Why isn’t there a hormonal birth control for cis men?
Top things to know:
Men are showing more and more willingness to take hormonal birth control
A hormonal topical gel is currently being tested in human clinical trials
New non-hormonal options for men are also being developed
Currently, birth control methods for men are limited to condoms, withdrawal, or vasectomy, each with variable failure rates (1, 2). While hormonal birth control methods for men have been studied since the 1970s, as of 2019, none are yet commercially available (3, 4) and it’s likely that we won’t see a commercially available product yet for many years (4).
By and large, women have taken on the burden of contraception. Research shows that women are responsible for planning and executing methods of contraception about 60% of the time, in sexual encounters (5).
Even when shared methods like male condoms are in the mix, women are still disproportionately involved with managing their use—studies show that 90% of the time, women are involved in managing all instances of contraceptive use (5).
The research on these topics uses the terms "men" and "women," so we are using those terms in this article, along with terms like "male" and "female" in reference to cismen and ciswomen. We don't know whether trans and nonbinary people were included in this research. More research is needed on birth control methods for trans and nonbinary people.
As a culture, we tend to think of contraception as a women’s responsibility—even in research reports, a woman’s use or disuse of birth control tends to be the only narrative (1) when it comes to explaining unintended pregnancies. But luckily, these views are changing. Surveys and men in hormonal contraceptive studies globally are showing an increasing interest in methods of male contraception (3, 6).
In 2005, a study of over 9000 men in nine different countries found that 55% of men in stable relationships were willing to consider using birth control (7).
And, the fact that nearly 50% of all pregnancies worldwide are unintended has created renewed interest and support amongst scientists, policy makers, and funding agencies (8, 9), to develop more options for male birth control. Below, we take a look at the main forms of hormonal birth control that have been developed for men and explore the challenges of bringing them to market.
Male hormonal birth control is largely based on suppressing sperm formation through the use of an androgen hormone, like testosterone (3). Testosterone can suppress the body’s natural formation of sperm (3) allowing for the body to produce semen without sperm, or at such a low number that the body produces too little sperm to cause fertility (4), a process called azoospermia. Azoospermia reduces the risk of pregnancy to about 1% per year, the same rate as female hormonal birth control (3, 10).
Using testosterone alone as birth control has proven challenging: when taken orally in a pill form, testosterone is rapidly excreted by the body, preventing it from being reliable at dropping sperm to levels that significantly reduce the risk of pregnancy (11).
Injectable testosterone isn’t so quickly excreted by the body, which allows it to last longer, but may take 3-4 months to take effect. It increases levels of testosterone in the body overall, which could contribute to liver toxicity (3) in the long term.
Oral birth control pills
An oral birth control method for men has been developed by combining testosterone and progestin in a pill, or by pairing an oral progestin pill with a testosterone injection (4). The combination of testosterone and progestins has provided a consistent means of achieving high rates of azoospermia and low rates of pregnancy (4).
A 2019 clinical trial of oral birth control for males showed promising results for efficacy and safety with few side effects (2). More research is needed to determine the long-term efficacy and safety of this new male pill, which, if successful, would make it a convenient and exciting new option for men.
In the last few years, a new wave of research into male hormonal birth control has resurged, leading to the development of a topical gel combining progestin and testosterone (13, 2), with reliable rates of azoospermia (13). The drug is reversible and the side effects (decreased libido, increased risk of sunburn at the application site and dry, scaly rash at application site), were found to be acceptable by most people in the study (13, 14).
More than 80% of people in the study said the birth control gel was acceptable, and 50% said they’d be willing to use it as their primary form of birth control if it were available (13). As of this writing, the treatment has passed human safety tests and a human clinical trial (11, 12).
This new combination hormonal gel may be the first drug that is an equal alternative to the female birth control pill, in terms of reversibility and availability in a single application, but will likely be in drug trials for years before it is available to the general public (14).
New research in male birth control is underway. In China, a new method is being developed, using an injection of non-hormonal chemicals that block the vas deferens, the tube that transports sperm to the ejaculatory duct. This is the same tube that gets cut in a vasectomy to inhibit sperm motility. (15) It also directly inhibits the ability of sperm to swim (15).
Known as the “chemical cocktail method,” this form of birth control aims to be reversible and to limit the side effects, like changes in mood, libido and weight, that have been documented in studies of hormonal methods (2). While hormonal methods may take 3-4 months to become effective, this method is believed to be effective in as little as two weeks (but may take up to 20 weeks) (15). It is an exciting new development in contraception and fertility, although as of 2019 it has only been tested on rats (15).
More research is needed to evaluate the efficacy and safety of both hormonal and non-hormonal approaches. Still, a male birth control method that gives people of all genders equal opportunity to take responsibility for fertility is an exciting prospect. Further, growing awareness of the disproportionate burden that women take on when it comes to pregnancy and contraception will hopefully shift the cultural conversation to help bring a product to market sooner rather than later.