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Male Contraception

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Ismail Munir

Overview

From as far back as 1850 BC, humans have used some form of contraceptive or another, ranging from honey to copper water[1]. While the forms of birth control have evolved quite a lot since then, the onus of preventing pregnancy has largely fallen on women. Thus, causing them to shoulder the economic, emotional, social, and physical burdens of contraception<a href="#accordion">[2]</a>.

Currently, women can choose from a wide variety of birth control methods, ranging from pills to sterilization procedures. On the other hand, men only have two options available to them - condoms and vasectomy. This is largely due to the uncertainty regarding the safety and efficacy of male contraception, and the lack of funding<a href="#accordion">[3]</a>.

However, researchers are working on several hormonal and non-hormonal birth control methods for men, many of which are undergoing clinical trials. 
&nbsp;

The Available Options

The following are the available birth control options for men<a href="#accordion">[4]</a>. 
&nbsp;

<h5>Condoms </h5>

These are barrier methods that prevent sperm from reaching the egg. They can be made of latex or polyurethane. As per estimates, condoms are 98% effective at preventing pregnancies. However, incorrect use or breakage can decrease its effectiveness.&nbsp;

<ul>
	<li>Pros: Readily available, easily accessible, protect against STIs, have no serious side effects, reversible, and do not require medical intervention.</li>
	<li>Cons: Possible allergic reactions, reduced sensation for some individuals, can be prone to breakage or slippage if not used correctly.</li>
</ul>

&nbsp;

<h5>Withdrawal (Pulling Out)</h5>

Also called &lsquo;coitus interruptus&rsquo;, it involves the man pulling out his penis from the vagina before ejaculation to prevent sperm from entering. It is the oldest form of birth control, but also the least effective. The method works 78% of the time when used alone.

<ul>
	<li>Pros: No cost, no side effects, no medical intervention required.</li>
	<li>Cons: High risk of pregnancy due to pre-ejaculate containing sperm, relies heavily on self-control and timing, does not protect against STIs. 
	&nbsp;</li>
</ul>

<h5>Vasectomy</h5>

This is a surgical procedure where the vas deferens, the tubes that carry sperm from the testicles, are cut, blocked, or sealed.

<ul>
	<li>Pros: Highly effective, permanent contraception, does not affect sexual pleasure or libido.</li>
	<li>Cons: Irreversible (requires additional surgery for reversal), possible surgical complications, does not protect against STIs. 
	&nbsp;</li>
</ul>

A Need For Male Contraception

Expanding the range of male contraceptive options is crucial for several reasons. Firstly, it would provide couples with a more diverse array of choices, allowing them to tailor their contraceptive methods to their specific needs and preferences. Shared responsibility for contraception empowers couples to make informed decisions about family planning and helps foster greater gender equality in reproductive healthcare.

&nbsp;

Moreover, the availability of effective male contraceptives can reduce the reliance on female-controlled methods, such as hormonal contraception or invasive procedures like sterilization. While these options have proven to be highly effective, they can come with potential side effects and risks. By offering more male contraceptive alternatives, the burden of preventing pregnancies can be more evenly distributed between partners, enhancing reproductive autonomy and promoting healthier relationships.

The development of new male contraceptive options is an ongoing area of research. Scientists are exploring various approaches, including hormonal methods that inhibit sperm production, non-hormonal methods that target sperm function or motility, and novel delivery systems. Clinical trials are being conducted to assess the safety, effectiveness, and reversibility of these methods. 
&nbsp;

In early 2019, researchers developed a once-daily birth control pill for men<a href="#accordion">[5]</a>. The hormonal pill, called dimethandrolone undecanoate (DMAU), worked by suppressing follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Thus, inadvertently decreasing testosterone and sperm production.

The pill was evaluated among 82 men aged 18 to 50 years. As per the study, the participants took the pill of varying dosages for 28 days. The pill had no adverse effects and significantly reduced FSH, LH, and testosterone levels. However, mild side effects, such as <a href="https://merisehat.pk/disease/acne">acne</a>, weight gain, headaches, tiredness, and reduced sex drive were reported among some of the participants.

A phase 2 clinical trial is required to further evaluate the pill. Researchers are also recruiting participants for the phase 1 trial of an injectable version of DMAU<a href="#accordion">[6]</a>.

Since hormonal options can cause side effects, similar to those experienced by women on birth control pills, researchers are working towards non-hormonal contraceptives.

Recently, researchers at the National Institute of Health (NIH) published findings from a study exploring the use of a compound called TDI-11861 as a reversible male birth control pill<a href="#accordion">[7]</a>. The non-hormonal compound was tested in mice and demonstrated the ability to temporarily immobilize sperm. Thus, providing a potential non-hormonal birth control option for men. However, further research is required before human clinical trials can begin.

The ADAM hydrogel implant is another male birth control option in the works<a href="#accordion">[6]</a>. The medical device is implanted into the vas deferens - the tube that carries sperm out of the testes. It can possibly serve as a long-term birth control option for men. Researchers are currently studying its safety and efficacy in a small human trial. 
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Key Points

<ul>
	<li>Male contraception refers to methods or techniques used by men to prevent pregnancy.</li>
	<li>Conventional methods of male contraception include condoms and withdrawal (also known as &quot;pulling out&quot;). These methods are readily available and effective in reducing the risk of pregnancy, but they are not foolproof.</li>
	<li>A vasectomy is a permanent form of male contraception. It involves the surgical cutting or blocking of the vas deferens, the tubes that carry sperm from the testicles to the urethra. Vasectomy is considered highly effective but should be considered a permanent decision.</li>
	<li>Hormonal methods for male contraception are being explored, such as the use of testosterone-based injections, implants, or pills. These methods work by suppressing sperm production.</li>
	<li>Non-hormonal methods of male contraception are also being investigated. Some of these methods target sperm motility or prevent sperm from fertilizing an egg, such as the use of ultrasound or heat to temporarily impair sperm function.</li>
	<li>Male contraceptives under development are focused on providing options that are reversible, safe, effective, and easily accessible to men. This would give couples more choices and enable shared responsibility for contraception. 
	&nbsp;</li>
</ul>

[1] Birth control throughout history: Facts, superstitions, and Wives Tales. Pandia Health.

[2] Kimport K. More Than a Physical Burden: Women's Mental and Emotional Work in Preventing Pregnancy. J Sex Res. 2018;55(9):1096-1105. doi:10.1080/00224499.2017.1311834.

[3] Page ST, Amory JK. The world needs better male contraceptives: What is taking so long?. FASEB J. 2022;36(12):e22658. doi:10.1096/fj.202201258R

[4] Male Birth Control Options. WebMD.

[5] Thirumalai A, Ceponis J, Amory JK, et al. Effects of 28 Days of Oral Dimethandrolone Undecanoate in Healthy Men: A Prototype Male Pill. J Clin Endocrinol Metab. 2019;104(2):423-432. doi:10.1210/jc.2018-01452

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