Why We Can’t Have the Male Contraceptive Pill

https://www.bloomberg.com/news/features/2017-08-03/why-we-can-t-have-the-male-pill

by drtillberg • 9 years ago

46 70 9 years ago

drngdds2• 9 years ago

This article makes it sound like WIN 18,446 is a safe and effective male contraceptive and it was abandoned completely just because it has bad interactions with alcohol. Is this actually true? There are lots of drugs on the market that have a bad interaction with alcohol. It's possible to just not drink alcohol.

auggierose• 9 years ago

Having a contraceptive pill not working together well with alcohol is probably one of the worst user interfaces ever. At least judging from the behaviour I observe amongst people in the UK :)

drngdds2• 9 years ago

Not for people who don't drink or would be willing to stop drinking. That has to be a nontrivial market. Why not make it and just put a big warning label on the bottle?

mabub24• 9 years ago

I'm saying this fully aware I am not a doctor but...

I think it depends on the severity of the response, and the context of use. For severity, it's not clear in the article but it seems like the adverse response was quick and quite severe. Another problem with reactions to alcohol: let's face it, many sexual encounters are surrounded by alcohol. For many people, for better or for worse, alcohol and sex go together. You want people to take your contraception, but if you get immediately ill whenever you drink are you going to be taking that pill like clockwork? Sex is important, and, frankly, people take a lot of risk for the sake of having sex. Often that means choosing to drink alcohol, not always, but often.

It's complicated, and I know I sound like someone trying to rationalize doing the least amount of work, but the truth is you want male contraception to be easy because men could potentially be using it their entire lives. Female oral contraception works, but it likely would not pass medical trials today precisely because of many of the side effects that occur when one takes it.

bdamm• 9 years ago

For many candidates I suspect the requirement of not drinking alcohol would be 98% effective.

SolarNet• 9 years ago

I think it is how dangerous the reaction with alcohol is. Most drugs with alcohol make you extra drunk. This one gives you a heart attack.

cbr• 9 years ago

I was also curious about this. A male contraceptive that is incompatible with drinking would be a good fit for many people who don't ever drink, including me. There would definitely be people it was a poor fit for, but it still seems like there's a teetotalers market. The main question to me is whether it's compatible with the small amounts of alcohol that are in many foods.

JohnJamesRambo2• 9 years ago

A great male contraceptive is already here and it is testosterone injections.

"The two-and-a-half-year study of 399 couples in nine countries found that the injections of the male sex hormone were an effective contraceptive for 98.6 percent of the participants."

https://nytimes.com/1996/04/03/us/testosterone-injections-wo...

true_religion3• 9 years ago

"It is a painful injection in the buttock,".... most likely the reason why it is not more popular.

JohnJamesRambo2• 9 years ago

It isn't that painful at all, that is the equivalent of FUD in this article. It is about as painful as any other shot.

walrus• 9 years ago

Disclaimer: I have no idea what I'm talking about.

Here's roughly how it works, if I understand correctly. First, a normal male endocrine system looks roughly like this:

  1. The hypothalamus produces GnRH.
  2. In response to stimulation by GnRH, the pituitary produces LH and
     FSH.
  3. In response to FSH and LH, the testes produce sperm and
     testosterone, respectively.
  4. Testosterone inhibits the production of GnRH by the hypothalamus (a
     negative feedback mechanism). This effectively keeps testosterone
     levels regulated.

When external testosterone is introduced, here's what happens:

  1. The increased testosterone inhibits the production of GnRH by the
     hypothalamus.
  2. In absence of GnRH, the pituitary produces less FSH and LH.
  3. In absence of FSH, the testes produce less sperm (this is the
     contraceptive effect). In absence of LH, the testes produce less
     testosterone.

The net effect is less sperm and the body produces less testosterone on its own.

This makes me wonder: would this lead to testicular atrophy? That happens with steroidal antiandrogens and GnRH agonists/antagonists, both of which have the effect of decreasing LH and FSH. Also, I think there are cardiovascular risks associated with high testosterone.

jgmmo2• 9 years ago

Its well known in the powerlifting/bodybuilding space that steroid use will cause small balls. Yes to testicular atrophy. Supposedly they will come back after you get off, assuming you did so properly.

throwaway911112• 9 years ago

Testosterone has a lot of other side effects.

chillacy3• 9 years ago

Wait this sounds like it'll be the ultimate temptation for people who play sports or lift weights. Once you get used to injecting testosterone regularly, it's going to be tempting to increase the dosage to gain some of these other benefits.

But I suppose women already have this going on with their birth control. One can read stories about benefits like skin clearing up, increased breast size, losing weight, etc from hormonal birth control. (And also stories of the opposite effects).

ams61107• 9 years ago

Female contraceptive pills have a lot of problems. They are linked to cancer, liver disease, gallbladder disease, stroke, blood clots, high blood pressure, and heart disease.

Taking pills to inferfere with your normal hormonal and bodily functions is not a great idea, when there are other options with fewer or no side-effects. As a man, I would not take pills for contraception.

evolve2017• 9 years ago

First, I agree that non-hormonal contraception decreases a lot of the risk associated with hormonal contraception (almost tautological, but worth stating).

Second, there is no increase in mortality between women who use oral contraceptive pills and women who do not (with the exception of women over 35 who smoke; OCPs are contra-indicated in this group).

For any OCP-users who might read this, there is no overall increase in cancer associated with OCPs, though some cancers are more likely with OCPs and others are less likely with OCPs.

Many of the side effects you're mentioning are either rare (hypertension, stroke/blood clots) benign (maybe you mean hepatic adenoma when you say liver disease?) or things I have not heard of (would appreciate scholarly references; gall bladder disease, heart disease[not sure what you mean here]).

Taking pills to inferfere with your normal hormonal and bodily functions is not a great idea, when there are other options with fewer or no side-effects

In general, all medications have risks and benefits. A blanket statement such as this one ignores the risk-benefit calculation that each patient and her physician must assess in picking a medication.

ams61107• 9 years ago

Many of the side effects you're mentioning are ... things I have not heard of

Admittedly hasty research, these are listed on WebMd as possible side effects of contraceptive pills.

djsumdog2• 9 years ago

The article mentions the gel injections that destroy sperm as semen travels from the testicles. Last I heard the Indian company that developed it was still doing trials in Indian and the US (long running trials in India show it effective and reversible for years).

It's more invasive than a pill, yes, but it seems like the most viable reversible solution so far.

ams61107• 9 years ago

I believe it was injecting/inserting a block (some kind of gel maybe?) into the vas deferens, with the effect of a vasectomy but much more easily reversible.

nxc182• 9 years ago

While I get that you could argue that 'pregnancy is the worst std' with 18+ years-long untreatable consequences, I don't really see the appeal for something that just targets pregnancy.

As a gay male, I would tend to favor condoms and other things that have a chance of reducing std transmission. If anything, the AIDS epidemic taught us that STDs are just as serious as pregnancies.

Ultimately it comes down to not fucking complete strangers and using protection when you do. For long term relationships, there are so many options: pills, IUDs, condoms, plan b, and even abortion.

I'm much more interested in research into how to make condoms more effective and better treatments for unsolved problems, like herpes, HIV, Chlamydia, gonorrhea, etc. (antibiotic resistance is still a thing btw).

nxc182• 9 years ago

Also it should be mentioned that female contraceptive is also advertised for beneficial side effects, like reducing the symptoms of PMS. While there are surely hormonal cycles that men experience, there really is no regular, painful, recurring symptom to be relieved.

Rjevski• 9 years ago

If you're in a relationship and are both clean, STDs are not an issue. However when only the female takes the pill its efficiency isn't 100%, so there is still a tiny risk of pregnancy. Having the male take a pill or similar contraception will pretty much nullify that risk (both the female and male pill would have to fail in this case)

ams61107• 9 years ago

The chances of both partners in a relationship staying monogamous are undoubtedly smaller than the chances of getting pregnant while on the pill.

Mikeb85• 9 years ago

The real benefit for male contraceptive is to prevent pregnancy in couples. Not all women react well to the pill, IUDs require a doctor to install/remove, plan B isn't reliable and abortion is morally troublesome for many (even if people are pro-choice, they may not want to get an abortion for themselves).

But yes, it's not a replacement for condoms as the article suggests.

accountyaccount• 9 years ago

Going to chime in with a nitpicky female voice here: abortion isn't really a reoccurring long-term form of birth control that should be lumped in with the pill or IUDs.

It's kind of like calling a fighter jet's eject sequence a landing option.

Not picking on you specifically, I just know a lot of men who toss around abortion pretty lightly. Even if you're pro-choice it can often weigh on you.

jgmmo2• 9 years ago

Spot on. Abortion is not just another option. It is orders of magnitude more expensive, more emotionally tolling, and even physically tolling.

tetromino_• 9 years ago

I don't really see the appeal for something that just targets pregnancy. As a gay male, […]

Your words read almost as a joke :) But when an issue cannot affect one at all, I suppose one may find it difficult to empathize with those it does affect.

throwaway911112• 9 years ago

I mean, we can go both directions. But realistically this is a large market; many dislike condoms for purely birth control purposes.

andruby2• 9 years ago

I am intrigued, what is "plan b"?

stonemetal• 9 years ago

It is a strong contraceptive made to be taken the morning after. Useful if a condom broke or wasn't used.

slindz• 9 years ago

The morning after pill.

cgb2234• 9 years ago

I understand your viewpoint and I think that's definitely something we should also be working on

But as a straight male currently just having casual relationships, I want to be able to control my body's ability to get someone pregnant so I don't have to worry about the consequences

I am the target market for something like this and I'd imagine many of my 20-something year old peers feel similarly

ams61107• 9 years ago

You'd rather chemically alter your hormones and reproductive system function than use a condom?

rory096• 9 years ago

Contraline, the polymer gel injection covered in the article, is a YC F3 (summer 2016) company. Kevin says he's on the road right now, but he'll be around later to answer any questions.

[0] http://contraline.com

heurist• 9 years ago

Question for Kevin: Is there any way we as private citizens can help push the FDA forward on this? I've been looking forward to this since I first heard of the successful trials in India 10 (ish?) years go. Women deal with some awful side effects to existing birth control methods. Effective male contraceptives, even with side effects, could alleviate a lot of suffering.

hjrnunes• 9 years ago

I remember reading some time ago about an Indian guy who was developing something like that. He said all he needed was investment but couldn't find anyone interested.

Edit: here it is https://www.bloomberg.com/news/features/2017-03-29/a-new-kin...

peteretep• 9 years ago

    > condoms, which have a real-
    > world failure rate of about 
    > 18 percent

That's odd, so I did some research and found:

    > With consistent and correct
    > use, condoms have a failure
    > rate of 2 percent. The 
    > typical use effectiveness
    > rate is about 18 percent

I ... don't understand. Are people putting them on their fingers? Can someone explain?

chimeracoder2• 9 years ago

I ... don't understand. Are people putting them on their fingers? Can someone explain?

Abstinence has a "consistent and correct" usage rate of 100% (within rounding error). Of course, in the real world, abstinence has a pretty poor rate of preventing unintentional pregnancies, when not combined with other methods.

Real-world use encompasses everything from people keeping condoms in their wallet (exposing them to heat + friction) to people deciding not to use a condom (whether because they forget, because they believe the other person is on birth control, because they decide to just "take a risk this once", or anything else).

userbinator• 9 years ago

to people deciding not to use a condom

I don't think that counts as part of the "use effectiveness rate", which AFAIK are only those who (claimed to?) have used one but failed.

Lon72• 9 years ago

You wouldn't believe what happens. They slip off or break and intercourse is continued without them. Some guys put two on at a time, some guys insist on wearing the larger sizes even though they don't fit. Some reuse condoms, some store them in their wallet for two years. Some guys put them on wrong or inside out. Some guys use a lubricant that weakens the latex.

throwawayaug6• 9 years ago

These arguments are always phrased as if every guy who's having trouble with condoms is an idiot. I think that's counterproductive.

I'm a "grower". The size difference is so significant that any condom that still feels comfortable when erect will easily slip off when flaccid. Smaller condoms are actually painful because of the ring at the base.

andruby2• 9 years ago

There's a right way to roll a condom on, and a wrong way. It isn't rocket science, but when your brain is competing for blood with another organ..

dogma11383• 9 years ago

Rolling it the wrong way, not rolling it all the way down, not rolling it correctly which leads to more frequent tearing when air is caught at the end.

And one of the most common issues buying the largest size available even when you don't have a 12" as thick as drink can tool.

While it's been 16-17 years since I had a sexed class i still remember the girl who came and told us to buy regular or even ("small") since it was still when I was 14-15 then she took a the smallest size Durex and rolled it over a 2 liter soda bottle and said unless you are bigger don't buy magnum super XL.

Scriptor• 9 years ago

Just because they can stretch that much doesn't mean they're comfortable.

ams61107• 9 years ago

Maybe the condom companies should just market the same size condom under the Magnum XL label. Then guys could feed their egos and still have a condom that fits.

ahh• 9 years ago

It's a hard problem. I think there's a simple observation that helps explain why it's going to be so hard (the article hints at this without saying it): a healthy adult man is, more or less, fertile. At all times. If a adult man is infertile--if him having sex can't result in pregnancy--there's something at least slightly wrong with him.

By comparison, an adult woman is often infertile--three weeks (ish) out of every month, or whenever she's pregnant, she can't get pregnant.

So it stands to reason that it's harder to produce male hormonal contraceptives: we can (at least sort of) fake healthy-but-infertile states of women, but there are no such states for men; we have to construct one from whole cloth, so to speak, and that's much harder.

cgb2234• 9 years ago

By comparison, an adult woman is often infertile--three weeks (ish) out of every month, or whenever she's pregnant, she can't get pregnant

So you're telling me that I could have unlimited unprotected sex with my partner for three weeks out of every month (assuming we had perfect fertility information about those three weeks) and there would be 0 chance that they would get pregnant...?

kbsletten• 9 years ago

Yes. The problem is nobody has "perfect fertility information". Little flukes in exact timing could change the "safe" days significantly. There's actually a whole bunch of info for couples wanting to do this with multiple ways to track fertility with more or less invasive options.

chillacy3• 9 years ago

Yes, this is called the Rhythm Method / natural family planning: http://www.everydayhealth.com/sexual-health/rhythm-method.as...

Of course the tricky part is having perfect fertility information

user59944613• 9 years ago

You're about to have a very bad surprise if you think women are infertile 3 weeks per month.

cgb2234• 9 years ago

I just want to share my two cents here:

I am a man in my 20's. At the moment, I am seeing people casually, because that's the kind of relationships I currently want and have time for.

I have been wanting male birth control for a while now.

As a guy I feel like a lot of what we are told as teenagers by our parents, and so on is that what ever you do, dont get someone pregnant. It will ruin your life, and probably the life of the child.

I know many people who have had pregnancy scares with people who were keen on keeping the child, without discussing whether the male counterpart felt similarly.

If men had the ability to control whether they could get someone pregnant, it allows them to live their lives, enjoy themselves, and explore without fear of negative life changing repercussions.

I'd imagine the arguments for women's birth control back in the 60's (70's?) were similar, with the added issue of carrying the child.

I'm not sure why male birth control is so controversial here on this forum, and in general, it sounds like the arguments for both sexes are similar, and having control of ones own body is never a bad thing.

ams61107• 9 years ago

So use a condom. Especially if you are seeing people casually, as that helps prevent STD infection.

user59944613• 9 years ago

As said in the article. Condoms doesn't work 18% of the time. That's a pretty high failure rate.

The contraception methods available to women are much more effective.

Why We Can’t Have the Male Contraceptive Pill

Related Stories