Finally, Male Contraceptives

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It's intuitive to think, you know, you need two people to conceive a child.

And currently,

our contraception options are almost entirely limited to one, you know, biological sex, people with ovaries and a uterus.

That's Atlantic staff writer Katie Wu.

And when she puts it like that, yes, the math is so so obvious.

It takes two to make a baby.

And yet when I say birth control, we mostly think of one, the one with the ovaries and the uterus.

I mean, yes, there are condoms and vasectomies, but the whole complicated apparatus of birth control, the decades of hormones and doctor's appointments and implants and worry and the costs, That's something mostly women have to deal with.

But of course, it doesn't have to be that way.

Why didn't I realize that sooner?

I'm Hannah Rosen.

This is Radio Atlantic.

And today, the rapidly advancing science of male birth control.

As a science and health reporter, Katie has followed this research for years.

When we spoke, I was curious and maybe even hopeful to see if some of the impetus for the research was to ease the burden on women.

Here's Katie.

There's a couple motivations.

Like, certainly, just having a little bit more equity in this whole world of family planning, if there are two people participating in the conception of a child, if the goal is to actually prevent that, why shouldn't multiple parties participate?

It would certainly ease the burden on women who are the primary people having to deal with the logistics of contraception, the side effects of contraception, paying for contraception, accessing contraception, even stigma around certain contraception, especially in parts of the world where contraception is not necessarily widely socially accepted.

But also to this idea that, you know,

I guess tackling something from two different vantage points, sperm and egg, is going to make the whole endeavor a little bit more successful, right?

Combining two methods of contraception, that's not a bad way to go about it if you really want to be sure that you are accomplishing your goal.

That's interesting.

And the scientists say this, like the scientists working on this say, yes, we're doing this partly for equity reasons.

Oh, absolutely.

I mean, I think there is this growing feeling that the burden of contraception, preventing pregnancy, and taking on the risks of doing that has really fallen unfairly on women.

And it's time that, you know, we spread that around a little bit more.

There are actually male participants in trials for some of these birth control methods for male contraception who say part of the reason that they want to participate is they watch their female partners go through the side effects and the hassle of taking birth control.

And they feel guilty.

They feel frustrated.

They feel like, why can't I be doing more to help out?

I'm almost like speechlessly, I'm a little speechless and a little,

I don't know, I'm just heartened to hear that.

It never occurred to me.

Maybe I'm just too cynical, but I've been so accustomed to thinking of birth control in the current political context that it just never occurred to me that in science, there was this decades-long effort to make this whole process more equitable.

It's really nice to hear.

It is, though.

Of course, I have to jump in here with a little bit of the cynicism, right?

It certainly has not been perfect culturally.

And I think as encouraging as it is to hear that a pretty decent contingent of people do feel this way, of course, there's been pushback on that idea.

And there's certainly reasons why it has taken so long to get to the point where we're on the cusp of having widely available male contraception beyond, you know, condoms and vasectomies.

Some of those reasons are definitely scientific, right?

We're dealing with a totally different reproductive system.

But I think we also do have to acknowledge that people are just a lot cagier about asking men to take on extra risks, extra burden, when the viewpoint has been for decades, we don't have to.

The women have that covered.

Yeah.

Okay.

I really want to get into that.

But before we do, let's just have some basic understanding.

What are the methods people are looking at?

Like, what can we expect in our local pharmacy in the men's contraception section soon in our near future?

What is it?

What are they?

Yeah.

So I will caveat this to say that not all of the things I'm about to mention will necessarily be on pharmacy shelves.

Some of them will have to be maybe sort of roughly akin to having an IUD placed.

Will require you to go to a doctor's office.

But there are a bunch of different options.

Probably the one that is furthest along is this tapical gel that has been in trials for several years now that men can basically smear on their shoulders.

And it's this hormonal concoction that really, really dramatically plummets their sperm counts.

And if they apply it regularly, it's a pretty great and almost side effect-free way to control their own fertility.

And it's totally reversible.

Wait, that sounds comically easy.

Like you put basically like a gel on your shoulders and it has no side effects?

Okay, it doesn't have zero side effects, but I certainly am comparing this to a baseline of like the typical side effects we see with female birth control, mood swings and depression.

There is almost none of that that is being reported in trials.

Men actually sometimes experience increased libido, and the investigators have been really surprised to see like, oh, you know, there's really not much going on here in terms of the typical side effects we we see with female birth control.

Why is this irritating me?

Okay.

You know what I mean?

We'll get to it, I promise.

Okay.

All right.

So, so, so keep going.

What are some of the other methods?

Yeah.

So, another that I think is super interesting is what I sort of liken to a really easy, reversible vasectomy.

So, you know, traditional vasectomy, you have this quick surgery where you go in and you're messing with the VAS deferens, which is the conveyor belt for sperm.

That is surgery, but this new method that researchers are experimenting with, they're basically plugging up a tube with a gel that can either dissolve or be removed at a later date so that, you know, it's pretty easy placement.

It's just plugging a hole, like a stopper in a sink that you can remove.

Basically capitalize on the convenience of having sperm so readily accessible, like right there in the testes, which hang outside the body, a lot harder to reach eggs that are hiding out in ovaries deep in the abdominal cavity sometimes.

Wait, you're saying it's easier, like biologically, the male contraception is an easier proposition?

Certain parts of it are.

Others aren't.

As you can imagine, some of the more challenging things is there are so many sperm being produced constantly and so many sperm in, you know, every attempt at conception that it can be hard to get them all.

But on the flip side of that, we only have to reduce sperm counts to a certain degree, not to zero, to make someone effectively infertile, even if only temporarily.

Right.

Okay.

I'm seeing a theme here, which is quick and easy.

Absolutely.

And I think the diversity of options, I mean, I've only named two, but we've already covered, you know, something that is super long-acting and reversible, the set it and forget it kind of method.

One is hormonal, one is non-hormonal.

And there are others still that could be a pill that you may only have to take occasionally rather than every day to like stop your sperm from being motile and how plausible are these things definitely a train that's coming into our station like this is definitely going to happen at some point i think some of these methods are far enough along probably that topical cream especially are far enough along that you know researchers even ones who aren't directly involved with the trials are pretty optimistic that yeah maybe sometime in the in the 2030s this will really become a reality

i think even just having having a couple options for men on the market will be a big step toward equity, but there are also some kind of frustrating things about how exactly that's going to manifest.

What do you mean?

Why?

Like, what's frustrating?

Right.

So, I think we have both noticed as I've been talking through these options with you that these sound pretty great.

Like, obviously, some unexpected hurdles could arise, some unexpected side effects could still crop up.

But so far, it really is looking like we're fast approaching a reality in which men are going to have easy access to super convenient, super effective birth control that hardly gives them any side effects at all.

While in the meantime, like millions of women are like, oh no, I have terrible acne again, or I have extreme pain because, you know, my IUD is doing weird stuff to my body.

And that just seems, oh, like we could be doing better.

And I mean, this is not an accident.

And I think that is one of the most frustrating parts of this.

From the get-go, the researchers involved in developing male contraception have paid extra close attention to can we develop products for which there will be almost no side effects?

And can we be extra vigilant about this so that these products are going to be basically the most convenient, easy things ever with almost zero risks.

Okay, now I'm speechlessly infuriated.

So, okay, just to summarize, you're just saying that what's on the table, what they've been very vigilant about is let's make sure this is easy.

Like it doesn't have side effects and it's easy.

And they didn't really worry about that too much with women.

Now, what I was hoping you would say is that scientifically it's just too difficult, too hard to devise birth control for women that is that easy.

But you're not saying that.

You're just saying it just wasn't a priority.

We don't know if it's easy or doable.

Absolutely.

There have been different sets of standards for men and women.

And the argument for this over the years has been one that

depending on who you are and how you feel about a bunch of different things, like you may find reasonable or not, this idea that, yeah, it's the woman who gets pregnant, the woman who must bear.

like literally the risk of pregnancy.

And so she has more to lose if the contraception doesn't work.

And so she should be willing to take on more risks with contraception that she takes because she's weighing that against the risk of pregnancy.

For men, you're taking contraception inevitably to prevent pregnancy in someone else.

And so it's not, am I going to get this headache versus become pregnant?

It's, am I going to get this headache versus nothing?

Right.

There, you know, the incentives have to be extra strong.

Like it has to be extra easy to get men to play along with this.

Yeah, I think it's both a marketability thing, but they also do have to contend with these kind of independent safety boards.

And those safety boards have certainly been stricter about saying, well, if we really are doing the risk-benefit calculation of every step along this clinical trial, we're going to do the math a little bit differently because we know what the risks are in scenario one and the risks are in scenario two.

Right.

And so like it's kind of funny because there have been trials for male contraception in the past that were were paused by these independent safety boards because they were thinking, oh my God, the math is not working out.

The risks to men are so great.

And meanwhile, participants in the trial that was paused were actually like, actually, I would have kept going with this if you'd let me.

So.

Wait, but were those a question of safety or what was the challenge there?

Right.

So this was a trial that was stopped in 2011.

Basically, this independent safety committee determined that that the drug side effects outweighed the potential benefits, but the side effects were mainly mood swings and depression.

They were experiencing side effects that I would certainly say a lot of women go through with their own birth control, even nowadays with our updated methods.

I will freely admit that I was pretty frustrated when I learned about this.

At the same time, and maybe this is the cynical part of my brain speaking up, it didn't shock me.

I think this one at face value, this illustrates the double standard that is absolutely still going on with birth control.

And at the same time, it also is almost like sickly

validating.

Because for anyone who is sitting here wondering, why don't we have these options yet?

This is it.

This can help to explain a lot.

And I think this illustrates what has to be overcome.

So we're edging towards the scientific breakthroughs, but it sounds like we still have cultural barriers to overcome.

Notions about masculinity, responsibility, promiscuity, all that after the break.

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Once there, Mike still did more laps around the pool.

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Okay, we're back.

Katie, we've been talking about equalizing the burden between men and women.

So what gets in the way of that in the past?

What stopped that from happening?

I think we struggle to reconcile some of the common side effects we associate with birth control with our modern conceptions of masculinity.

Is it especially not okay for like a dude, like a dude to take a drug and have his sex drive go down, to undergo mood swings and get really emotional, to break out with acne in his 30s?

We have, for whatever reason, socialized that to be normal and acceptable for women, but this is not a norm that we've been taught to accept for men.

And I think there may be an additional struggle there.

Also, certainly anyone who has a problem with female contraception right now in today's world is going to have concerns about male contraception and, you know, the implications of that for promiscuity, how we think about sex for the purpose of not conceiving, but just having sex.

I mean, God, I would love to see people reconceptualize this as like, who's allowed to have a sex drive, right?

We've been so cagey about men losing their sex drive for X, Y, and Z reasons to the point that this is a prominent concern in trials for male contraception.

If that can help inspire more enlightened thinking about, you know, how important it is for women to maintain a sex drive and for them to even have a sex drive to begin with, and for that to be culturally okay,

that would be fantastic.

Yeah, yeah,

here, here.

Okay, so we understand now that the pill was a massive cultural revolution.

Like we can see that now.

From everything you're saying, there is a possibility that we're on the brink of another moment like that.

Like, there could be, maybe you're laughing inside, but could we, if male contraception, if they figure out how to message it correctly, if it starts to show up slowly and then be accepted in the mainstream, is there a possibility that it helps build a sense of genuine shared risk and responsibility for sex and having a baby.

I hope so.

I mean, I certainly see this feature playing out in gradients rather than a switch being flipped.

And any step in the direction of more equity, I will take it.

I do fully anticipate that there is going to be pushback against male birth control.

I mean, there already is.

I think if you go into the darker corners of the internet, you will see that people are freaking out about the fact that these trials are even happening.

And like, why bother?

The women already have it fixed, blah, blah, blah, blah.

You can imagine the sorts of things that people are already saying.

Because why?

Because it destroys masculinity.

Like, I don't actually know what the cultural, even if it's the dark cultural resistance.

I will admit, it's hard for me to get into this space as someone who has never felt this way.

And also, I am not a man.

But I do think there are some concerns about masculinity.

The production of a lot of sperm is very tied up in traditional notions of masculinity.

And this is something that would directly imperil that.

I also think there is just a lot of pushback against the newness of the notion that contraception should be a shared risk.

For people who think that box was checked long ago by products being made available for women, this seems like an unnecessary additional risk for huge swaths of men to be taking on.

Got it.

Right.

Now, among the scientists, do you get the sense that

the future they see is a possible replacement for the pill in lots of quarters?

Because I can imagine a situation where a couple sits down, they're looking at a male contraception that has virtually no side effects.

Most female contraceptives have some side effects, some very significant side effects, and they would choose the male contraceptive.

Yeah, it's a great question.

And opinions about this are a little divided.

I think a lot of researchers are curious to see what is going to happen.

I can see on an individual to individual basis how for a lot of couples where the woman has really struggled with the side effects of birth control or not wanting to go through somewhat invasive procedures to have longer acting methods placed.

There are many good reasons to not be excited about women's contraception right now.

There may be a scenario in which male birth control replaces female birth control within those couples.

But I also have heard from a lot of people that they don't expect overall population or community-wide enthusiasm for female contraception to really diminish all that much.

There are going to be a lot of couples who want to team up and use multiple methods at once.

You know, why not?

That will that much more decrease the chances of pregnancy.

It's almost like using both an IUD and a condom, but splitting that even more equitably between men and women at this point.

And then I think

this is a slightly more cynical reason, but there are going to be plenty of women who don't trust their male partners to fully take on the responsibility.

Even if that does become pharmaceutically an option, is the male partner in the scenario going to apply that cream regularly enough?

Right.

Like it definitely opens up the question of shared responsibility.

It doesn't necessarily explode it so that we're all of a sudden living in a different world.

But I do feel like it inches closer.

And I am thinking about what changes in society if we start to think of preventing the birth of the child as also the responsibility of a man.

We kind of vaguely do now, like a condom, very vaguely.

But when a man has like many, many options, it becomes harder to duck, you know?

Right.

It shifts the burden of vigilance.

I would hope so.

I'm sure there will still be a lot of lingering sentiment that like the women's contraception should be the biggest safety net here because unfortunately like some men will continue to see this as a still very low stakes endeavor for themselves.

But we'll see.

I mean I think another thing that I am excited about that could shift things culturally and just make all of this feel easier for women in a kind of indirect way is maybe this could inspire female contraception to

be less riddled with side effects, to be more convenient, you know, to take some inspiration from the male side of things.

Why can't we revamp female contraception at the same time, not just by saying, hey, there are more options for your partner to take, but there are also better options for you to take too?

So just to end here, an equitable world for you, given where you know the science is going and what's possible, what would it look like?

Well, it would certainly go beyond contraception.

Okay, that's that's we can go there if you want.

I was mostly thinking about like, let's limit it to the pharmacy aisle.

Like if we're talking about contraception and I'm, you know, going to a doctor or walking down the aisle, what is equitable?

Yeah, I mean, I think there are a lot of ways to imagine how that future would be different.

Certainly pharmacy shelves would look different.

But also, would we have, you know, a revolution in medicine?

Would we train a huge contingent of doctors to be a larger like counterpart to what we currently see as the realm of OBGYNs?

And

would those conversations start to happen with men?

Would we like regularly check in with men about their sperm counts, their fertility, how they're participating in their partner's health, that sort of thing?

And I would certainly hope that there would be expanded thinking about how to access these options.

Like how are we going to think about who is able to access them?

How insurance is going to cover them?

You know, what is going to require a prescription versus what can just be grabbed off the counter?

If there's going to be a huge disparity in the methods that are available, can we at least think about like making several options freely accessible to men and several options being freely accessible to women so that it's not creating or reinforcing the sort of gender disparity that we've been talking about?

There are just so many things.

And, like, gosh, even how sex ed is taught in schools that could really start to change young people's minds about gender and sexual freedom and just the culture around all of this from really early on oh wow okay i hadn't thought of this you're blowing my mind now so basically what you're talking about is all of the complications and variations and the whole idiom we're used to around women's health.

That same equivalent starts to develop for men, not just male contraception, but at every step, like they're they're taught in schools, not just wear a condom, but that it's their responsibility to take contraceptions and how contraceptions affect them.

And they talk to their doctors about what the contraception will do to them.

You know, they talk to their partners and on and on.

And that's where you get a sense of equal investment, price paid, and joy in the whole process of family planning.

Totally.

And I think what's fascinating about this is you can even think about the tale of these interventions being different for men and women.

Women go through menopause, men don't.

You know, there's a universe in which men and women, young men and women, maybe start to think about contraception, use contraception around the same time.

But maybe because men might end up using it for several more decades than women in this utopian future that we're imagining, you know, maybe that actually helps push things again in the direction of, yeah, this is actually something that should really be a normal, natural, sustained part of how we envision male health and what it means to be a man alive for multiple decades in this world.

Wow.

Yes.

Okay.

My thinking on this has been so limited and you've just thoroughly expanded it.

So thank you so much for that.

Happy to help.

This episode of Radio Atlantic was produced by Kevin Townsend, edited by Claudina Bade and engineered by Rob Smirciak.

Claudina Bade is the executive producer of Atlantic Audio, and Andrea Valdez is our managing editor.

I'm Hannah Rosen.

Thank you for listening.