The future of the male pill.

Health and medicine explained.
Oct. 1 2004 7:50 AM

Jagged Little Pill

Will male birth control ever become a reality?

Illustration by Robert Neubecker

Since its introduction four decades ago, the birth control pill has not entirely lived up to its original hype: While it may have offered women sexual freedom, the pill has also introduced a number of hormone-related side effects and health issues—everything from intense mood swings to a possible risk of cancer. Though we're of course much better off than in the precarious days of the "rhythm" and "withdrawal" methods, birth control remains a stressful business: Should I stay with condoms, even though they're uncomfortable and fail 10 percent of the time? Should I risk the side effects and go on the pill? Should I resort to something as clumsy and dated as a diaphragm? But even with so many issues still on the table, one seems to have been long ago put to bed: Birth control is unquestionably a woman's responsibility.

Or is it? A remarkable new product is on its way that may make it possible to shift the burden of reproductive responsibility—gasp!— to men. Earlier this year, Dutch pharmaceutical giant Organon, along with Germany's Schering, announced that they expect their hormone-based contraceptive for men to hit the European market in as few as five years. Once that happens, it may only be another year or so before a U.S. debut. So, it will soon be possible for a man to avoid impregnating his partner by drastically lowering his sperm count. Unlike a vasectomy, the effect is temporary, completely reversible. And of course, the very notion is incredible: For over 30 years a "male pill" has been in various stages of development, but this is the first time serious drug money has backed it up.

As a woman, I can't help but ask: What took so long?

On the one hand, the wait can be chalked up to the biological challenges: Fighting off some 800 million raring-to-go sperm is certainly more daunting than suppressing a single monthly egg. The European solution comes not as a pill, but as a progestin implant, supplemented by a testosterone injection every three months to keep the man's hormones in balance. It's similar in application to the splinterlike Norplant device women were putting in their arms in the '90s. Other forms are also being explored, but research is slower going, as scientists have yet to receive adequate funding: The Contraceptive Development Network (with centers in Edinburgh, Shanghai, and Capetown) is working on an implant that would not require supplementary injections; and both the Seattle-based University of Washington's Male Contraception Research Center and Harbor-UCLA Medical Center are working on a longer-lasting injection, a gel, and a patch. All versions lower the man's sperm count nearly to zero without significant side effects (or any effect on his sex drive); according to clinical trials, sperm production returns to normal within three months of discontinuing use.

Conversations with stateside specialists highlighted the main reason for the decades-long delay: utter lack of corporate interest, which has meant seriously limited funds for research. Thus far, the largest-scale clinical trial in the United States—conducted by the Seattle center, but funded in great part by the World Health Organization—followed 40 men over a six-month period at a cost of $100,000. A major clinical trial of, say, 1,000 men monitored for five years would cost several million dollars. In addition to impacting the scale of the trial, the historical lack of financing has made it difficult to attract talent to the field: In total, there are only about 10 specialists in male contraception in this country, split between the two centers.

Why the crippling lack of support? There are the obvious cultural factors. Population pressure is not exactly the urgent issue in America that it is in countries like India or China, creating the impression that progress in contraception is not a burning issue. Added to that is our country's religious conservatism, which has certainly contributed to our rigid outlook on birth control. After all, this is a country in which, over 30 years after Roe v. Wade, the right to abortion is still considered up for debate; and the morning-after pill is legal but difficult to find. Then there are the financial reasons. Not surprisingly, the pharmaceutical companies have a firmly entrenched if-it's-not-broke-why-fix-it mind-set: If the existing product for women is already making a killing, why cut into that market by targeting men? Indeed, with the European trials in late Phase 2 (a drug goes through four phases before marketing), the American giants have yet to get on board.

Still, the tenacious clique of American researchers—led by endocrinologists William Bremner in Seattle and Christina Wang at UCLA—would actually have participated in the Organon and Schering trials were it not for a controversial decision by the FDA. According to one doctor, the FDA panicked over the three months it takes for the hormonal levels of men who have used the experimental contraception to return to normal. Nevermind the fact that that time period is similar for women who choose to go off the pill. (An FDA spokesperson could offer no comment.)

What, then, is safe enough? For men, the major side effects of the contraception are slight weight gain and some suppression of good cholesterol. But what about the discomforts and health issues women have been living with for over 40 years? Almost every woman who has been on the pill has experienced the rollercoaster mood swings, the weight gain, acne, and bizarre changes in breast size. In some cases, the pill can affect a woman's libido and ability to orgasm, or even raise her chance of a life-threatening blood clot. And then there's the mysterious, persistent link of estrogen to cancer. What kind of double standard is this? It's great to have control over your reproductive destiny, but women—at least the women I know—are more than ready to share the load.

Here's the real question: If this male contraception became available by prescription tomorrow, would American men go for it? The knee-jerk assumption is a resounding no—but studies suggest otherwise. According to a survey of 2,000 men in Capetown, Edinburgh, Shanghai, and Hong Kong, 67 percent were interested in some form of hormonal birth control. There seems to be a serious disconnect between our perceptions and what men are actually open to. To test my theory, I decided to conduct an informal "survey," speaking to approximately 20 male friends and acquaintances—all in their 20s and 30s, ranging from techies to fiction writers. Their responses were not what I'd expected.

Many of the men were initially thrown: "Isn't that a woman's problem?" But after getting over their shock, each admitted he could imagine a circumstance in which he'd go on birth control, usually in a serious relationship. (All agreed that single men would be too concerned about STDs to go without condoms.) And in a pretty remarkable testament to shifting attitudes, there were hardly any worries about a social stigma attached to a near-zero sperm count—as long as, of course, their sexual performance remained the same (it does). Much more of a red-alert priority was health: All were eager for more information on the mysterious side-effects hormones might have. Few were aware that women—including their girlfriends—had been dealing with this issue for years: "I'm amazed women let themselves get talked into this!" was a response heard several times.

On the other hand, there was some enthusiasm about taking the reins, which had a few of my subjects sounding like First-Wave Feminists: "It's my body, and I'd be more in control." (Control quickly emerged as the way to hook men.) But what will really determine whether the "male pill" catches on is the way in which younger men are taught to think about birth control. What if it became common practice for 16-year-old boys to talk to their fathers about getting "that prescription," just as many girls do with their mothers? Maybe young men might even start viewing sex in a more serious, responsible light.

Perhaps men are ready to compromise, to share the inconveniences and the health risks. But will the American drug companies be able to put aside their gendered views?

This week, specialists from Europe and their American counterparts met for the annual four-day "Future of Male Contraception" conference in Seattle to share theories, discuss recent breakthroughs, and boost morale. Specialists chatted with the handful of U.S. pharmaceutical reps in attendance, hoping word of their latest research would be taken back to those holding the purse strings and we might finally see some results. After all, with so many unhappy women and quite a few willing men, a male "pill" is looking like a great investment.

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