Ask A Scienceblogger – Why don’t they make a birth control pill for men?

i-133b9fea8ea6b307d8c9133b7f3e23bf-dice.jpg This time the Ask a Scienceblogger Challenge is to explain why a male contraceptive pill does not exist.

Good question! It’s because medical researchers are all sexist bastards. Didn’t you know?

Actually that’s only part of the reason. Research into hormonal or pharmaceutical contraception for men is a hot topic. Male hormonal contraception is actually fairly effective. Using a combination of testosterone and other hormones to suppress the secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary you can, after several months, prevent men from making sperm. For the men that respond (not all do), this treatment is highly effective as a contraceptive method. But the problems are delivery and efficacy. If you first screen men to see if they respond, then it is highly effective. But it doesn’t work on everyone: unlike the pill, you have to inject these drugs, put in implants or use a patch for delivery. This makes it far less attractive than the oral contraceptive pill for women, which is 98% effective when usedcorrectly and works with few exceptions. In the future, researchers may develop a more effective delivery and screening system for men that would allow them to more reliably assess the efficacy of the treatment.

Sexism has played some role in the long delay in the development of male contraception. But these days the far more important issues are those of physiology and capitalism. Women produce one egg a month and have a biologically built-in mechanism for preventing ovulation. Men, on the other hand, are sperm machines, producing an overabundance of genetic delivery vehicles from adolescence until death–with no simple mechanism to interrupt production. That’s why barrier methods, such as condoms, will likely remain preferable even after the development of hormonal birth control for men as they are highly effective and also prevent STD transmission. And for women, the pill (especially in lower-dose modern formulations) is safe, effective, and very well tolerated.

The second problem, that of capitalism, refers to the difficulty in developing a market for male contraception and thus the limited incentive for their production. It will be difficult for drug companies to sell a formulation for men that alters their hormones, lowers their sperm count (a cultural barrier), and requires doctors visits, injections, sperm counts, etc., when highly effective alternatives already exist. Many women will also likely prefer to remain in control of contraception because it’s their body, their health, and because men are liars. The capitalist barrier may be even more significant than the physiological obstacles.

Male hormonal birth control options will probably be offered within a decade. But they will likely be a niche market, limited to people in committed monogamous relationships, or for the partners of women who can’t tolerate the pill, and thus, not widely adopted.