For most of history, the responsibility for birth control has fallen on women. With the current climate around reproductive health in the US, however, it makes sense that men take on some of that responsibility. In this post, we’ll discuss the options out there in terms of male birth control, as well as what it will take to make male birth control effective and easily accessible.
The most widely known method of male birth control is the condom. Available in your local drugstore, condoms are easy to get and easy to use. When used correctly, condoms only have a 2 percent failure rate. The trouble is, condom use is rarely perfect and they can break or come off during intercourse.
Another method of male birth control in wide and imperfect use is withdrawal, where the penis is removed from the vagina before ejaculation. The failure rate of this method is high—about 20 percent—because of pre-ejaculate, which may contain sperm, and because it’s not easy to stop what you’re doing at the height of sexual arousal.
This method has a failure rate of less than 1 percent, putting it up there with some of the best methods of female contraception like the intrauterine device or IUD. But the issues here are that this method requires surgery that—although it’s outpatient and minimally invasive—is kind of a pain to schedule and experience and that the longer that it’s been since the vasectomy, the more difficult it is to reverse. The difficulty of reversal means that vasectomy is for most intents and purposes permanent, which may not be preferred by people who don’t wish to conceive at present, but may want to in the future.
Several hormonal methods of male contraception are currently in development. In a commentary for The Conversation, Christina Chung-Lun Wang, a researcher and physician at UCLA, explains that male hormonal contraceptives could include progestin, which suppresses hormones that control the testes (the organ where sperm are made), and testosterone, which when it circulates at high levels can cause a drop in sperm production.  Wang’s team is currently running a phase two clinical trial to test the effectiveness of a gel containing both progestin and testosterone for male contraception and also developing another drug that would act like both progestin and testosterone together. 
Reversible physical barriers
Another promising concept is the use of hydrogels—materials that can be injected into the vas deferens to block sperm from traveling from the testes to the urethra to be ejaculated. Vasalgel is the product that’s been tested most thoroughly so far. In both rabbits and monkeys, the product rendered the animals sterile, but the effects of the gel can be reversed by flushing the vas deferens with something that dissolves the gel. Another company in Virginia, called Contraline, has invented a way to inject a dissolvable gel using ultrasound to guide the injection, meaning even outpatient surgery is not required. 
Researchers have also tried to shut down the synthesis of vitamin A, which is necessary for sperm production, in the testes. And another team at the University of North Carolina at Chapel Hill has shown that giving monkeys a vaccine against a protein found on the surface of sperm rendered 7 of 9 animals infertile. 
Despite the promise of these options, Wang writes that most of the support for male contraception has been supported by governments and non-governmental organizations, not by pharmaceutical companies, which is where the money really is.  Because it’s not clear that the market would support male contraceptive use, pharmaceutical companies are hesitant to invest and risk wasting money. Plus, regulating these products is complex. Because they don’t yet exist, it’s not clear that the US Food & Drug Administration would be able to move quickly to evaluate and approve them.
- Wang CC. Male birth control options are in development, but a number of barriers still stand in the way. The Conversation. 2022.
- Long JE, Lee MS, Blithe DL. Update on Novel Hormonal and Nonhormonal Male Contraceptive Development. J Clin Endocrinol Metab. 2021;106(6):e2381-e2392. doi:10.1210/clinem/dgab034
- Gray A. Overcoming the challenges in developing male contraceptives. The Pharmaceutical Journal. 2016.