i-133b9fea8ea6b307d8c9133b7f3e23bf-dice.jpg This time the Ask a Scienceblogger Challenge is to explain why a male contraceptive pill does not exist.

Good question! It’s because medical researchers are all sexist bastards. Didn’t you know?

Actually that’s only part of the reason. Research into hormonal or pharmaceutical contraception for men is a hot topic. Male hormonal contraception is actually fairly effective. Using a combination of testosterone and other hormones to suppress the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary you can, after several months, prevent men from making sperm. For the men that respond (not all do), this treatment is highly effective as a contraceptive method. But the problems are delivery and efficacy. If you first screen men to see if they respond, then it is highly effective. But it doesn’t work on everyone: unlike the pill, you have to inject these drugs, put in implants or use a patch for delivery. This makes it far less attractive than the oral contraceptive pill for women, which is 98% effective when usedcorrectly and works with few exceptions. In the future, researchers may develop a more effective delivery and screening system for men that would allow them to more reliably assess the efficacy of the treatment.

Sexism has played some role in the long delay in the development of male contraception. But these days the far more important issues are those of physiology and capitalism. Women produce one egg a month and have a biologically built-in mechanism for preventing ovulation. Men, on the other hand, are sperm machines, producing an overabundance of genetic delivery vehicles from adolescence until death–with no simple mechanism to interrupt production. That’s why barrier methods, such as condoms, will likely remain preferable even after the development of hormonal birth control for men as they are highly effective and also prevent STD transmission. And for women, the pill (especially in lower-dose modern formulations) is safe, effective, and very well tolerated.

The second problem, that of capitalism, refers to the difficulty in developing a market for male contraception and thus the limited incentive for their production. It will be difficult for drug companies to sell a formulation for men that alters their hormones, lowers their sperm count (a cultural barrier), and requires doctors visits, injections, sperm counts, etc., when highly effective alternatives already exist. Many women will also likely prefer to remain in control of contraception because it’s their body, their health, and because men are liars. The capitalist barrier may be even more significant than the physiological obstacles.

Male hormonal birth control options will probably be offered within a decade. But they will likely be a niche market, limited to people in committed monogamous relationships, or for the partners of women who can’t tolerate the pill, and thus, not widely adopted.

Comments

  1. #1 Coturnix
    January 9, 2008

    It’s still Wednesday… just sayin’

  2. #2 a. brown
    January 9, 2008

    Ha! As a woman in a monogamous relationship, I trust my husband– but not enough to put him in control of contraception. The impetus is not as close-to-home. Yes, he would like to prevent an unwanted spawn, but since that spawn won’t be having a parasitic relationship with HIS body, it may not be ever-present in the back of his mind like it is in mine.

    Before we go crazy making BC for men that probably won’t use it, we should focus on getting those inexpensive and easily-deliverable pills to women who truly want (and need) to take them. Anyone heard about this birth control spike? Egads.

    This article is hilarious, by the way. “Men are liars.” Ha!

  3. #3 Rick
    January 9, 2008

    I think male birth control would help a lot of guys out. It’s not too uncommon for a woman to purposefully get pregnant in order to push a man into marrying her.

    Male birth control would usher in a new era of male reproductive rights very similarly to how female birth control helped women.

  4. #4 Toaster
    January 9, 2008

    Male birth control would usher in a new era of male reproductive rights very similarly to how female birth control helped women.

    Did I miss the news somewhere that men can get pregnant now?

  5. #5 Laurel
    January 9, 2008

    @Toaster–Of course men can get pregnant. After all, they’re having abortions:

    http://www.latimes.com/news/nationworld/nation/la-na-menabort7jan07,0,5749127.story?page=1&coll=la-home-center

  6. #6 HP
    January 9, 2008

    “birth control spike”?

    Yikes. You can’t imagine the mental image that phrase conjured up. Though I don’t doubt it would be effective.

  7. #7 jba
    January 9, 2008

    “because men are liars”

    Not for nothing, but people are liars, not just men (I’m guessing you meant it as a joke, but it’s a bit of a button for me). I think that the comment above: “It’s not too uncommon for a woman to purposefully get pregnant in order to push a man into marrying her” is very relevant. I think the optimal solution is for both people to be taken contraceptives, then there is not only less chance of accidental pregnacy but also less chance of one person “missing” a pill. I agree that women shouldn’t be forced to be mothers, but it is just as wrong to force someone to be a father.

  8. #8 Suricou Raven
    January 9, 2008

    The pill and condoms still face quite a strong social and political opposition from those who regard all forms of contraception as a ticket to promiscuity and sin. I expect a male-only contraceptive would face that is a much greater extent, because it would play into a (In large part truthful) steriotype that all men want lots and lots of no-strings sex with many partners.

    ie. if a man finds his girlfriend is on the pill, his response will be ‘This is a sensible woman who wants a committed relationship without children yet.’ If a woman finds her boyfriend is on the male-pill, her likely response will be ‘How long as the b*astard been sleeping around, and with how many girls?’

  9. #9 Ted
    January 9, 2008

    I’m just thankful for the yeoman work that scientists at UVA are doing. Priorities set and met.

    And please folks; no talk of male BC until we get the pressing issue of chromodomium resolved. Don’t fork the effort.

  10. #10 kevinj
    January 9, 2008

    male pills have been discussed for years. I remember it in my a level class 10 years back. As the tutor put it
    woman: are you on your pill?
    bloke: ermm, yes.

  11. #11 Molly, NYC
    January 9, 2008

    a. brown nailed it: Women are the ones to take BC pills for the same reason that skydivers pack their own parachutes.

  12. #12 Punditus Maximus
    January 9, 2008

    Sure, but why don’t we have explicitly reversible vasectomies, then?

  13. #13 Interrobang
    January 10, 2008

    I don’t see why you’re listing using a transdermal patch as a downside. I use the transdermal birth control patch, and I like it ever so much more than I ever liked the pill. It’s easier to use, and it doesn’t cause persistent bouts of dry-heaving. It’s not great for women who, for whatever reason, want to conceal their birth control use (and it’s also not great for avoiding unwanted questions from jerks, if one wears a tank top in the summer).

    Contrary to the old MRA saw about women trapping men by getting pregnant (which doesn’t actually happen all that often), many abusive men do try to sabotage their partner’s birth control. After all, if he knocks her up and she has the kid, he can still walk away, but she’s tied to him forever.

  14. #14 Dave Briggs
    January 10, 2008

    I don’t mean to circumvent the topic, but what I did was get a vasectomy. They are relatively inexpensive. I have heard they are reversible. It seems like a wise way to go.
    Dave Briggs :~)

  15. #15 Victoria
    January 10, 2008

    To A. Brown – Since he’s not worried about his body, just remind him that any offspring you may have will soon have a parasitic relationship with his bank account!

  16. #16 Anonymous
    January 10, 2008

    “Many women will also likely prefer to remain in control of contraception because it’s their body, their health, and because men are liars.”

    This sentence disgusts me. Women are just as much liars as men are, and men have every right to protect themselves from unwanted pregnancies as women do.

    Just because there is a pill for women does not mean there should not be one for men, that’s ridiculous.

  17. #17 Calli Arcale
    January 14, 2008

    Vasectomies can be reversed many times, but mileage varies; men considering vasectomies are generally advised to consider it a permanent sterilization procedure, since there’s no guarantee that a reversal will be successful.

    So if you’ve had one and now want a baby, go ahead and ask your doctor about reversal. But if you’re considering a vasectomy, try to keep this option out of your mind, because it may not be as reversible as you hope.

    Maybe the solution will be something along the lines of Norplant, which was an implantable birth control device for women, or the new birth control hormone releasing IUDs. Something that can be “implant and forget”, but which will allow fertility to (theoretically) return when it is removed.

  18. #18 liz
    January 15, 2008

    I would trust my husband with my life but I would not feel comfortable with him being in charge of taking the pill. I don’t know why, he is a health care professional and also has a vested interest in not having another child.

    I have recently gone off the pill after being on it for 15 years due to a blood clot so at the age of 46, we’re back to doing it the way we did when we met and I was 19, using condoms. At least I can see that the condom is being used.

  19. #19 LB
    January 15, 2008

    You greatly overstate how ‘well-tolerated’ the pill is. It often causes depression, weight gain, and acne. It increases risks for heart disease. And it is very likely that it lowers fertility when used for an extended period. Overlooking these side effects is evidence of the kind of ongoing sexism that dominates reproductive health care.

  20. #20 The14thOpossum
    January 15, 2008

    What I don’t get is the people who say they don’t like it because they don’t trust their husband/boyfriend/whatever. Why would you stop taking the pill/using nuvaring/patch/wev just because he started being more proactive about birth control? I think the more barriers to pregnancy, the better. If he doesn’t take it correctly, well, you’re still on yours, or using condoms, right? And it allows men who don’t want kids and are very sure of that to have another method to protect themselves from that outcome. Oh, and the people who say that women will think their guy is cheating if he takes BC, why? That doesn’t even make sense. That’s like saying women who take BC are loose, and easy. It’s just someone trying to take control of their reproductive abilities, no matter their sex.

  21. #21 paul
    January 15, 2008

    So it sounds as if most of the reasons there’s no perceived market come down to a) men facing less social, financial and personal grief from unwanted pregnancies than women, so that there’s less incentive for them to take a pill and b) men being more anxious about their gender identity, so that they won’t tolerate any treatment that might cast doubt on their potency (be it in the way of altered hormone levels, reduced sperm count or just a patch that — gasp — other people can see. In other words, the pharma folk and researchers are merely embedded in and complicit with a sexist culture rather than actively cackling with glee as they work to perpetuate it.

    (Meanwhile, the “men-are-physiologically-overfertile” meme has some serious problems with it, as any andrologist who treats the partners of women who want to get pregnant but can’t can tell you. It doesn’t take much of a reduction in count, motility, or normal-morphology-fraction to have a huge impact on fertility.)

  22. #22 Greta Christina
    January 15, 2008

    “Many women will also likely prefer to remain in control of contraception because it’s their body, their health, and because men are liars.”

    Seriously.

    I mean, if it were my husband or long-term partner, I’d probably be okay with it. But if I were still catting around like I used to, there’d be no way I’d trust some guy at a party or an orgy who told me, “Don’t worry, baby, I’m on the pill.” And I’d want to use condoms anyway, since the pill doesn’t protect against STIs.

    But as others here have pointed out, women are liars too. So I wonder if there might be a market for this thing: not just for men in long-term relationships, but for single men who are playing the field and want the moral equivalent of a temporary vasectomy.

    If I were a single guy, I might well want it.

  23. #23 stuffyface
    January 15, 2008

    I just have to say, I’d really be wary of using the female birth control patch. It caused me to have a blood clot at the age of 19. It’s much more dangerous than the pill, and there are lawsuits going on.

    Not to say there’s anything against male patches…I’m sure they’ll do a lot of testing.

  24. #24 Eden Isfet
    January 15, 2008

    I think it’s terribly degrading to accuse all men of being horny liars who will gladly deceive their potential partners about being on the pill to get poon. Would I trust a potential fling who told me that? No. I also wouldn’t really trust him if he told me he was single, had a vasectomy, and was STD-free. If I’m sleeping with him, he’s going to wrap his dick in a snug latex or polyurethane cover until I get to know him better. I’m a suspicious, paranoid bitch that way.

    The issue is not one of “Can women trust men to be honest about being on the pill?” Men are liars. Women are liars. Women are honest. Men are honest. It’s incredibly irresponsible to throw up our hands in defeat and say that men cannot be trusted to take their birth control pill, therefore developing one is unrealistic. We women have a wide host of birth control options to choose from – the Pill, the patch, a diaphragm, an IUD, getting one’s tubes tied, etc. Men have: the almighty condom, vasectomy and abstinence.

    Women should not be expecting men to control their own fertility for the woman’s sake. Nor should the men be expecting women to control their own fertility for the man’s sake. Instead, people should be taking their fertility into their own hands.

    A woman who does not want to get pregnant should have her own form of birth control, insist her lovers use condoms, etc. She should be proactive about not getting pregnant. A man who does not want children should be proactive about using condoms and taking advantage of the ‘male pill’ when it arrives. I know lots of men who would love to be able to take the male pill as a way to further assert their own control over their sexuality and fertility. They’re not ready to have children and recognize that, at the end of the day, the only person responsible for your fertility is you.

  25. #25 purpleshoes
    January 16, 2008

    Oh for heaven’s sakes. I second previous commenters who have said “why exactly would she go off her pill just because he’s on his?”. As Interrobang noted, there are men who want to get their partner pregnant against her will just like there are women (largely mythical) who get pregnant against their partner’s will. Moreover, and more commonly, people are forgetful about taking their pills and swapping out their patches, birth control doesn’t work because of some strange and unpredictable hormonal voodoo, or you’re the one person on earth who can get pregnant (get someone pregnant) through two condoms and a pair of jeans. Everyone involved should be taking responsibility for their own reproductive outcomes, and the risk that everything that they’re using might fail.

  26. #26 MarkH
    January 19, 2008

    It is clear the next research I should do should be into sense-of-humor transplants. There’s got to be a solution to this obvious problem.

  27. #27 Maureen Lycaon
    January 20, 2008

    I’m a staunch feminist who had the usual opinion on why there’s no male Pill, but I was interested in what a ScienceBlogger would have to say. MarkH, thank you for this entry — it’s a good, informative, easy-to-understand explanation.

  28. #28 Anonymous
    January 25, 2008

    @ Liz: I’m guessing you’ve already considered having an IUD, but if not, look into it. I love mine.