Why There’s Still No Birth Control Pill for Men

At Aeon Magazine, there’s a long and engrossing article up about what’s been causing the dearth of options in male contraception, an arena that contains just the 100-year-old vasectomy and the 500-year-old condom (apologies to anyone who just pictured a 500-year-old condom and died). “In a society that increasingly recognises that men and women should share responsibilities and opportunities equitably,” writes Jalees Rehman, “the lack of adequate reproductive control methods for men is striking — and puzzling — especially since many newer methods for male contraception have been developed during the past decades yet none has become available for general use.” An example from one of the biggest clinical trials ever conducted, testing a testosterone/progestin contraceptive method delivered via injection:

In April 2011, the trial was terminated prematurely when the advisory board noticed a higher than expected rate of depression, mood changes and increased sexual desire in the study volunteers.

To me, those sound exactly like the average user experience of birth control pills, except a bit better because of the “increased” part. But now:

The discontinuation of the WHO/CONRAD trial was a major setback in bringing male contraceptives to the market. It also raised difficult ethical questions about how to evaluate side effects in male contraceptive trials. Since all medications are bound to exhibit some side effects, what side effects should be sufficient to halt a trial? Female contraceptives have been associated with breakthrough bleeding, mood changes, increased risk of blood-clot formation, as well as other side effects. Why should we set a different bar for male contraceptives?

The twist here is that female contraceptives prevent unintended pregnancies in the person actually taking the contraceptive. Since a pregnancy can cause some women significant health problems, the risk of contraceptive side effects can be offset by the benefit of avoiding an unintended pregnancy. However, men do not directly experience any of the health risks of pregnancy — their female partners do. Thus it becomes more difficult, ethically, to justify the side effects of hormonal contraceptives in men.

That last part is very interesting, as is this tidbit of country-by-country data:

The willingness of respondents to use newer male contraceptives was highest in Spain (71 per cent), Germany (69 per cent), Mexico (65 per cent), Brazil (63 per cent) and Sweden (58 per cent). Nearly half of the men in the US (49 per cent) and France (47 per cent) expressed an interest. On the other hand, disapproval of newer male contraceptives was highest in Indonesia (34 per cent) and Argentina (42 per cent).