Male birth control research is starting to make progress : Shots

Illustration of a decrease in sperm count.
Illustration of a decrease in sperm count.

Condoms have been used for contraception since the Middle Ages, with latex versions appearing in the mid-1800s. Over the years, they have become more effective and comfortable to use.

But it was the invention of the birth control pill, followed by the IUD in the 1960s, that created an earthquake in human birth control. More and more pills, patches, and implants are available to women. And yet, an elastic condom that covers the penis remains the only medically approved form of contraception for men, other than a vasectomy.

But now, researchers are looking at both hormonal and non-hormonal contraceptives for sperm carriers. The hope is that couples will begin to treat contraception as a shared responsibility.

“We wanted to create a list of options for men similar to what women have available to them,” said Stephanie Page, a researcher and endocrinologist at the University of Washington.

(Note: The studies mentioned here were typically done on transgender men ages 18 to 50, so this story calls these drugs “male contraception” and their target demographics. is “male” or “male” even though people of the other sex can produce sperm.)

Endocrine method is researched innovation

Dr. Page’s lab is conduct clinical trials along with researchers at 15 other locations around the globe, tested a topical gel that a man applied to his shoulder daily. This gel contains synthetic hormones – a combination of testosterone and progestin – that signal to the brain to reduce testosterone levels in the body. And because testosterone is needed for sperm to reach maturity, the testicles then produce less and less sperm.

Dr. Page’s research recruited married couples – nearly 450 of them worldwide. For a woman to participate also means “she got consent as well as he did, and they were really both participants,” says Page.

Test run in stages. In the early stages, the man applies the gel daily, but the couple still uses another form of birth control when they have intercourse. During this phase, researchers are periodically monitoring the man’s sperm count. Then, when the numbers are low enough to prevent pregnancy, the couple enters a second phase: they stop using other birth control methods, while the man continues to use the gel daily.

In the third and final phase, the man stopped using the gel and the researchers started monitoring his sperm count again. The researchers hope their results will demonstrate that the impact on fertility is reversible – just as women can regain their fertility when they stop taking the Pill.

Brian Nguyena gynecologist and professor at the University of Southern California’s Keck School of Medicine who also studies male contraception said he was encouraged by what he heard from some of the men in the trial. gel testers, especially those who “really just want to support their female partners.”

He said: “I hear stories of men getting really tired of hearing about their partners suffering from hormonal side effects or in some cases complications related to the IUD. or implant. “And they want to do something.”

Nguyen’s lab is also working on a hormonal drug that works similarly to a gel, and Page’s lab is hoping to eventually develop an injectable hormonal solution.

In the 1990s, the World Health Organization funded trials of male hormonal contraception – where men were given high doses of testosterone injections – but those drugs never hit the market. . They are not effective enough to sell, and the side effects are serious, including toxicity to the heart, liver, and kidneys, and an increased risk of prostate cancer, the researchers said.

Stephanie Page of the University of Washington said the gels and drugs being tested today do not come with the same risks.

“We’ve been working very hard to develop methods that don’t affect other physiological parameters,” says Page. liver and the like.”

As for side effects, some of the participants reported weight gain, changes in sex drive, acne, or mood swings.” She pointed out that those side effects were “very similar to the side effects that we’ve had.” some women experience when using the female hormonal contraceptive pill.”

Promising hormone-free approaches

Another area of ​​research targets precise points in the sperm’s life cycle, including its ability to swim or fertilize an egg. These drugs are a bit more precise than hormonal drugs, says Logan Nickels, research director for the Institute. Male Contraception Initiativesupport researchers working on non-hormonal contraceptives.

“They target a very specific link in the sperm making or life cycle chain and… if you break that link, there won’t be any other bodily functions or any kind of signaling effect that you’re disrupting.” In other words, someone using these methods is likely to experience little or no side effects, he says.

“The male reproductive system is really interesting in that there are hundreds of links in this chain, [so] that if you get rid of any of them, you’ll end up with an infertile man,” says Logan.

Another non-hormonal method working in Australia is a gel that is injected into the vas deferens – the tube that carries sperm to the urethra in preparation for ejaculation – and blocks sperm transport. Logan says it could look like a reversible alternative to a vasectomy.

Why is it taking so long?

Page estimates it will be another seven to ten years before any of these new methods can be sold. So why do women have to shoulder so much responsibility for contraception over such a long period of time?

“Women bear the life-threatening burden of pregnancy,” says Page. “And so the initial energy went into making sure that women have control over their own reproduction.”

And, she says, developing a male contraceptive is more complicated. Women usually release one or two eggs per month. Men produce millions of sperm per day — one ejaculation contains about 15 million to 200 million sperm per milliliter of semen. Researchers had to figure out how low the number should be to reliably prevent pregnancy. They have now determined that less than 1 million sperm are needed per milliliter of semen, Page said.

And the FDA’s criteria for approving male contraceptives are vague.

The pharmaceutical industry and FDA use data from trials to weigh benefits and risks for patients. But Dr Page said that in this case, the risk calculation should be different.

“When we think about the risks, what are we protecting the man from? In the case of female contraception, the woman is protected from the risk of pregnancy and the possibility of an unsafe abortion. But with men, they are actually using contraception to protect their partners.If we just think of the man as a single unit, then there are obviously no side effects and There’s no risk. But I think we really need to move on to thinking about couples as a couple and this is a shared risk.” she speaks.

Another barrier to bringing male contraceptives to market is effectiveness rates. The female IUD and IUD are 99% effective and the Pill is 93% effective, according to Planned Parenthood. Male contraceptives may have to be as effective at preventing pregnancy in order to be marketable.

“Pharmaceutical companies invest millions upon millions of dollars in a drug before they see a dime of profit,” says Nickels. “And so when they take those calculated risks, those calculated investments, they try to make sure they see their money at the end of it,” he said.

Nickels, Page and Nguyen all expressed optimism that a male contraceptive will hit the market within the next decade, although funding could be a limiting factor.

Logan predicts that non-hormonal injectable gels or topical hormonal gels will be the first to reach the market.

For the male birth control pill to be successful in the market, it’s important for men to be better educated about what women have to go through, says Brian Nguyen.

“Men often avoid discussing menstruation, pregnancy, labor, infertility. Most men have a feeling of invulnerability because they don’t have to think about the need for contraception. And the only way to remedy this. It’s about having more and more open conversations with men about reproduction and their responsibilities in a process that isn’t just a women’s issue.”

Women have been waiting for that mindset change for a long time. But even if that doesn’t happen immediately for most heterosexual men, perhaps the freedom to come out of the shell will be enough motivation.

The audio for this episode was produced by Rebecca Ramirez, edited by Gisèle Grayson, and verified by Abē Levine. Tre Watson is a sound engineer.


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