Male Birth Control Options

We women talk about anything and everything over drinks with friends. One of the things that I can bet that you don’t talk about is male birth control and the guy’s role in family planning, right? I mean, what is there to even talk about?

Apart from condoms, are there any other options? Let’s take a good look at what is on the table now as men’s birth control and dispel some of the ‘fake news’ that is out there. 

Key Takeaways

• Contraceptives such as vasectomy and condoms are the most effective. 
• The prototype pill for men is in development, but none have passed clinical trials and therefore have no FDA approval. 
• Outercourse and the withdrawal method are not forms of reliable birth control.
• Several topical gels are currently in clinical trials that offer a reliable and reversible male contraception option.

What Are the Options for Male Birth Control?

Pregnancy prevention is the name of the game, the prevention of unintended pregnancies. Let’s have a deep dive into the male contraceptive methods currently available. We can also dispel some of the myths and rumors you may have heard about with other products.

Vasectomy

We’ll start with the big one, known commonly as ‘The Snip’. As far as male birth control options go, this is the definitive procedure that is almost 100% (99.7%) effective [1]. It involves cutting the vas deferens, the tube that transports sperm from the testes to the penis and then out into the woman’s vagina [2]. 

A vasectomy only resulted in 0.15% of pregnancies, whereas male condom led to 18%

The operation can be done as minimally invasive surgery, through just a very small cut. Local anesthetic is used in the operation. It has the bonus of being an outpatient procedure so you can be back at home that same afternoon. 

You will generally have a consultation with your doctor to find out if it is right for you. There will also be a check of your ‘plumbing’ to ensure that there will be no complications for the procedure. 

Most operations will be carried out by a urologist with an assistant but may also be done as an outpatient in a clinic by a general surgeon. There is around a 1% risk of complications, additional bleeding, or discomfort, but your doctor will address all these issues pre-op [3]. 

The operation is referred to as irreversible, though there are possibilities if you change your mind later on—again your doctor will go through this with you. After the operation, sperm may still be produced, so testing post-op will be required to verify the success of the surgery. Until then, you must still use alternate methods of contraception to prevent pregnancy. 

This is the most common family planning option for older couples with children who have no plans to expand their brood. 

You should notice no difference in the sexual experience after the procedure [4]. There will be no change in the volume or aspect of your sperm. It is a myth that erectile dysfunction or low libido are side effects; everything will continue as usual. 

Condoms

Everyone will be familiar with these guys, the most common male birth control method. They have a number of benefits that other male birth control methods don’t. Condoms are cheap, readily available, and super easy to use. If used correctly, they are pretty effective too, around 98% [5]. 

This is the only male birth control option effective in pregnancy prevention and preventing sexually transmitted infections (STIs) [6].

Male condoms, when used correctly, are almost 90% effective at preventing the transmission of HIV and hepatitis B

 

If you have a latex allergy, plastic (aka latex-free) condoms are available [7]. You can use oil-based lubricants during sex as they do not affect the integrity of the sheath. 

Care must be taken with the care and storage of condoms. They shouldn’t be kept in wallets or billfolds. The friction and abrasion can damage the packaging and the condom. 

If you are using extra lubrication, you should not use oil-based lubricants with the standard (latex) condoms as they can weaken the material of the condom and cause it to break. You should choose water-based lubricants. Always check the condom packet for instructions if you are unsure.

Spermicides

Many over-the-counter spermicides are available. All are only recommended to be used in conjunction with condoms as they provide very poor protection on their own [8]. Their use isn’t classed as an official form of birth control. 

Outercourse

This covers a wide range of practices. As the name suggests, it does not involve penetrative sex. In theory, conception should not be possible, but there are pitfalls. 

Before ejaculation, sperm may be expressed, so any practices that involve close contact between the penis and vagina have some chance of pregnancy. Typically dry-humping and grinding are the riskiest practices. 

With oral or anal sex and even masturbation, pregnancy may occur if semen is expressed close to the vagina opening. Any further outercourse may introduce semen into the vagina and result in pregnancy. 

Behavioral Methods

Many forms of sexual activity can cause pregnancy. We all know several methods used to prevent it, typically the pull-out method (withdrawal contraceptive method based on pulling out of the vagina before ejaculation) being the most common [9]. As you can imagine, this is one of the least reliable forms of male contraception. 

As we have previously mentioned, sperm can be released before ejaculation, so it is easy to see why this method is ineffective (78% efficacy). 

The rhythm method is a contraceptive technique based on following the woman’s menstrual cycle to see when she is less likely to be fertile. This can be imprecise, as sperm can live for up to three days in the woman’s reproductive tract, and ovulation times may change from month to month. 

The human reproduction cycle can also be estimated with help from your female partner by finding slight changes in body temperature or by inspection of the vaginal mucosa. As discussed above, these are very imprecise methods and can not be relied upon to have a meaningful effect on preventing pregnancy.

If you take any medication that can potentially increase testosterone, such as Nugenix Total T or injectable testosterone, you should be aware of possible effects on fertility. If you are taking human growth hormone and having HGH side effects, you should also discuss this with your physician.

The Male Pill

No doubt you have seen and heard various things regarding the male birth control pill. The prototype male pill is being developed, but none have passed clinical trials and therefore have no FDA approval.

What Is the Male Birth Control Pill?

It is a form of hormonal birth control in pill form. Researchers are looking at the introduction of a combination of hormonal contraceptives into the body either by injection, implants, or an oral contraceptive pill. This is to stop sperm production or achieve a lower sperm count. 

It should be noted that although it will prevent pregnancy, it will not prevent sexually transmitted infections (STIs). If you are engaged in casual sex, you should also wear a condom to avoid any possible infection between you and your partner.  

How Does the Male Pill Work?

The male birth control pill will work similarly to the widely available female methods—a single daily pill. There are differing products currently in development that use a hormone or combination of hormones to suppress the production of sperm. 

Typically there is a mix of female and male hormones. Some, in pill form, contain follicle-stimulating hormone (FSH) and luteinizing hormone to prevent sperm production or a combination that reduces sperm production below fertile levels. 

Some contraceptive methods reduce free testosterone and overall testosterone levels in men to reduce sperm production. Your doctor may prescribe treatments to remedy this, as low testosterone in women and men can cause issues. 

Dimethandrolone undecanoate, or DMAU, is currently being tested as a new male birth control pill [10]. It is at the clinical trial stage, and as noted above, it is still a long way from the marketplace.

About 80% of subjects were satisfied with the method, whereas 54% would use it as their main contraceptive

 

A second, newer focus of contraception is an anti-fertility vaccine [11]. A number of US manufacturers are looking at targeting the way individual sperm attach to the egg to fertilize it. 

The vaccine would target the specific regions on the surface of the head of the sperm. Antibodies produced would bind to these regions preventing attachment of the sperm to the egg and stopping fertilization. 

As it stands, the pill would initially be for women as it would be easier to target the smaller amount of sperm in the fallopian tubes rather than all the sperm contained in the testes. As the efficacy of the treatments improved, a rollout of a male contraceptive pill would be on the cards. 

Clinical Trials for Male Birth Control

There are a number of trials (over 25) of various types of hormonal birth control underway [12]. They are at different stages, both animal and human clinical trials. As yet, none are close to the market; some estimates put the release dates between five and ten years. 

Trestolone is an anabolic steroid [13]. Studies are looking into subdermal implants for longer-term birth control. The results are quite promising. 

A compound called ouabain has some promising results [14]. It is from a plant that hunters in Africa use as arrow poison to stop the hearts of their prey. 

A non-hormonal treatment from the Chinese herb Tripterygium wilfordii is currently showing good results in animal trials [15]. It has reversibly inhibited sperm production in rats. 

A treatment targeting the production of sperm in the testes has shown impressive, reversible results, and work is still ongoing [16]. 

The message is, don’t hold your breath for a male birth control shot or pill just yet!

What Is the Male Contraceptive Gel?

There are a number of topical (applied to the skin) gels that are currently in preclinical or clinical trials. They offer a reliable (97% estimated efficacy) reversible male contraception option [17]. 

Most work in a similar way, akin to the female birth control pill. A hormone or hormones are introduced to suppress the sperm count to below fertile levels. 

Is Vasalgel Available in the US?

In short, no. Trials are not sufficiently advanced to allow for submission to the FDA for approval. It will be some time before it is on the market. 

Vasalgel is a new approach to male contraception. It involves blocking the vas deferens with a gel barrier rather than cutting it (vasectomy). The gel introduced to block the passage of sperm can be removed, so this will be reversible inhibition. There is no impact on sexual function; you will have a normal sex drive. 

Once again, don’t hold your breath!

FAQ

Why Isn’t There Male Hormonal Contraception? 

It takes a long time to go from the drawing board to FDA approval. Products are in human development, but male hormonal birth control is still a long way from being available. 

Why Was Male Birth Control Discontinued?

A common question and a common mistake. There have never been any products on the market to discontinue. 

There is a common misconception that a study on male birth control pills was put to a halt because the subjects were unable to tolerate the side effects, such as mood imbalances and acne. In fact, an independent safety board put a stop to the study [18].

How Effective Are Male Birth Control Pills? 

Currently, the estimates for efficacy are around 90% or slightly above. This isn’t easy to judge as clinical trials are not finished, and data isn’t fully available.

When Will Male Birth Control Pills Be Available?

Most estimates put the time frame between five and ten years. 

What Are Risks Associated With the Male Birth Control Pill or Similar Hormonal Treatments? 

For FDA approval, the risks must be minimal and manageable with consultation with your physician. No procedure or treatment is totally without risk. 

If you look at the possible side effects women accept when taking ‘The Pill,’ the list looks pretty terrible, with weight gain, blood clots, high blood pressure, and mood disorders being relatively common. In reality, the risks for healthy men are minimal across the cohort taking the pill. The male contraceptive pill will be similar. 

Conclusion

The male birth control pill or allied products will truly be a game-changer, a once-in-a-generation medical advance. For the first time, they will promote shared accountability for contraception, something that until now was not a viable option for men.

As it stands, there are only two reliable and safe methods for male birth control. These are vasectomy and condoms. Both have been available for decades, and yet the burden for birth control has always fallen squarely on the shoulders of women. 

When the options are finally presented, it will be up to men to take onboard these medical firsts and embrace them as fully as women did in the 60’s with ‘The Pill’. 

References

1. Stormont, Gavin. “Vasectomy.” StatPearls [Internet]., U.S. National Library of Medicine, 16 Apr. 2021, www.ncbi.nlm.nih.gov/books/NBK549904/. 
2. “Overview of the Male Anatomy.” Johns Hopkins Medicine, www.hopkinsmedicine.org/health/wellness-and-prevention/overview-of-the-male-anatomy. 
3. “Vasectomy.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 19 May 2021, www.mayoclinic.org/tests-procedures/vasectomy/about/pac-20384580. 
4. “Ejaculation after Vasectomy: What to Expect.” Medical News Today, MediLexicon International, www.medicalnewstoday.com/articles/326585. 
5. “How effective are condoms,” Planned Parenthood, https://www.plannedparenthood.org/learn/birth-control/condom/how-effective-are-condoms
6. “Sexually Transmitted Infections (STIs): Types and Symptoms.” Medical News Today, MediLexicon International, www.medicalnewstoday.com/articles/sexually-transmitted-diseases#chlamydia. 
7. Parenthood, Planned. “Condoms: How to Put On a Condom Video.” Planned Parenthood, www.plannedparenthood.org/learn/birth-control/condom. 
8. “Spermicide for Birth Control.” Spermicide for Birth Control | Michigan Medicine, www.uofmhealth.org/health-library/tw9509#:~:text=A%20nonprescription%20method&text=Spermicide%20and%20a%20condom%20used,sexually%20transmitted%20infections%20(STIs). 
9. “Birth Control for Men: 8 Options.” Medical News Today, MediLexicon International, www.medicalnewstoday.com/articles/birth-control-for-men#behavioral-methods. 
10. Nguyen BT;Farrant MT;Anawalt BD;Yuen F;Thirumalai A;Amory JK;Swerdloff RS;Bremner WJ;Liu PY;Blithe DL;Page ST;Wang C; “Acceptability of Oral Dimethandrolone Undecanoate in a 28-Day Placebo-Controlled Trial of a Hormonal Male Contraceptive Prototype.” Contraception, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/32298717/. 
11. A S V;Dhama K;Chakraborty S;Samad HA;Latheef SK;Sharun K;Khurana SK;K A;Tiwari R;Bhatt P;K V;Chaicumpa W; “Role of Antisperm Antibodies in Infertility, Pregnancy, and Potential ForContraceptive and Antifertility Vaccine Designs: Research Progress and Pioneering Vision.” Vaccines, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/31527552/. 
12. “Search of: Male+Contraception – List Results.” Home – ClinicalTrials.gov, clinicaltrials.gov/ct2/results?cond=male%2Bcontraception&term=&cntry=&state=&city=&dist=. 
13. Sinnesael, M., et al. “7α‐Methyl‐19‐Nortestosterone vs. Testosterone Implants for Hypogonadal Osteoporosis: a Preclinical Study in the Aged Male Orchidectomized Rat Model.” Wiley Online Library, John Wiley & Sons, Ltd, 26 July 2011, onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2605.2011.01198.x. 
14. “Heart-Stopping Arrow Poison Could Be the Key to Male Birth Control.” Smithsonian.com, Smithsonian Institution, 31 Jan. 2018, www.smithsonianmag.com/science-nature/arrow-poison-key-male-birth-control-180967985/. 
15. Chang, Zongliang, et al. “Triptonide Is a Reversible Non-Hormonal Male Contraceptive Agent in Mice and Non-Human Primates.” Nature News, Nature Publishing Group, 23 Feb. 2021, www.nature.com/articles/s41467-021-21517-5. 
16. Mruk, D., et al. “[PDF] A Male Contraceptive Targeting Germ Cell Adhesion: Semantic Scholar.” Undefined, 1 Jan. 1970, www.semanticscholar.org/paper/A-male-contraceptive-targeting-germ-cell-adhesion-Mruk-Wong/dcd92c9300aa8cd4fa93ca03863bc7b092f7ff6f. 
17. “Study of Daily Application of Nestorone® (NES) and Testosterone (T) Combination Gel for Male Contraception – Full Text View.” Full Text View – ClinicalTrials.gov, clinicaltrials.gov/ct2/show/NCT03452111. 
18. “Update on male hormonal contraception.” Giulia Gava, Maria Cristina Meriggiola, Ther Adv Endocrinol Metab. 2019; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419257/#bibr12-2042018819834846.