People have long asked why there aren’t more birth control methods available for men. Women seem to hold most of the burden financially and physically, even though it takes two to tango, as they say. The good news is female birth control options are now covered for most insured patients under the Affordable Care Act (ACA). But there are plenty of exceptions when it comes to the contraception mandate, as well as other barriers to access. The Hobby Lobby ruling allowed for religious employers to take exception with women’s birth control methods, while the company interestingly has no problem covering vasectomies. The ACA’s list of preventive services actually does not include male birth control at all, so vasectomy coverage depends on the plan. Both men and women must pay for condoms, unless they obtain them from a free clinic or use Condom Finder.
Men want better birth control options
American men are more interested in taking responsibility for their own contraceptive needs than some might think. As with female methods, current contraceptives for men are not perfect, but women at least have many more options to choose from. There are only two options for male birth control: condoms, which are not covered by medical insurance, and vasectomies, which typically are not reversible. A Kaiser Family Foundation study found 66% of men were willing to take an oral contraceptive, 44% would get a birth control shot, and 36% would try an implant.
A hormone-free injection method called Vasalgel may be one of the most promising male contraceptives for the near future. Vasalgel is backed by the Parsemus Foundation, a non-profit with a mission of “finding low-cost solutions neglected by the pharmaceutical industry.” Elaine Lissner, director at Parsemus, says most inquiries about the product come from people in their 20s. That includes men looking for more control over their reproductive health and women who are experiencing problems with the options available. Lissner says the most vocal group has been “the young men on the dating market who are concerned about an ‘oops’ with a condom or the pill.”
She added, “I think as far as what’s holding things back, it’s definitely the idea that men 20 years ago weren’t interested. And maybe men 20 years ago weren’t. But men today sure are.”
Why it’s so difficult to develop male contraceptives
The reason it’s typically universities and foundations researching male contraceptives is pharmaceutical companies have no interest in getting involved. These companies likely fear disrupting the lucrative female oral contraceptive market. There are several other factors that make it difficult to get male birth control methods on the market, such as long development periods, financial shortages, and scientific challenges unique to male biology. It’s harder to block millions of sperm than the ovulation of one egg, for example. More than anything, Joseph Tash, a reproductive biologist at the University of Kansas Medical Center, says it takes a long time to fine-tune potential contraceptives to minimize physical risks.
Austrian-American scientist Carl Djerassi, often referred to as the father of the female pill, said in a 2014 interview that he believes a male pill will never go to market for political and economic reasons alone:
“This has nothing to do with science; we know exactly how to develop them. But there’s not a single pharmaceutical company that will touch this, for economic and socio-political rather than scientific reasons. Their focus is on diseases of a geriatric population: diabetes, obesity, cardiovascular, Alzheimer’s. Male contraception is nothing compared with an anti-obesity drug.”
Vasalgel and RISUG
Regardless of the huge challenges associated with developing male contraceptives, the demand is there, so there are a number of methods currently in the research stages. Vasalgel is one of the most promising ventures in progress in the United States. It was developed from RISUG, another injection method in development in India since the 1970s. Though they are different formulations, Vasaglel and RISUG are based on the same concept of injecting a polymer gel into the vas deferens. The process takes only a few minutes and, so far, has been shown to be incredibly effective for up to 10 years. It’s also thought to be easily reversible with an injection of sodium bicarbonate, though Parsemus says until more reversibility studies are complete, Vasalgel should be thought of as a vasectomy alternative.
One celebrated aspect of the non-hormonal injection method is that the propensity for human error, which we see with condoms and pills, goes away because there are no steps for the patient to remember. “There’s nothing for you as a person to screw up,” said Aaron Hamlin, executive director of the Male Contraceptive Initiative. There are roughly 22,000 men on the waiting list for Vasalgel clinical trials and Parsemus is hopeful the product will be available by 2018.
A pill for men
Many attempts are being made to bring about the long-awaited birth control pill for men. For example, Dr. John Amory of the University of Washington is revisiting 1950s research trials on male prisoners in the hopes of finding a way to stop the sperm maturation process. Tash and his team are looking to get a drug called Gamendazole into human clinical trials, and Parsemus is researching what it calls the “Clean Sheets Pill,” a drug that allows for male orgasm while inhibiting ejaculation. The result could potentially be an oral contraceptive that also reduces the transmission of HIV.
A male pill called Gendarussa is in phase II human trials in Indonesia and would prevent sperm from fertilizing an egg, while a drug called Eppin works by targeting the Eppin protein to stop sperm from swimming. Non-hormonal methods like these could be the most promising methods being studied, according to David Sokal of the Male Contraception Initiative.
Gels, patches, implants, and injections
The Population Council, a nonprofit that conducts biomedical and public health research, is developing a one-year implant for men called MENT that’s similar to Nexplanon, a contraceptive implant for women. The Council and other researchers are also conducting trials on a variety of topical contraceptive gels, based on gels currently used for hormone-replacement therapy. Other hormonal methods like patches and hormone injections are being investigated as well.
All of this research remains challenging, but with the increased demand for male contraceptives, American men may not have too many more years left to wait before there is at least one meaningful alternative to condoms and vasectomies.