Male Contraceptive Pill
Men's choices
At the moment about all that's available to men in the way of contraception is either the condom or the more drastic step of vasectomy. The third option is the rather unpopular technique of abstinence - it's never been a favourite among my male patients! But it has its advantages - see, for example, this safer sex website.
For lots of information about every sort of contraceptive issue see the International Planned Parenthood Federation.
The contraceptive pill revolutionised life for women in the 1960s and is now used by millions of women around the world. But what about a pill for men? The answer is that plenty of researchers are racing to develop a male pill (it's a potentially lucrative business) but so far there's nothing like it in general use.
Hormone treatments
Early attempts to develop a male pill were based on using testosterone
Most of the early attempts to develop a male pill were based on using testosterone to trick the brain into turning off sperm production. But this has not been as successful as the female pill has been in switching off ovulation. Results have been a bit hit-or-miss, and this approach has proved ineffective in as many as one in five men.
More recent research has been based on the finding that another hormone also controls sperm production. This hormone is prolactin - familiar to women because it controls the production of breast milk, but also produced by men. To act as a contraceptive, tablets that inhibit the production of prolactin must be taken every day along with injections or implants of testosterone - quite a commitment for young men, who are notoriously less reliable than women in taking medication.
Injections and patches
Other combinations have also been looked at, such as weekly injections of testosterone and daily progestogen pills. It may be possible to give the testosterone component using a skin patch instead of an injection.
Research in Manchester has combined desogestrel (also used in female contraceptives) and patches of testosterone. The desogestrel stops the production of testosterone in the testes, so stopping sperm production, while the testosterone patch provides the needed testosterone to the rest of the body (without this men would lose their facial hair and could develop breasts). But scientists have been struggling to make this work in every man who takes the hormone combination rather than just about 60 per cent of them.
Side effects
Side effects have been a particular problem
All drugs have some potential side effects. Side effects have been a particular problem for hormone-based male contraceptives. It's hoped that by combining hormones, side effects of testosterone such as prostate problems, nausea, jaundice and headaches may be reduced.
Another problem is ensuring the effect is temporary or reversible.
A different approach
New research is looking for a different way to stop sperm production. Some work that's proving promising but is still in its very early stages is looking at how to disrupt protein signals between the cells that make sperm. Another technique under scrutiny stops sperm being ejaculated out of the testis. These are just two of many techniques being studied.
Would men want to take a pill?
Many women, used to bearing the brunt of decisions about contraception, may be a bit cynical about men's interest in taking a contraceptive pill.
But in a recent international survey two-thirds of men questioned said they would use the pill if it were available - and nearly all women trusted their partners to take it. Even in Hong Kong, the most conservative area of the study, nearly half of the men said they would use it.
How far off is the male pill?
The biggest problem facing scientists at the moment is developing a male contraceptive that can be expected to work in every man all of the time. It's not good enough to reduce sperm counts from the normal levels of several million down to just a few - one sperm is all that's needed to create a new life.
Shortage of takers
In 2003 researchers in Australia did a limited trial of a combination contraceptive that showed it was 100 per cent effective and free of unacceptable side effects. Importantly, it was also reversible - normal fertility levels returned within a few months of stopping the treatment. The word ‘pill' is a misnomer as this form of contraceptive combines a testosterone implant and a three-monthly injection of progestin, a hormone used in female contraceptive pills.
However, it's likely to be a long time before this treatment comes out of the research lab and into the chemists.
It's been estimated that there will be a commercially available male pill within the next few years. Mind you, people were saying that ten years ago! Right now there's nothing anywhere near as simple as the pill for women.
This article was last medically reviewed by Dr Rob Hicks in May 2005.
First published in October 1997.
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