Assessing the costs and benefits of emerging male contraceptive methods
By: Maya Goyal
September 20, 2021
"When you hear the word “contraception”, what comes to your mind?” As I asked this question to my classmates and colleagues, I kept hearing the same repetitive words: the pill, IUD, a patch, and abstinence. The common thread amongst these words is that the responsibility is put solely on females. I often ask myself why the burden of contraception is traditionally given to one gender and why women must endure the hormonal changes and side effects that accompany contraceptive methods. However, recent advancements in male contraception have been introduced as feasible options in place of female contraceptive methods.
Before I get into the medicine and reasoning behind male birth control, I’ll begin with the bigger picture of contraception first. Contraception ranges in its usage, with its most popular being pregnancy prevention. It helps to dramatically reduce the number of unintended pregnancies worldwide which consequently lessens unsafe abortions and facilitates family planning. As seen in the graph below, most unintended pregnancies are a result of inconsistency or inaccessibility with birth control. This illustrates the importance of contraception and its large role in planned parenthood.
Birth control can also be prescribed to regularize a woman’s menstrual cycle, reduce acne and excessive body hair, and alter virtually any bodily function driven by hormones. Studies have even shown that the mechanisms behind contraceptives parallel prevention methods for ovarian cancers in women. Overall, contraception is a universal tool that promotes proper family planning and a healthy reproductive journey and is a responsibility that men and women should be able to equally share.
WHAT IS IT?
Male contraception can come in many forms. More conventional methods include condoms, which are commonly used in conjunction with other methods, and a male vasectomy, which prevents sperm from meeting the egg in the first place. Other forms work by manipulating hormone levels in the body to prevent fertilization. These include the male birth control pill, birth control shot, and birth control gel.
HOW DOES IT WORK?
Hormone-based contraceptives work by manipulating the reproductive system to prevent conception rather than physically blocking it, like other methods do. The primary goal of male birth control is to block spermatogenesis, or the production of mature sperm, and this is done by targeting the hypothalamic-pituitary-gonadal axis, which is also known as the HPG axis. The HPG axis plays an important role in regulating the reproductive cycle through the controlled release of varying hormones. A properly functioning HPG axis first secretes gonadotropin-releasing hormone (GnRH) at the hypothalamus. Next, the anterior pituitary gland releases luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Finally, the testicular cells are signaled to release testosterone, the hormone responsible for enabling spermatogenesis. In females, the ovaries are instead activated to secrete estrogen and progesterone.
Each of these releases are checkpoints which prompt the next step to take place. Consequently, if one of these checkpoints is interrupted, the entire loop would be stunted. Male hormonal birth control presents an interruption by introducing extra testosterone into the loop. This suppresses GnRH production which causes a chain reaction of LH, FSH and eventual spermatogenesis suppression.
IS IT SAFE?
Before considering a new form of birth control, it is important to assess its safety and efficacy. Since hormonal male contraception is still in its working stages of development, efficacy trials and research are still being conducted.
First, trials were performed to test safety in the Journal of Clinical Endocrinology and Metabolism. They focused on the pill form of male contraception and enrolled 82 men in the study. They were randomly given one of four treatments: the placebo or three different doses of the pill. They found that as the dose of the pill increased, the testosterone, FSH, and LH hormones became more suppressed.
Some side effects were recorded which include acne, headaches, mild erectile dysfunction, reduced sex drive, tiredness, and subtle weight gain. However, it is important to note that side effects vary with the patient. Some may not experience them at all. This is attributed to its basis in hormones. Hormone levels vary with patients and their responses vary as well, thus determining their reaction to the birth control. The long-term effects of male birth control are still being researched. Ultimately, the goal of testing is to observe the sperm count, which is where efficacy trials come in.
Efficacy trials work by enrolling couples and observing the reproductive result of a specific contraceptive method. This allows scientists to gauge the effectiveness of these new hormonal birth control methods. The World Health Organization performed two efficacy clinical studies on male birth control in which the participants received intramuscular injections of testosterone enanthate. The first study found 70% of participants with no detected sperm in their ejaculate, which is known as azoospermia; this method ensures contraception. The second found 98% of the men to have some detected sperm, or severe oligospermia, but with conclusive high efficacy. Oligospermia presents a considerable difference in the sperm count and the consequent pregnancy result. Overall, these trials resulted in a 1.4% failure rate. While these specific trials only tested the injection form, there are several more studies that have been performed for other types, such as the male pill and gel.
HOW MUCH DOES IT COST?
Since hormonal birth control for men has yet to be officially published into the medical world, the costs are undisclosed, both financially and physically; this includes the shot, gel, and pill. However, it can be safe to assume that once it is approved by the FDA, insurance companies will be willing to cover the costs.
Other methods that are non-hormonal include condoms and a vasectomy. These methods are more established, and therefore more common. Condoms act as a physical barrier between the sperm and the egg and come in many different sizes, textures, and materials. They vary in price but cost no more than a dollar each. The risk of condoms is their efficacy. They are not 100% reliable as they can break, slip off, or expire. In contrast, vasectomies (pictured to the right) are more than 99% effective. For men, this procedure is permanent and involves the closing of the vas deferens, which transports sperm. The risk of a vasectomy parallels that of any procedure. There is a recovery period, side effects such as swelling and pain, and risk of infection or complication. Finally, it can range between $500 to $1,000 but is commonly covered by insurance plans.
WHY SHOULD YOU CONSIDER IT?
The decision to start male contraception can be swayed by different factors. If you are considering contraception, plan to visit your family planning doctor and walk through the different forms to see which is the right fit for you. Ultimately, the decision depends on your goal at the end of your reproductive journey and hopefully this article brings you one step closer towards discovering what that might entail.