Why don't we have a male birth control pill yet?

Scientists say they're one step closer to developing a contraceptive for men, but there are big questions marks over why it's taking so long


When it comes to contraception, the responsibility often falls to women as men's choices are limited indeed. Use condoms or try your luck with the withdrawal method: essentially pregnancy Russian roulette. Unless a man has a vasectomy, if he's in a heterosexual relationship, it's likely his partner will be the one thinking about birth control.

There's been talk of a 'male Pill' being just around the corner for years, but here we are in 2016, still waiting. This week however, news broke that scientists have made a small change to a previous version of a contraceptive tablet for men to make it effective over a longer period of time. But even if it proves successful in trials, it will need years of testing before it makes it to market.

Man in pink shirt taking pill medicine with water
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Campaigner Elaine Lissner made it her mission several years ago to change the contraceptive landscape. When she was still a university undergraduate, she was procrastinating in the library and ran into a book that sparked her interest. It was called Outrageous Practices: The Alarming Truth About How Medicine Treats Women.

"It had this chapter on a Swiss woman doctor who had developed a low cost method of male contraception in the 1930s," Elaine reveals.


Elaine had come across the work of Dr Marthe Voegeli who discovered that soaking men's testicles in a hot bath once a day for 45 minutes for three weeks resulted in 6 months of infertility. And once the method was discontinued, the volunteers went on to successfully have children.

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Fascinated, curious as to why Dr Voegeli's method was never taken further, and frustrated that contraception was still seen as a woman's responsibility, Elaine decided to try and carry on the cause and campaign for more contraceptive options for men. After coming into some personal money, she started the Parsemus Foundation. The organisation is working on getting a long-acting contraceptive to market.

Why don't we already have a 'male pill'?

The science is often blamed for the reason men are stuck with condoms and coitus interruptus. As Professor John Guillebaud, Emeritus Professor of Family Planning and Reproductive Health at University College London, puts it:

"It's much easier to stop one egg once a month in a woman than 400 million sperm in a healthy man's ejaculate. Men produce 1000-plus sperm a second, night and day. This production line takes 70 days, so interfering with the process of making sperm has the built-in snag of a long delay before it can be effective."

The last major clinical trial of hormonal male contraception ended a decade ago. It had to be stopped when the advisory board noticed a "higher than expected rate of depression, mood changes and increased sexual desire in the study volunteers."

"This was a serious blow. The whole field [of male hormonal contraception] has been at a complete stand still for the last ten years," reveals Professor Ilpo Huhtaniemi, Emeritus Professor of Reproductive Endocrinology at Imperial College London.

But, hormonal efforts aren't the only options. Elaine suspects the biggest hurdle is not scientific, but economic:

"Most people are using something, even if they hate it. So if you're a pharmaceutical company, you're potentially cannibalising your own sales of other methods. For every man who uses your male method, you may have a woman who stops taking your Pill."


And although most drugs have some side effects, when you're a company developing a product for sick people, undesirable reactions are offset by treating the condition. With contraception, as you're giving a pill to healthy people, even the slightest side effect is considered unacceptable.

Positive pregnancy test
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But women might point out that the Pill has unpleasant side-effects, from weight gain to mood swings, so why should that stop development of a 'male pill'? The general argument is that the negative effects of female contraception are set against the positive health benefits of avoiding an unintended pregnancy. Which begs the question: are adverse effects of contraception seen as more acceptable for women than for men?

The other options for men

Elaine's company is working on Vasalgel, a product inspired by the work on a similar contraceptive called Risug which is in advanced clinical trials in India. It's intended to be a less invasive alternative to a vasectomy.

The technology behind Vasalgel is simple. It's a gel that acts as a sort of mesh which allows some fluid to pass, but sperm are too big to get through. The gel is injected into the man's vas deferens (the tube that carries sperm from the testes). Vasalgel filters out the sperm as they pass by. It's likely reversible too; animal experiments have shown that all is needed to remove the gel is an injection of baking soda.

Elaine says it has a few advantages over a vasectomy:

"The gel is injected so there's no cutting involved. Plus, it seems to take action more quickly. With vasectomy, men are generally advised to wait three months or a certain number of ejaculations to clear the sperm out. But with Vasalgel, we've been seeing effect within weeks. It's similar but it's less surgical. And what will make it revolutionary if it's reversible.

Human trials are expected to begin before the end of this year. On top of her own product, Elaine is passionate about other options out there too, such as The Clean Sheets Pill.

"The concept that gets used is a 'contraceptive supermarket'. The more options there are, the more likely there is to be something right for everybody," she says.

The Clean Sheets Pill

Invented by Dr Nnaemeka Amobi, the Clean Sheets Pill is affectionately named because it stops the release of semen when a man has an orgasm. Essentially, it allows men to have sex without any of the mess. It even has the potential to reduce HIV transmission. The pill would be swallowed, when and as needed. It's effective within four hours and reversible after 24.

It works by relaxing a group of muscles in the vas deferens, effectively cutting off the flow of semen to the penis. The fluids remain where they are, without any apparent health concerns. Professor Guillebaud says:

"An implant might potentially follow. It would provide a suitable contraceptive option for men who do not wish to undergo surgical vasectomy and are bothered about some of the health issues of any hormonal 'male pill'."

The Clean Sheets Pill project has run up against funding hurdles, and progress has stalled. It's likely the project's failure is down to acceptability; most men simply wouldn't want to have a semen-free orgasm as ejaculation is so strongly associated with pleasure.

A herb that prevents fertilisation

Some recent news in male contraception comes from Indonesia. Professor Bambag Prajogo, of the University of Airlangga in East Java had heard rumours since the 1980s about a tea made from leaves of the Justicia gendarussa plant that tribesmen drank in order to prevent conception. The professor extracted the active ingredient and turned it into a pill.

Justicia gendarussa

The medicine works by disrupting enzymes in sperm that allow it to penetrate an egg, so fertilisation can no longer occur. Some small clinical trials have yielded good results, and the only side effect seen in some of the men was slight weight gain. The Indonesian government has plans to try and market the pill soon, but people elsewhere in the world could have a long wait.

An on-off switch for sperm

It sounds bizarre, but in January, German carpenter, Clemens Bimek, announced he had developed a contraption which would allow a man to turn off the flow of sperm from his testicles at the flick of a switch. The tiny valve is less than an inch long and is surgically implanted in the vas deferens in a simple half-hour operation. Some doctors are sceptical (a few worry the valve will cause severe scarring) but the device will be implanted in 25 men later this year to see how effective and tolerable it is.

Man sitting in bed in morning waking up
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Men want more options

Some question the need for male contraception, and whether men would even be interested in pursuing it, but studies have shown that men aren't unwilling to shoulder the responsibility.

"This has been studied extensively and the great majority of men and women say they would use male contraception," says Professor Huhtaniemi.

And Elaine points out that in the UK, condoms and vasectomies are the options used by about a third of couples.

"I think attitudes have changed. And that's shown by men already using what limited methods they have and I think men bear a lot more responsibility now for child costs. We have over 31,000 people on our mailing list, waiting to hear about clinical trials. I think that speaks for itself."

She's passionate that for the methods that have shown promise, funding needs to be coughed up, so that they can be developed to full term.

"There's a lot of whizz bang cool technology out there, but we have a pipeline that's full and emptying into the sea. We need to commit the scale of funds, and efforts to finish the job for the methods that are already started. Otherwise, it's just a crime to see this research go to waste."


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