Male birth control pill — Available?

Dear Sam,

Finally, a male birth control pill, right? Unfortunately, not just yet. While there are several methods of what’s called "male-directed" contraception being developed and tested in clinical trials, none are currently available to the public. Surveys have shown that people with penises (and their sexual partners!) around the world have expressed interest in male-directed contraception. Although there is interest, people with penises may have to wait several years before any viable methods can be brought into a bedroom near you.

Developing contraceptives for people with penises provides unique challenges that require different solutions than for those with vaginas. While individuals with vaginas release one ovum (egg) per month and are fertile for about 48 hours a month, people with a penis are always fertile, producing sperm at a rate of approximately 1,000 sperm per second! Knowing when and where to intervene when it comes to those with penises can be tricky. Unlike those with penises, scientists were able to develop the birth control pill for people with vaginas based on the regularity of the menstrual cycle. Other challenges of producing effective yet reversible contraceptives for people with penises include concern over affecting future sperm production which could potentially alter genes in any children eventually conceived with that sperm. Additionally, it's difficult to access the site of sperm production due to the blood-testes barrier, which blocks access to the testes where sperm is created.

All that said, there are some options currently being researched. In general, there are two main types of contraception: hormonal and non-hormonal. Hormonal birth control, no matter who it’s made for, works by changing hormone levels that affect fertility (like testosterone or estrogen). On the other hand, non-hormonal birth control designed for those who produce sperm would hypothetically target specific parts of sperm such as the flagella (or tail) to block its function and control it’s movement. In short, it stops the swimmers from swimming!

Current research on hormonal options for people with penises, have included clinical trials that were delivered via injectables, gels, implants, and oral formulations. Of these, the most promising methods have been oral and gel formulations. The hormonal gel known as NES/T

(Nestorone and Testosterone) has shown to be promising. This gel is applied daily to the participants upper arm and works by blocking sperm production while maintaining sexual drive and function. Just like with female-directed birth control, this gel is reversible, and its effects end once the participant stops using it. Because two ingredients used in NES/T are already considered safe and effective for other uses, there is hope for a speedy Food and Drug Administration (FDA) approval process. For oral options, both DMAU (Dimethandrolone Undecanoate) and 11-βMNTDC (11β-methyl-19-Nortestosterone17β-Dodecylcarbonate) are currently under investigation and show promise. However, more research needs to be done to prove their ability to decrease testosterone and other fertility hormones that influence the production of sperm.

Unfortunately, less headway has been made for hormone-based injectables or implants. Researchers found that a testosterone-based injections proved effective in reducing sperm production but caused multiple side effects that participants disliked, such as discomfort at the injection site, acne, weight gain, mood changes, and changes in libido.

In terms of non-hormonal options, no study has made its way to human trials. A study published in February 2023 found that administering a single dose of a compound prior to sexual activity blocked the movement of sperm in the vaginal canal. The effects lasted about two and a half hours after the dose and sperm production returned to normal within 24 hours. That being said, this study was only conducted in mice, not humans. Given that this method of contraception doesn’t include hormones, researchers predict that individuals will experience fewer side-effects. Although this trial was considered successful, it still may take a while before this drug is approved for human trials.

While birth control for people with penises may be a ways off, there are variety of alternative ways to prevent pregnancy and protect yourself and your sexual partner(s) from sexually transmitted infections (STIs).