What you need to know about the ‘male pill’ and hormonal contraceptives for men

The idea of a male contraceptive gets plenty of media attention and every few months sees headlines suggesting the imminent arrival of the “male pill”. But in reality, more research and testing are required before a safe and effective product is ready to hit the market. So, we’re clearing up some of the misconceptions and answering the frequently asked questions male hormonal contraceptives.

Are male hormonal contraceptives currently available to buy?

No, not yet. Despite starting research on long-acting, reversible birth control for men in the 1970s, promising results from many clinical trials and public interest, we’re yet to see a product hit the market.

There are several reasons why the pace of male contraceptive development has been slow. Firstly, it’s much harder to achieve effective pregnancy prevention in men than women. In women, a contraceptive needs to block the production of one egg per month but in men, a contraceptive needs to stop approximately one thousand sperm being produced every heartbeat.

Another major hurdle has been a lack of investment in research and development. Pharmaceutical companies have preferred to spend their time and money creating therapies to treat diseases and disorders with greater perceived need (thus more buyers).

The most promising option — an injectable combination hormonal contraceptive — entered a Phase II trial across seven countries between 2008 and 2012, with results released in 2016. The injection was effective in preventing pregnancy in nearly 96% of couples but the trial was stopped after an independent review panel determined that the drug had too many side effects. These included injection site pain, mood disorders, acne and increased libido, which caused 22 of the 320 participants to drop out. This also saw the last pharmaceutical backer pull out. However, more than 75% of the men who didn’t drop out of the trial said they would use the injection if it became available. In hypothetical studies and actual drug trials, the proportion of women who report willingness to use a male contraceptive method is high (42.8% to 94%).

So, is there a “male pill”?

Female hormonal contraceptives are often colloquially referred to as “the pill” – a term that’s been similarly applied when discussing male hormonal contraceptives. However, much like female contraceptives, there is a range of approaches being trialled for men. These include implants, long-acting injectables and transdermal gels, as well as pills.

How does male hormonal contraception work?

Over the past three decades, a wide variety of hormonal contraceptives have been trialled. These methods involve using hormones, particularly androgen- and progestin-like compounds, to shut down the body’s own testosterone production and suppress sperm production. This can take anywhere from weeks to months to achieve. These methods are fully reversible, but the time it takes to recover sperm production can be several months.

Many of these formulations are very effective at suppressing sperm output. The complete suppression of sperm counts to undetectable levels (azoospermia) is achievable in many, but not all, men but their efficacy is comparable to the most effective female contraceptives⁴. Suppression of sperm counts is achievable in around 95% of men. A small proportion of men fail to achieve adequate sperm count suppression for unknown reasons.

Could a male contraceptive harm future fertility?

Hormonal contraceptive approaches work by temporarily halting the process of sperm production, and a return to normal sperm counts after finishing treatment has been proven for many different formulations.

Are there side effects of male hormonal contraceptives?

Side effects occur and vary with formulation but are generally similar to those experienced by women taking hormonal contraceptives. These include acne, weight gain and impacts on libido (though men tend to report increased libido compared to decreased libido in women). Some products are associated with bad changes to ‘good’ and ‘bad’ cholesterol in the blood. Effects on depression and mood with some formulations are a cause for concern, and this needs to be monitored carefully in future clinical trials.

The ultimate goal is to create a product with the most favourable risk/benefit profile. It’s important to consider that female hormonal contraceptives have side effects and risks yet are still widely prescribed. Weighing up the risks and benefits for both partners is an important consideration when it comes to deciding on contraceptive method.

Male hormonal contraceptive research requires more investment, and public support, so that effective and safe options are brought to market. Unfortunately, there is currently little interest from the pharmaceutical industry in doing this, but innovative work continues in universities and medical research institutes towards finding a safe and effective hormonal contraceptive for men.