Male birth control pill — Available?

Dear Sam,

Finally, a male birth control pill, right? Unfortunately, not just yet. There are several methods of "male-directed" contraception being developed and tested in trials; however, none are currently available to the general public. Clinical trials are underway and men surveyed in countries throughout the world have expressed their interest in male-directed contraception. The road is being paved, but men may have to wait several years before any viable methods reach the market place.

So, what research is currently underway as far as new methods of male contraception are concerned? Below are a few of the methods being investigated:

• Hormonal contraceptives —This method, whether administered through pills, implants, and/or shots, is considered to be the most promising. Hormonal methods would work by using male hormones to stop sperm production — in theory, similar to female hormonal contraception. Specific hormonal contraceptive methods being studied include: androgen, testosterone and progestin, and oral testosterone. Research studies are testing these various hormonal treatments to see which, if any, can successfully lower the sperm count to zero, while still being reversible.
• Thermal methods — Have you heard that tighty-whitey's (briefs) can lower a man's sperm count? Well, there's something to the idea that heat reduces fertility. Heat methods would allow men to systematically bathe their boys in heat (most likely water baths) to diminish sperm production. Current research findings suggest that this may be used in conjunction with other new male contraceptive methods to increase effectiveness.
• Ultrasound methods — Some research studies are experimenting with using ultrasounds combined with water baths to examine the effect on sperm count.
• Non-hormonal pills — Certain pill-based drugs that do not specifically manipulate the aforementioned hormones may limit sperm production in a variety of ways, some of which may be successfully reversible.
• Vas deferens-blocking methods — Referred to as “vasal occlusion” or “vasal interruption,” these methods use a type of implant as a temporary version of a vasectomy. They work by plugging the vas deferens so that sperm cannot enter the semen — yet unlike a vasectomy, they are intended to be reversible.
• Sperm vaccines — Some current research is in early stages of determining if an immunologic approach is possible to decrease sperm count to zero.

So with all this research going on, what's taking so long? The male reproductive system provides unique challenges to researchers that require different solutions than contraceptives for women. While women release one ovum per month and are fertile for about 48 hours a month, men are fertile 24/7, producing sperm — though a process called spermatogenesis — at a rate of approximately 1,000 sperm per heartbeat! Scientists were able to develop the birth control pill for women, also known as oral contraceptives (OCs), based on the regularity of the menstrual cycle. Other challenges of producing effective yet reversible contraceptives for men include concern over affecting future sperm production that could potentially alter genes in any children eventually conceived with that sperm and also difficulty accessing the site of sperm production, which is protected by the blood-testis barrier —similar to the blood-brain barrier — that prevents certain molecules from getting through.

As with female-directed methods, factors such as cost, convenience, and ease of use will likely play a role in overall acceptance for these male contraceptive methods. Finally, none of the methods being researched would provide protection against sexually transmitted infections (STIs). Even when new male-directed contraceptive methods are available, condoms will still be essential in STI prevention.

Also, read Current contraceptive choices for men? for information on currently available contraceptive options. Men with female partners can also discuss any birth control methods she may be willing to use, and can even contribute money to help off-set the cost. However, it seems that it may be some time before men have access to reversible contraceptive methods, other than condoms, of their own.