Men on the pill

The Guardian


We have come some way since sheep’s bladder condoms but male contraceptive options are still pretty basic. Not counting one Chinese invention — a small electronic device worn in the underpants, which causes infertility for a month after a current is switched on briefly — it is still down to the old favourites: abstinence, coitus interruptus, condoms or vasectomy.

None of these — my son is living proof — is wholly reliable. That is why all couples who want equal rights in family planning should rejoice at the news that researchers from the Anzac Research Institute in Sydney, Australia, have come up with something that is 100 per cent effective.

Previously, the best effort was a male pill, which in 2002 proved 93 per cent effective, so the Australian study is a breakthrough. It is the first such trial using real couples. The treatment is a combination of an implant (inserted under local anaesthetic in the skin of the abdomen) containing the male sex hormone testosterone, which has to be replaced every four months, and a three-monthly injection of the same drug used in female contraceptive injections. This progesterone-like drug “switches off” two hormones (called LH and FSH) which stimulate sperm production.

Professor David Handelsman, who led the research, once wrote that for male contraception the central problem is that “reversible methods are not reliable and the reliable method is not reversible”. This trial, he says, “shows the way for a final product to be a single injection containing testosterone and a progestin which will easily be given by doctors on a three-four monthly basis and maintain male sexual health”.

Unfortunately, you — or your partner — won’t be popping to the doc’s tomorrow for your fix. More extensive trials are needed and pharmaceutical companies have still to develop a marketable treatment. However, there is scepticism in the industry about men ever taking to such a product.

Notions of the male pill have been around for a decade but few studies have been done since initial work by a US/WHO team. So could this be “the one”?

Dr Richard Anderson, a specialist in reproductive medicine at Edinburgh Royal Infirmary, Edinburgh, Scotland, says the Australian study — while it may not be “the biggest advance since the pill was invented 50 years ago”, as one tabloid newspaper described it — is “an important step forward”.

Indeed, Anderson’s team are just completing an implant-based study of their own (“different drug, same idea”) — which has also, he says, proved 100 per cent effective. So it seems that, for the first time, it is possible to switch off the hormones that stimulate sperm production without unpleasant side effects. And for the first time, the treatment is reversible.

The latter point is important. Many men would not want to neutralise their testes forever. Anderson says these trials are fully reversible, though it “can take a bit of time — a few months — for sperm production to be back to normal because it normally takes two and a half months, from start to finish, for the body to produce a fully formed sperm”. (In a fertile man, this is a continual process.)

Another major challenge in male contraception is testosterone levels. “When you switch off the two key reproductive hormones,” Anderson explains, “you also, unavoidably, stop testosterone production.”

You might think this could be beneficial in avoiding world wars and fights when the bars turn out, but a man without testosterone would, says Anderson, “feel very unhealthy indeed”. (Side effects include loss of libido, bone-thinning and mood alterations.) The key, then, is to replace the testosterone at “normal” levels.

The Australians reported virtually no side effects — indeed, many of the men in Sydney said their sex drive had actually improved. The fact that generations of women have suffered weight gain, depression, nausea, breast tenderness and an increased risk of blood clots and strokes in the name of planned parenthood surely puts this bonus into perspective.

There are other good points. The female pill is highly reliable, technically failing only once in every 1,000 cases. However, about three per cent of women using oral contraceptives get pregnant every year, usually because they forget to take them. For men, there will be nothing more to remember than an injection every quarter.