Why isn't there a male birth control pill?

“The 360” shows you diverse perspectives on the day’s top stories.

What’s happening

In the late 1950s, an American biologist named Gregory Pincus began researching how hormones might influence the female reproductive cycle and thus prevent pregnancy. In 1960, the first oral contraceptive was approved by the FDA.

Pincus’s work led to one of the most important medical breakthroughs in modern history. Over the past 50 years, various forms of hormonal birth control have become so common they’re known simply as “the pill.” But Pincus didn’t focus only on women. He also hoped to create a similar treatment for males. After minimal research, however, he abandoned the pursuit. 

To this day, no male birth control product has made it to market. But over the past year, there has been promising early progress on new treatments — including a pill, a gel that’s rubbed onto the skin and an injection that acts as a nonsurgical vasectomy —  that could finally bring the first male contraceptive to the public. If that happens, research suggests a “male pill” could drastically reduce unplanned pregnancies, especially in developing countries.

Why there’s debate

There are a number of factors that have prevented the creation of male birth control, some of them medical and others societal. 

Part of the challenge comes down to simple biology. To interrupt fertility in a female body, a contraceptive needs to prevent a single egg from being fertilized, which can only occur in a limited time window. Males, on the other hand, create 1,500 sperm a second and are fertile at all times. Hormonal treatments in development are designed to limit sperm production by lowering testosterone levels. But the effects need to be calibrated just right. Testosterone levels need to be low enough to create infertility — but they can’t go so low as to cause side effects like decreased libido.

Beyond medical reasons, the development of male birth control has been hampered by a lack of interest by the pharmaceutical industry and rules about which side effects are permissible in drugs. A large clinical study in 2016 was halted after men in the trial reported serious side effects, including mood swings, altered libido and acne — issues commonly associated with female birth control. Cultural factors, such as the notion that women are responsible for contraception, and fear that birth control would make men less masculine are also frequently cited as inhibiting research.

What’s next

Recent clinical trials of male contraceptives have shown promising results, but experts say it could be another 10 years or more before any of the drugs are made available to the public. 

Perspectives

The female reproductive system is easier to disrupt with hormones

“Female birth control is about preventing the fertilization of one ovum, primed for procreation once per month. That’s it. Male birth control requires wrangling millions of sperm produced constantly and en masse.” — Joshua A. Krisch, Fatherly

The burden of contraception falls on women

“A big part of the answer is that, as a society, we consider the work of pregnancy prevention to be women’s work.” — Katrina Kimport, Gizmodo

Pharmaceutical companies don’t see male birth control as profitable

“The thought is that industry pulled away from male contraceptive development due to concerns that the market was already saturated with female methods. Moving into the male market, where the risk profile is uncertain, was too risky.” — Dr. Jill Long, Inverse

Women face greater risks from pregnancies

“The need for female contraceptives has been greater historically because pregnancy and childbirth can be dangerous, even life-threatening. Men face no similar danger, so medical regulators have had a much lower tolerance for risks caused by male contraceptives compared to female contraceptives.” — Julia Belluz, Vox

Finding the right balance of hormones is tricky

“There's a challenge with hormonal birth control: suppressing testosterone in men to super-low levels while avoiding the side effects of low hormone levels, such as changes in sexual function.”  — Michael Nedelman and Jamie Gumbrecht, CNN

Side effects are seen as less acceptable in male contraceptives

“While certain symptoms are considered acceptable in female contraceptives, because they are weighed against the risks of pregnancy, they are often viewed as ‘deal breakers’ for male contraceptives, because the comparison group is healthy young men.” — Lisa Campo-Engelstein, BBC

Men may not want to take it

“It’s not clear whether men would take a birth control pill: Some surveys show that men are reluctant, while others suggest the opposite. The most pervasive feeling might be apathy — a sense of complacency because women are running the contraceptive show.” — Arielle Pardes, Wired

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Cover thumbnail photo illustration: Yahoo News; photo: Jane Doe/Agency