The Male Contraceptive Pill: Is a Safe and Effective Pill just Around the Corner?
WWYW | 1 June 2023 | WWYW Articles
Just last month, two separate groups of scientists from the United States made significant break throughs in the development of an oral form of male contraception.[1]
In the state of Washington, scientists from Washington State University have identified the gene responsible for normal sperm production as well as a way to stop its activation.[2]
While in New York, scientists from Weill Cornell Medicine are in the trial stages of testing a pill that has been observed to effectively stop sperm production during a two-hour window without any adverse side effects.[3]
Both of these developments represent significant break throughs in the journey to developing a safe and effective male contraceptive pill.
However, what may be the impact of such a pill entering the pharmaceutical market? And why has it taken so long for such a pill to become a reality?
All these questions and more will be discussed down below.
Contraception generally
Before we get on to these questions however, we’ll first take a look at male contraception more generally.
It’s no surprise that for thousands of years, men have been trying to find ways of enjoying sex without the burden of baring children.
The ancient Greeks for example, came up with the idea that the heating of a man’s testicles over fire might reducing fertility.[4] And, before you dismiss that idea as being stupid, scientists have recently discovered that exposing the testicles to excessive heat does in fact lead to infertility.[5]
Anyway, in more modern times, condoms and the surgical procedure of a vasectomy have become the most common kinds of contraception used by men.
However, whilst these forms of contraception are certainly effective. They both have their downsides. Condoms, for example, have been observed to be 98% effective.[6] Which, although this seems like a high percentage, it still means that there is a 2% chance of unplanned pregnancy per use. Condoms are also prone to breaking and limit sensation and comfort as opposed to not being worn.[7]
Likewise, vasectomies, while certainly extremely effective in their goal of preventing unplanned pregnancies are also burdened by downsides. The permanent nature of a vasectomy means that those seeking to get the surgery are doing so at the price of not being able to have children.[8] Although it is possible to have a vasectomy reversed, the prospect of having to go under the knife presents a significant hurdle to those wanting a non-permanent form of contraception.[9] Further, the cost of affording a vasectomy makes it inaccessible to those who may not be able to afford the procedure.[10]
It is hoped however, that the availability of a safe and effective male contraceptive pill would be able to solve many of the issues commonly associated with current forms of contraception.
So how would such a pill work?
A male contraceptive pill would work by suppressing the secretion and production of the gonadotropins, both luteinising and follicle stimulating hormone (LH, FSH) from the pituitary by exogenous sex steroids or ganadotropin releasing hormone.[11]
For those of us who aren’t fertility scientists, all this means is that it prevents sperm from being transmitted when a man ejaculates during sex.[12] Thus, preventing pregnancy.
The idea is that a pill such as this would be able to act as a fertility switch.[13]
A biological male therefore, would be able to consume this pill and for a temporary amount of time be infertile.[14]
What would be the benefits of a male contraceptive pill?
Due to its digestible design, a pill wouldn’t be prone to issues such as breaking and discomfort associated with condoms.[15] Further, unlike a vasectomy , a pill would be able to provide effective protective against unplanned pregnancy without threatening a biological male’s capacity to bare children in the future.[16]
What are the cons?
However, the introduction of a safe and effective contraceptive pill into the pharmaceutical market doesn’t appear to be all sunshine and rainbows.
The availability of this form of contraception poses a number of potential societal consequences in its use.
Unlike condoms, a pill won’t be able to effectively prevent the spread of certain STDs.[17] There is a concern therefore, that a widespread use of a male contraceptive pill would also result in significant spike in the spread of STDs.[18]
Further, there is the potential that a male contraceptive pill on the market may lead to a rise in stealthing. Stealthing, is currently associated with the use of condoms and involves an individual removing a condom during sex without the other party’s consent.[19] There is a concern that having a pill such as this on the market may lead to a rise in individuals deceiving their partners into thinking they are on contraception.[20] The difficulty in a situation such as this, besides the obvious risk of unplanned pregnancy, would be that there would be no way for a consenting party to be able to tell whether their partner has taken this form of contraception.[21]
In the present, we can only look to the future to see how these potential issues pan out.
Why has it taken so long for the ‘man pill’ to become a reality?
Issues aside, the availability of a male contraceptive pill would significantly shake up the pharmaceutical market. However, why has it taken so long for this contraception to only now be on the verge of entering the market?.
After all, the female contraceptive pill has been in widespread use since the 1960s.
The answer appears due to a mix of increased medical standards and different ethical values towards the sexes.[22]
In 1964, the World Medical Organisation established the declaration of Helsinki.[23] In effect, this was an international code of medical ethics that was designed to protect participants of medical research.[24] This new breed of ethics sought to place greater value on the health and safety of participants and assessed whether harm caused would outweigh potential societal benefits.[25] As a result of this tightening of ethical standards, many drugs which would have previously entered the pharmaceutical market have been barred due to adverse impacts upon participants.[26]
Thus far, every attempt to introduce a male contraceptive pill in to the market has been struck down due to complications experienced by participants.[27] Interestingly enough however, many of the side effects participants have experienced from taking male contraceptive pills are quite similar to those commonly associated with the female version.[28] This includes symptoms such as acne, oily skin and weight gain.[29]
So, if the side effects are similar, why is the female contraceptive pill readily available and the male version isn’t?
The answer appears due to a couple of factors. Timing, for example, played a big role in the female contraceptive pill’s approval into the market.[30] The female contraceptive pill was first tested in the 1950s and gained approval by the US Food and Drug administration in 1960 prior to the tightening of international medical ethical standards four years later.[31]
This was despite the fact that the initial version of the pill was tested on a sample population of 1500 women.[31] Half of which dropped out of the study and three of which died as a result of taking the drug.[32]
However, timing was just one factor. Another reason is down to the fact that biological men cannot get pregnant.[34] As a result of this, ethical committees were more inclined to approve the medication as the perceived benefits outweighed the risk of harm caused.[35] Factors influencing this decision included issues such as the prevention of childbirth related complications and infant mortality.[36]
Thus, the reason why a male contraceptive pill isn’t already available is due to a combination of historical timing and ethical factors.
However, with the recent break throughs in the development of a male contraceptive pill in the United States, there is more optimism than ever before that this form of contraception may finally get approved into the market. However, although a male contraceptive pill certainly has a number of benefits, there a number of potential consequences that may come from its use.
The impact of this pill, therefore, remains to be seen.
References
1. Zoe Williams, ‘Great news, a contraceptive pill for men without side-effects! Now how about one for women?’, The Guardian (online, 19 April 2023) < https://www.theguardian.com/commentisfree/2023/apr/19/contraceptive-pill-men-side-effects-women-pregnancy>
2. Ibid.
3. See, ibid.
4. Zaria Gorvett, ‘The weird reasons there still isn’t a male contraceptive pill’, BBC Future (online, 17 February 2023) < https://www.bbc.com/future/article/20230216-the-weird-reasons-male-birth-control-pills-are-scorned>
5. See, ibid.
6. Wendy Satmary, ‘Which type of birth control is most effective?’, Medical News Today (online, 9 February 2023) < https://www.medicalnewstoday.com/articles/how-effective-is-birth-control>
7. See, ibid.
8. Johnathan Fainberg & James Kashanian, ‘Vasectomy’ (2018) 319(23) JAMA 2450, 2450.
9. See, ibid.
10. Ibid.
11. NIH, ‘Male contraceptive disable sperm’, National Institute of Health (online, 28 February 2023) < https://www.nih.gov/news-events/nih-research-matters/male-contraceptive-disables-sperm>
12. See, ibid.
13. Gorvett (n 4).
14. See ibid.
15. Ibid
16. Ibid
17. Cf M Rosenberg, ‘Contraception and STDs’ (1991) 25(5) PMID 3,4 for a discussion on how the female contraceptive pill doesn’t protect against STDs.
18. See, ibid.
19. Kelly Davis & Kenneth Freedland, ‘ “Stealthing”: Factors associated with young mens non-consensual condom removal’ (2019) 38(11) Health Psychology 997, 1000.
20. Ibid.
21. See, ibid.
22. Gorvett (n 4).
23. Ibid.
24. Ibid.
25. Ibid.
26. Ibid.
27. Weill Cornell Medicine, ‘On demand male contraceptive shows promise in preclinical study’, Weill Cornell Medicine News Room (online, 14 February 2023) < https://news.weill.cornell.edu/news/2023/02/on-demand-male-contraceptive-shows-promise-in-preclinical-study>
28. Gorvett (n 4).
29. See ibid.
30. Ibid.
31. Ibid.
32. Ibid.
33. Ibid.
34. Ibid.
35. Ibid.
36. Ibid.
