made available, men will have to face the same problems and live with the same caveats that women have struggled with for decades. They will have to decide if the health risks are too great, and if they are willing to live with annoying adverse events. There will undoubtedly be preventable tragedies and even deaths. Perhaps they will have to argue with doctors who insist that their complaints of problems are all in their heads.

I don’t wish these problems on the men in my life. But until men have the opportunity take on their half of the responsibilities for birth control, we must continue to commit the radical act of imagining a world in which contraception is an equal undertaking for both sexes.