We are well into the 21st century and we still don’t have good options for male contraception—other than condoms or a vasectomy? Why is that? And is this absurd situation going to change anytime soon?
Researched by: Rachel John & Priyanka Gulati
The history of contraception
Human beings have long grappled with a thorny question: how do we have sex without making babies? The earliest answers involved all sorts of strange and unsafe antics—almost always involving women:
Centuries ago, Chinese women drank lead and mercury to control fertility, which often resulted in sterility or death. During the Middle Ages in Europe, magicians advised women to wear the testicles of a weasel on their thighs or hang its amputated foot from around their necks. Other amulets of the time were wreaths of herbs, desiccated cat livers or shards of bones from cats (but only the pure black ones), flax lint tied in a cloth and soaked in menstrual blood, or the anus of a hare. It was also believed that a woman could avoid pregnancy by walking three times around the spot where a pregnant wolf had urinated.
Think this is deranged? During the Great Depression, Lysol soap was the hottest selling form of contraception in the US. A terrible idea since the household cleaner caused burning, irritation and even death. And as recently as 1985, Harvard researchers claimed Coke killed sperm in lab experiments—a miraculous feat no other study could replicate.
History of the condom: The more practical version of birth control—the male condom—has also been around for thousands of years. The earliest known depiction of a man using a condom during sexual intercourse was found in a cave painting in France—dating back 12,000–15,000 years ago. In the 16th century, an Italian anatomist described a condom made out of linen—used to prevent the transmission of syphilis. But the earliest condoms found in England—dating back to 1640—were made of animal gut.
More amusingly: “By the 18th century, condoms were prized as male contraceptives, and were even mentioned by the Italian adventurer Giacomo Casanova, who described them as ‘English Overcoats’.” In 1839, Charles Goodyear invented vulcanised rubber—and used it to manufacture rubber condoms, intrauterine devices, douching syringes, and "womb veils" (diaphragms).
But, but, but: The use of any contraception was alway at war with social norms that frowned on interfering with ‘god’s will’—or encouraging sexual promiscuity. And just because we were using contraception, it didn’t mean we actually knew how human anatomy worked. In 1843, scientists finally figured out that conception occurs when the sperm enters the female egg: “Prior to this it was assumed that men created life and women just provided the home for it.” And it took another 20-odd years to confirm that human fertilisation requires the union of an egg and sperm.
The female pill: Herbs and seeds were the earliest form of oral contraception for women. According to Greek mythology, Persephone refused to eat anything but pomegranate seeds when she was abducted and raped by Hades. Women in India would eat a papaya a day to keep the dreaded stork away.
In the 1950s, women’s rights activist Margaret Sanger finally freed women from these dietary experiments—by pushing through the research on the modern birth control pill. Ironically, the hormone progestin was first extracted from yams. The first pill combined progestin with estrogen—and was approved for wide use by the FDA in 1960. By 1962, 1.2 million American women were on the pill.
Key point to note: The pill came with all sorts of health hazards for women:
The first pill contained 4 times the estrogen and 10 times the progestin of modern-day oral contraceptives, and many women experienced side effects like bleeding, nausea, and weight gain.
And later research linked it to serious diseases such as blood clots, heart disease, and stroke. There is no doubt that the pill put women in charge of their sexuality. But it also transferred the entire burden of contraception onto them.
Where, oh where is the pill for men?
Today, women have at least 11 different contraceptive options—from vaginal rings to IUDs and, of course, pills. But seventy years later, we still haven’t developed equally effective and diverse methods of contraception for men. We’re still stuck with coitus interruptus, condoms or vasectomy. Why is that?
One: Women become pregnant—not men. It is why women are more willing to put up with the many side-effects of hormonal birth control. Men and women have a different risk calculus:
For example, taking the female pill increases a woman’s risk of developing deadly blood clots. But pregnancy increases the risk of deadly blood clots by ten times more. So in that case, the pill’s side effects are worth the risk. For men, the calculus is different. Men don’t get pregnant, and therefore don’t suffer the health complications of pregnancy. So according to the cost-benefit analysis, male contraceptives aren’t really allowed to have side effects. Even a tiny increased risk of, say, blood clots or strokes will doom a male contraceptive—as did the harsh, potentially fatal interaction with booze.
That’s why pharmaceutical companies often shelve promising research at the first sign of trouble. Back in the 1950s, researchers junked an effective pill called WIN-18446—because the drug also made it impossible to drink any booze. As recently as 2011, development of a serum containing progestin and testosterone was shut down because some of the men developed depression and ramped-up libido.
Two: It is far easier to block ovulation than to stop the production of sperm. Look at this way: when a man ejaculates, more than 250 million sperm start wiggling outwards, looking for an egg to fertilise. Women, OTOH, only produce one to two eggs per menstrual cycle. Women’s pills use low doses of hormones to fool ovaries into thinking that the body is already pregnant. Doing the same to stop sperm production requires very high doses—which increases the risk of side effects:
The hormonal machinations and different varieties of testosterone and progesterone that have been used are very difficult to calibrate, to try to reduce the side effects by using different hormones. The hormonal approach has tried many different candidates and combinations. One issue is that, for example, you can't take testosterone orally, because the things you eat go through the liver and testosterone taken orally is toxic to the liver.
Three: Funding for research into male contraception is scarce. Pharma companies don’t think it is worth the investment when female contraception is already getting the job done:
Even if a research lab were to develop a promising product, that lab would need a pharmaceutical company to bring the drug to market—and the pharmaceutical industry’s support for new contraceptives has been tepid. Drug companies are wary of cannibalising the existing oral-contraceptive market, and of being sued.
For example, in 2007, Bayer junked a male contraceptive that involved an annual implant and a quarterly injection—because men would consider the regimen “not as convenient as a woman taking a pill once a day.”
Looking faaaar into the future…
Let’s be honest. There is no big breakthrough in male contraception looming on the horizon. But there are a number of strong possibilities.
The topical gel: Forget swallowing a pill—and high doses of hormones. The latest research involves slowly shutting down sperm production by applying a topical gel. Here’s how it works:
The most researched version of this is a topical gel applied to a man’s shoulders and arms every day. The gel contains a synthetic female hormone called progesterone that lowers testosterone, a male reproductive hormone, to a level where he can no longer produce sperm. As the gel is absorbed into the skin, small amounts remain just underneath, slowly releasing contraceptive hormones that make the man infertile for as long as he continues to use the gel.
It has the same side effects as the pill—but researchers are optimistic since men already use gels to treat hormonal deficiencies. But don’t expect this to hit the market before 2030.
Injectable gels: Vasectomies involve snipping the vas deferens—the tubes that carry sperm. This gel is a temporary version. It is injected into the vas deferens to block their travel from the testes—and is effective for around two years. A similar gel called RISUG is going through late stage human trials in India. This one “damages the sperm that passes through so they aren’t able to reach and fertilise an egg”—and is effective for ten years. And it is completely reversible—needing only an injection of sodium bicarbonate (aka baking soda) to flush it out.
The male pill: The most recent version does not involve any hormones—and has shown promising results in, well, mice. Unlike the female pill, this would be taken right before sex (sorta like Viagra). How it works: “It keeps sperm stunned for at least a few hours - long enough to stop them reaching the egg.” Translation: the pill stops the sperm from swimming.
The bottomline: According to a reproductive health expert, "I think people are more risk-averse in the world of male contraception. Men are more risk-averse, ethics panels are more risk-averse, and possibly pharmacy companies are more risk averse." Maybe because women already bear all the risks?
TIME and this essay from Planned Parenthood are best on the history of birth control—while WebMD has a list of the kookiest facts. The Wire looks specifically at India. BBC News and The Atlantic have good overviews of the reasons why male contraceptives rarely see the light of day. The Conversation sums up some of the new options in development.