Why We Can’t Have the Male Contraceptive Pill

So use a condom. Especially if you are seeing people casually, as that helps prevent STD infection.

> By comparison, an adult woman is often infertile--three weeks (ish) out of every month, or whenever she's pregnant, she can't get pregnant

So you're telling me that I could have unlimited unprotected sex with my partner for three weeks out of every month (assuming we had perfect fertility information about those three weeks) and there would be 0 chance that they would get pregnant...?

You're about to have a very bad surprise if you think women are infertile 3 weeks per month.

> I ... don't understand. Are people putting them on their fingers? Can someone explain?

Abstinence has a "consistent and correct" usage rate of 100% (within rounding error). Of course, in the real world, abstinence has a pretty poor rate of preventing unintentional pregnancies, when not combined with other methods.

Real-world use encompasses everything from people keeping condoms in their wallet (exposing them to heat + friction) to people deciding not to use a condom (whether because they forget, because they believe the other person is on birth control, because they decide to just "take a risk this once", or anything else).

You wouldn't believe what happens. They slip off or break and intercourse is continued without them. Some guys put two on at a time, some guys insist on wearing the larger sizes even though they don't fit. Some reuse condoms, some store them in their wallet for two years. Some guys put them on wrong or inside out. Some guys use a lubricant that weakens the latex.

There's a right way to roll a condom on, and a wrong way. It isn't rocket science, but when your brain is competing for blood with another organ..

Rolling it the wrong way, not rolling it all the way down, not rolling it correctly which leads to more frequent tearing when air is caught at the end.

And one of the most common issues buying the largest size available even when you don't have a 12" as thick as drink can tool.

While it's been 16-17 years since I had a sexed class i still remember the girl who came and told us to buy regular or even ("small") since it was still when I was 14-15 then she took a the smallest size Durex and rolled it over a 2 liter soda bottle and said unless you are bigger don't buy magnum super XL.

Question for Kevin: Is there any way we as private citizens can help push the FDA forward on this? I've been looking forward to this since I first heard of the successful trials in India 10 (ish?) years go. Women deal with some awful side effects to existing birth control methods. Effective male contraceptives, even with side effects, could alleviate a lot of suffering.

I remember reading some time ago about an Indian guy who was developing something like that. He said all he needed was investment but couldn't find anyone interested.

Edit: here it is https://www.bloomberg.com/news/features/2017-03-29/a-new-kin...

Having a contraceptive pill not working together well with alcohol is probably one of the worst user interfaces ever. At least judging from the behaviour I observe amongst people in the UK :)

I'm saying this fully aware I am not a doctor but...

I think it depends on the severity of the response, and the context of use. For severity, it's not clear in the article but it seems like the adverse response was quick and quite severe. Another problem with reactions to alcohol: let's face it, many sexual encounters are surrounded by alcohol. For many people, for better or for worse, alcohol and sex go together. You want people to take your contraception, but if you get immediately ill whenever you drink are you going to be taking that pill like clockwork? Sex is important, and, frankly, people take a lot of risk for the sake of having sex. Often that means choosing to drink alcohol, not always, but often.

It's complicated, and I know I sound like someone trying to rationalize doing the least amount of work, but the truth is you want male contraception to be easy because men could potentially be using it their entire lives. Female oral contraception works, but it likely would not pass medical trials today precisely because of many of the side effects that occur when one takes it.

For many candidates I suspect the requirement of not drinking alcohol would be 98% effective.

I think it is how dangerous the reaction with alcohol is. Most drugs with alcohol make you extra drunk. This one gives you a heart attack.

I was also curious about this. A male contraceptive that is incompatible with drinking would be a good fit for many people who don't ever drink, including me. There would definitely be people it was a poor fit for, but it still seems like there's a teetotalers market. The main question to me is whether it's compatible with the small amounts of alcohol that are in many foods.

Also it should be mentioned that female contraceptive is also advertised for beneficial side effects, like reducing the symptoms of PMS. While there are surely hormonal cycles that men experience, there really is no regular, painful, recurring symptom to be relieved.

If you're in a relationship and are both clean, STDs are not an issue. However when only the female takes the pill its efficiency isn't 100%, so there is still a tiny risk of pregnancy. Having the male take a pill or similar contraception will pretty much nullify that risk (both the female and male pill would have to fail in this case)

The real benefit for male contraceptive is to prevent pregnancy in couples. Not all women react well to the pill, IUDs require a doctor to install/remove, plan B isn't reliable and abortion is morally troublesome for many (even if people are pro-choice, they may not want to get an abortion for themselves).

But yes, it's not a replacement for condoms as the article suggests.

Going to chime in with a nitpicky female voice here: abortion isn't really a reoccurring long-term form of birth control that should be lumped in with the pill or IUDs.

It's kind of like calling a fighter jet's eject sequence a landing option.

Not picking on you specifically, I just know a lot of men who toss around abortion pretty lightly. Even if you're pro-choice it can often weigh on you.

> I don't really see the appeal for something that just targets pregnancy. As a gay male, […]

Your words read almost as a joke :) But when an issue cannot affect one at all, I suppose one may find it difficult to empathize with those it does affect.

I mean, we can go both directions. But realistically this is a large market; many dislike condoms for purely birth control purposes.

I am intrigued, what is "plan b"?

I understand your viewpoint and I think that's definitely something we should also be working on

But as a straight male currently just having casual relationships, I want to be able to control my body's ability to get someone pregnant so I don't have to worry about the consequences

I am the target market for something like this and I'd imagine many of my 20-something year old peers feel similarly

"It is a painful injection in the buttock,".... most likely the reason why it is not more popular.

Disclaimer: I have no idea what I'm talking about.

Here's roughly how it works, if I understand correctly. First, a normal male endocrine system looks roughly like this:

  1. The hypothalamus produces GnRH.
  2. In response to stimulation by GnRH, the pituitary produces LH and
     FSH.
  3. In response to FSH and LH, the testes produce sperm and
     testosterone, respectively.
  4. Testosterone inhibits the production of GnRH by the hypothalamus (a
     negative feedback mechanism). This effectively keeps testosterone
     levels regulated.

When external testosterone is introduced, here's what happens:

  1. The increased testosterone inhibits the production of GnRH by the
     hypothalamus.
  2. In absence of GnRH, the pituitary produces less FSH and LH.
  3. In absence of FSH, the testes produce less sperm (this is the
     contraceptive effect). In absence of LH, the testes produce less
     testosterone.

The net effect is less sperm and the body produces less testosterone on its own.

This makes me wonder: would this lead to testicular atrophy? That happens with steroidal antiandrogens and GnRH agonists/antagonists, both of which have the effect of decreasing LH and FSH. Also, I think there are cardiovascular risks associated with high testosterone.

Testosterone has a lot of other side effects.

Wait this sounds like it'll be the ultimate temptation for people who play sports or lift weights. Once you get used to injecting testosterone regularly, it's going to be tempting to increase the dosage to gain some of these other benefits.

But I suppose women already have this going on with their birth control. One can read stories about benefits like skin clearing up, increased breast size, losing weight, etc from hormonal birth control. (And also stories of the opposite effects).

First, I agree that non-hormonal contraception decreases a lot of the risk associated with hormonal contraception (almost tautological, but worth stating).

Second, there is no increase in mortality between women who use oral contraceptive pills and women who do not (with the exception of women over 35 who smoke; OCPs are contra-indicated in this group).

For any OCP-users who might read this, there is no overall increase in cancer associated with OCPs, though some cancers are more likely with OCPs and others are less likely with OCPs.

Many of the side effects you're mentioning are either rare (hypertension, stroke/blood clots) benign (maybe you mean hepatic adenoma when you say liver disease?) or things I have not heard of (would appreciate scholarly references; gall bladder disease, heart disease[not sure what you mean here]).

> Taking pills to inferfere with your normal hormonal and bodily functions is not a great idea, when there are other options with fewer or no side-effects

In general, all medications have risks and benefits. A blanket statement such as this one ignores the risk-benefit calculation that each patient and her physician must assess in picking a medication.

I believe it was injecting/inserting a block (some kind of gel maybe?) into the vas deferens, with the effect of a vasectomy but much more easily reversible.