Why isn’t there a birth control pill for dudes?

by Lady Perv on February 27, 2013

in Contraceptives,Junk,The Pill

Now that Atavacron has started writing stuff, I’m having performance anxiety about not putting out on here, so I’m back to revisiting some of the posts that I started a couple years ago and never finished. Back in 2011, I had actually started doing some research about the contraceptive options that were in trials for men. I got as far as hormonal options and gossypol, and then went back to researching my thesis paper on hormonal contraceptives and libido. (Which I will totally post sometime, for real.) But reading up on the studies of contraceptives for men was a pretty fascinating diversion from what I was supposed to be working on. Up until that point, I had always assumed that there were no options for men other than condoms or vasectomy due to pharmaceutical companies assuming that men wouldn’t want to mess with their perceived virility. It turns out that it’s just a lot harder to stop the gazillion sperm that are constantly renewing themselves in male-bodied folks than it is to stop a single ovum once a month. A lot of the studies I read had kind of perplexing results as well, like one hormonal method that for some reason only worked in Asian men.

Here’s procrastinating 2011 Lady Perv:

I’m beginning to do the research for my final paper for nursing school. Of course, once I get started digging around in scholarly articles about reproductive health, I get totally lost in a list of a zillion things I want to read about. Somewhere in there, I came across a bunch of studies on hormonal contraception for men. Whoa, what? I totally didn’t know that there was that much research being done!

I had always kind of assumed that there wasn’t a pill for dudes that is comparable to the zillion hormonal contraceptive options for the ladies because of some combination of machismo and physiology. Most men have a serious attachment to their own virility. I’d heard about so many guys who were 100% sure that they are done making babies, but they don’t want to get vasectomies because the idea that there wouldn’t be any sperm in their spooge was just too weird. So, I wondered if there was no pill for guys because pharmaceutical companies didn’t think there would be a market for it. I also supposed that it was just easier to stop one egg from being released every month than it would be to stop a gazillion sperm from escaping with every ejaculation.

The fact that there seems to actually be a fair amount of research going into this endeavor was frankly pretty surprising. And fascinating! It turns out it is really difficult to figure out a way to get that sperm count down to something approximating zero. Clinical trials have apparently been going on for the past forty years with limited success. Researchers have been testing out different combinations of shots, patches and pills with varying levels of testosterone and progestins, and the failure rates seem to be all over the map so far.

I read this systematic review of 33 randomized control trials of steroid-based hormonal contraceptives. (You can find the abstract here, but you have to pay to read the whole article; damn you, scientists!) The review was conducted in 2010, so it’s pretty up to date. The idea is that steroid-based hormonal contraceptives for men should work the same way that hormonal contraceptives for women do: by breaking the hormonal feedback loop. In women, this means that the hypothalamus stops telling to the pituitary gland to release the hormones that tell the ovaries to release an egg. In men, it’s the same process, except that the last step involves telling the testes not to produce a gazillion sperm. The researchers basically found that most of the studies they studies were too small to produce conclusive results, but that the major problems with the male hormonal contraceptives they’ve tried so far appear to be “incomplete or heterogeneous sperm suppression, the lack of long-acting steroid preparations, and undesired metabolic effects.” This means the dudes are suffering the side effects of taking testosterone, and the sperm aren’t being consistently stopped.

So, 2011 Lady Perv deduced that it’s not entirely true that the lack of birth control options for men is part of a big patriarchal conspiracy. Female-bodied people have a very predictable and comparatively lengthy cycle that’s easy to interrupt to prevent conception from occurring, whereas male-bodied people are constantly producing baby batter like a Looney Tunes assembly line. Progesterone is theoretically a good tool for overriding the sperm-making process, but it significantly decreases testosterone, which then needs to be added back periodically. Messing with testosterone levels is not only unpleasant; it can also have some significantly negative effects on health.

In closing, here are a couple of fun facts about things that can affect the male reproductive system:

  • Depo-Provera (also known as the contraceptive injection, or “the shot”) is given to male sex offenders to essentially chemically castrate them. (Oh hey, there’s that significant decrease in testosterone!) It does not seem to have the same libido-squashing effect on women.
  • A friend of mine who used to work in a sperm bank tells me that they could always identify the sperm of the marijuana-smoking donors by their sluggish motility. (However, smoking weed is not a good method of contraception; it doesn’t really do much to reduce sperm count.) I like to picture sperm sitting there going, “Have you ever looked at your tail? Like…REALLY looked at it?” and eating a bag of Cheetos instead of swimming towards the egg. I’m sure that’s a scientifically accurate vision.

OK, back to Atavacron’s self-experimentation odyssey.

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