The invention of hormonal birth control revolutionized women’s healthcare, but for the past 70-odd years it’s also meant most of the contraceptive burden has been on women. And for a lot of people of all genders, that’s a problem.
All long-term methods of birth control come with side effects, from acne to mood swings to painful periods. Anyone taking hormonal contraceptives is probably dealing with some kind of unpleasant trade-off, and guess what? They (and their partners!) may not want to anymore. But in heterosexual relationships, the burden is generally on whichever person has a hormonal option. That isn't to say that there aren't straight men who'd like more control over their fertility. A majority of them say they’d welcome a male version of the pill, whether it’s to spare their partner from unfortunate side effects or because they want some control over pregnancy prevention.
But now—finally—equivalent versions are coming out for men. So here’s the lowdown on exactly what those options are and when you’ll be able to get your hands on them.
How does it work?
Like many existing birth control options, these new methods work by preventing the egg and sperm from meeting in the first place. For folks with testicles, that means decreasing the sperm count in semen to the point where you’re considered infertile (if you have ovaries, hormonal birth control prevents you from ovulating each month). And also like existing contraceptives, the new pills and topical gels in development use a combination of hormones.
Testosterone works together with progestin, another type of hormone that both sexes have, to suppress yet other types called luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Sufficiently low LH and FSH prevent sperm from forming, but have the unfortunate side effect of decreasing testosterone—that’s why you need replacement testosterone in the contraceptive.
There’s been research into just how low sperm count needs to get before a person is infertile, and endocrinologists developing new contraceptives are starting with those numbers as a baseline. In theory, sperm counts below one million per milliliter are considered low enough to make pregnancy extremely unlikely.
Does it work?
So far, the evidence suggests it does. Clinical trials for these new methods haven’t been going on long enough to reach phase 3, which is where you test a drug to see how effective it is against a placebo. Right now, most of the potential medicines are in phases 1 or 2, which use much smaller groups of participants to assess how safe the drug is and whether it seems to be working as planned.
In the most recent trial of the inconveniently named 11-beta MNTDC pill, researchers reported that the drug successfully suppressed LH, FSH, and naturally-occurring testosterone while participants took it for a 28-day cycle. After they stopped, their hormones went back to normal. That same team also tested a related pill in 2018 and found similar success rates. There’s also a topical gel, which works on the same principle as the pill, that can also suppress hormone levels below the necessary limit.
Is it safe?
These most recent trials have all gone without a hitch. There have been side effects, ranging from lowered libido to acne to fatigue, but they haven’t been bad enough to stop the testing. In these early-phase trials, that’s the whole point—if you start giving the pill to people and the side effects are sufficiently bad to make them drop out, or to make it unethical to keep giving them the drug, you have to stop.
Back in 2016, one trial of a hormonal injection stopped after an unusually high number of men started reporting adverse effects. The trials’ review panel decided it was too risky to keep going. Plenty of media outlets mistakenly interpreted this as men being too wimpy to deal with the kind of side effects that millions of women experience every day. But that’s not what happened. For starters, this trial showed much higher rates of adverse effects than existing female birth control. For another point, 75 percent of the men actually said they were happy to continue. Still, many of the adverse outcomes the men reported were exactly the kind of thing that women complain about on their own pills.