- After the Supreme Court overturned Roe v. Wade,
clinics reported a surge in demand for vasectomies.
A warning to my mother, this episode contains
multiple instances of me saying the word penis.
A vasectomy is pretty simple.
You cut the tube called the vas deferns
that connects the testicles to the penis,
which cuts off the flow of sperm.
It's a safe enough procedure with few complications.
But contrary to popular opinion,
it is not always reversible.
That's especially true if you had one a long time ago
because scar tissue builds up on the severed ends
of the tube, which makes rejoining them harder.
That's why doctors never advocate for it
as a temporary form of birth control.
In the past, the burden of birth control
has fallen largely on women.
And with 40% of pregnancies unplanned
and restrictions on abortion ramping up in some US states,
the future of contraception may look a lot more inclusive.
And speaking of inclusive, it's important to note
that there is a range in the relationship
between gender identity and biological ability to conceive.
It's important to note that some men don't produce sperm,
don't have XY chromosomes, and don't have two testicles.
And some women don't ovulate, don't have XX chromosomes,
or don't have a uterus.
Whether they're queer, intersex, and/or have a condition
that affects the reproductive traits.
With that in mind, I'm Swapna Krishna.
Let's talk about the future of male birth control.
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As of 2022, the only available birth control
for men are condoms and vasectomies.
But there are two kinds of birth control
we're gonna talk about here that are in development,
hormonal and non-hormonal.
Male hormonal birth control works similarly
to women's by tricking the body into producing less sperm
by fiddling with hormones.
Hormones are chemical messengers
sent through the bloodstream to maintain
specific bodily functions like metabolism,
mood, and sexual function.
Normally, the brain releases a hormone
that triggers the anterior pituitary gland,
which in turn triggers even more hormones.
These tell the testes to release testosterone
and produce sperm.
Now, the treatments in clinical trials release two hormones,
progestin and testosterone.
The progestin, which is the same as in female birth control,
tells the brain to stop sending hormones to the testes,
which lowers testosterone levels end sperm production.
But since the testes are where testosterone is made,
you need to add it back in to avoid side effects.
That's why most medications in development
include a testosterone supplement to balance out
any side effects of low testosterone in the blood,
like fatigue, libido, that sort of thing.
Adding back in that testosterone won't stimulate
the production of sperm because you need a lot
of testosterone in the testes to make sperm.
But it's the testosterone in the blood that performs
those other functions like mood and muscle maintenance.
And that requires less testosterone.
Part of the reason it's taken so long to make
hormonal male birth control is because it's been hard
to find the right balance of those levels.
And men are concerned about side effects.
But it is worth pointing out that birth control
for women has also produced hormonal
side effects for decades.
Two versions of this method
are in clinical trials right now.
One is a pill and one is a gel you apply to your shoulders.
The gel is further along.
It's in phase two of clinical trials.
Phase one of clinical trials are where you establish
whether treatment is safe.
Phase two is where you find out whether it really works.
Results aren't published yet but the treatment so far
is more effective at preventing pregnancy
than currently available birth control pills
and definitely better than condoms.
- It's been extremely positive.
I wanna personally, I wanna declare victory and go to FDA
and say, "Now we need to go into phase three."
- But the gel needs to be tested again in phase three,
which compares the effectiveness of this current treatment
against others that exist and then approved by the FDA.
But since it's a completely new treatment,
no hormonal birth control for men currently exists.
Researchers don't know what the FDA will require
for it to go on the market.
Another big factor for how fast these drugs go on the market
is the pharmaceutical industry.
These companies need to be willing to see the market value
and manufacture them.
All the research and funding so far has been provided
by the NIH and the Population Council,
as well as various non-profit groups.
To really accelerate the research,
larger companies need to be involved in funding
and actually making the products.
And the questions surrounding what it will take
to get FDA approval might be causing them to hesitate.
Okay, so this is all about hormonal birth control.
What about non-hormonal options on the horizon?
Non-hormonal birth control is the holy grail
to many researchers.
There are lots of exciting treatments in the lab.
But none are close to human trials.
Most focus on the mechanics, like targeting enzymes
on a sperm that prevents it from swimming.
- The way I think about non-hormonal methods,
there are things that interrupt the plumbing.
So they're anatomic.
So essentially a reversible vasectomy
where either a plug is put into the tubing that connects
the testicle through the penis and blocks that
and then can be reversed or naturally degrades on its own.
- The problem so far with targeting specific
enzyme molecules on sperm is just that it's hard to do.
- We have a lot of redundancies in our physiology.
So enzyme that works in the testicle or in the sperm,
and I'm just kind of ad-libbing this, but to make the sperm
swim fast might have a very similar enzyme
that works somewhere else in your body
for a muscle or something.
And so developing a drug that only targets that one form
of that enzyme is just really challenging.
- Getting drugs into the testicles
and in high enough concentrations to do the job
is difficult without side effects.
And often those drugs stick around for a long time,
especially if you need a large amount.
- There's really no drugs without side effects for somebody.
So while that's a holy grail and I hope that we'll reach it,
I think non-hormonal methods are gonna be really important
but they may not be quite as side effect-free
as we would hope.
- Okay, So we've talked a lot about what's coming.
But why has it taken so long to develop male birth control?
It's not for lack of trying.
Research on male birth control
has been in development since the 1970s.
But funding comes in fits and starts,
partly because the emphasis has been on women,
since they bear most of the risk
and responsibilities of pregnancy.
But it's also a math problem.
It's hard to formulate birth control
because men make so much sperm.
Men's bodies produce 1,500 sperm a second.
And a single milliliter of semen can contain
20 to 300 million sperm.
Women, one egg a month.
And that's only if you ovulate regularly.
So finding the sweet spot, how much medication is needed,
how low does sperm count need to be to prevent pregnancy,
is like finding a needle in a haystack.
- God knows, and only God knows,
why we need that many sperm when you think,
you know, it only takes one.
But the reality is that if we get it down below
one million per mil, we don't expect pregnancies.
- But it's taken decades to find that out.
That, in combination with the lack of investment
from pharma companies, has meant a slower pace.
Also, these source of clinical trials are really intense.
For the gel clinical trial for instance,
you'll need to enroll a certain number of couples
who will commit to taking the medication for two years.
And the partner who can get pregnant
needs to go off birth control.
Otherwise, we won't know it's effective.
It's a huge commitment.
- I have so much respect and admiration for the women
who were willing to take a chance on this.
You know, they're like, I don't know if it's gonna work
but would you be in our study?
And they're oh sure, you know, we'll take that chance.
- Experts agree that we need more
birth control options for everyone.
- The number one thing that impacts
unplanned pregnancy is contraception.
And also that impacts abortion rates.
Development of novel contraceptives to expand that menu
and to expand options is just absolutely critical.
40% of pregnancies are unplanned and about roughly half
of those unplanned pregnancies end in abortion.
So, you know, really we're backing.
Women are really getting backed into a corner.
- But even if and when one of these birth control methods
is approved, there's still the question of trust.
Will people who conceive trust their partners
to use contraception?
- Everything about a sexual encounter
has an element of trust.
And everything about relationships do.
And so to say, well, women would never trust their partners.
I mean, that's talking about a judgment
of 50% of the population.
So I think it would be very shortsighted of us
to not develop more male methods based upon a presumption
that women will not trust their partners.
- As of 2022, IUDs are the most effective
form of contraception.
But that could easily change with the introduction
of one of these new birth control treatments.
It's one way of easing the burden of contraception on women.
- Everything needs to be done to try to help women
control their, you know, reproductive choice
and not have an unintended pregnancy
if they don't want it.
- Oh, and there are more birth control innovations for women
on the way too, including a pill in clinical trials
through MIT that you can take once a month instead of daily.
Over the month, it slowly releases levonorgestrel,
a hormone already used in other birth control methods,
including the morning after pill.
But as more and more people want non-hormonal options,
more research and funding will be needed
to make these products a reality.
Thanks for watching.
What do you think about male birth control?
Let us know in the comments.
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