The Perfect Birth Control for Men Is Here. Why Can't We Use It? (2015) | Hacker News Reader

The Perfect Birth Control for Men Is Here. Why Can't We Use It? (2015)

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From

https://blogs.biomedcentral.com/on-health/2017/04/05/vasalge...

AB: Are studies being conducted that focus on the reversibility of Vasalgel? If so, does the data seem promising?

EL: Yes, preclinical studies focused on reversibility are promising, but not conclusive in larger animals. Preclinical testing of Vasalgel in a rabbit model resulted in rapid and durable efficacy of the contraceptive. Vasalgel was then flushed from the vas deferens with a sodium bicarbonate (baking soda) solution, which restored sperm flow.

However, in larger animals (baboons and dogs), reversing the contraceptive effect in a similar way has not yet been successful. Research is ongoing to clarify the issues and optimize the procedure, and additional preclinical studies will be conducted before testing reversal in humans.

---

It looks like the reversability is only theoretical as it has failed testing in larger mammals and has not been tested in humans.

I've been following this for a while, and while I don't remember seeing anything about them attempting to reverse it in dogs. For the baboons, it seems that their vas deferens is not quite as strong as rabbits' or humans'.[0]

Looking into it again, they do mention they were starting trials with dogs, but I don't see any updates on their website about that specifically.

[0]http://myemail.constantcontact.com/Baboon-study-milestone--p...

SO I just checked the Parsemus foundation website and this is their first line describing Vasalgel:

> VasalgelTM is a long-acting, nonhormonal contraceptive with a significant advantage over vasectomy: it is likely to be more reversible.

"It is likely to be more" does not sound very reassuring.

This is medical speak, can't say "100% reversible" if it isn't exactly "100% reversible".

Without FDA approval, they are not allowed to market it as treating almost anything medical.

They have to be very careful about what they say in public, because they are trying to get FDA approval, and the FDA is (for good reason) twitchy about medical product manufacturers saying things that haven't been proven out through a strict testing process.

Right now, since they have a limited budget, they're just focusing on doing the studies they need to do to get approval for marketing it as a non-reversible contraceptive. Getting approval to market it as being reversible will come later.

IIRC, all of this is explained on their website, possibly in the FAQ.

Edit:

Yeah, more or less. From the FAQ --

"The idea is to develop a fully reversible long-acting male contraceptive, and recently-completed rabbit studies showed rapid restoration of sperm flow. This was accomplished by flushing the Vasalgel from the vas deferens with an injection of sodium bicarbonate (baking soda) solution. Additional reversibility studies must be completed before Vasalgel can be marketed as a reversible male contraceptive."

In a study on rabbits, all seven were successfully reversed after 14 months.

https://www.eurekalert.org/pub_releases/2017-04/pf-sro033117...

Not quite as successful in larger mammals, though:

https://www.parsemus.org/contraceptives/reversal-whats-statu...

Vasagel has had no reversibility studies so they cannot make a firm claim that it is reversible. It would take many additional years to prove that. They're targeting demonstrating that it is safe first, releasing to market, then studying reversibility at a later date.

Could they get it approved as a "chemical vasectomy" and get to the reversal later? It's already better than the state of the art because there's no surgery

That’s what they are pursuing with trials now. Efficacy as a contraception is proven in animal models and they’re pushing for human studies of that.

> Vasalgel would cost less than your typical $800 IUD.

> [I]f the average person hits puberty at 13, and doesn't want to have a kid until they're in their mid-30s, that's more than 20 years worth of contraception from which pharmaceutical companies can profit.

So there's the answer.

Also - why isn't the US govt. helping to fund something like this? It seems like low-hanging fruit in terms of public health.

> why isn't the US govt. helping to fund something like this?

It’s extremely hard to get grant funding for such a project. First of all, final stage drug development is virtually never done in government-funded labs: there’s no suitable infrastructure, and such projects are too long-term and too costly to fit well within the government funding cycle (think about who would be doing the research: most researchers’ stay at a given employer are too short).

In addition, the current (but not necessarily recent!) political climate probably makes this even harder to get funding for. Sexual health is very much at the side-line already, and funding something that would be politicised as “supporting promiscuity” might well be political suicide.

Or, if they're on the other side of the political aisle, accusations that the government is sterilising minorities.

Great explanation for someone who doesn't know much about the drug development process.

Agreed re: the politics. It's frustrating that what should be a slam-dunk bipartisan issue - something that likely could: 1) help with family planning & give a viable option other than hormonal birth control and 2) lower the number of abortions performed would just be attacked by both sides of the aisle.

Letting people have sex without facing repercussions is seen as a negative by those of a strong (social) conservative mindset

They don't want to prevent abortions to stop killing babies, they are more concerned about making sure the new mother suffers the result of sex. Reducing aid to new mothers and post-birth babies is a pretty good indicator of this

> Also - why isn't the US govt. helping to fund something like this?

I'm guessing that the religious nuts that have issues with 'controversial' government involvements in other contraceptives is likely to blame, or at least the threat of pressure from them would keep the government away. The government funding something like this would cause a lot of noise from them.

> Perhaps the best reason to be skeptical of RISUG and Vasalgel from a scientific standpoint rests on a cultural factor: guys generally don't want to talk about their balls with doctors.

Uh... If HN had polls, I bet it would look like this:

Would you be willing to talk to your doctor about getting a safe, reversible 15 minute injection into your testicles to prevent unwanted pregnancies?

    Yes: ========================== 99%
    No:  0%
    I don't know: 1%

There's probably 2-3% of the population actively trying to conceive at any given time, and at least another 2-3% for whom sex is but a distant dream.

I'd like to have you at my party :)

Shame, 'cause I'm not good at parties ;)

HN has polls. They look like this: https://news.ycombinator.com/item?id=16558310

Nice!

Meanwhile I saw that we are getting trials done on a male birth control pill that works by lowering your testosterone to castrate levels...

how else are you going to nuke millions of sperm?

Vasagel

read the article

Doesn't lowering testosterone reduce the male sex drive? Well I guess that makes it only a more effective birth control agent.

Yes typically. The male libido will essentially entirely disappear if you take testosterone low enough. This effect is commonly seen in men that get testosterone reduction therapy for prostate cancer.

eg: https://well.blogs.nytimes.com/2008/12/02/after-cancer-the-e...

Another (old) method that is known to work is injecting low levels (say TRT levels or slightly less) which shutdowns endogenous testosterone production which also shuts down sperm production. This gets you @ next to zero sperm levels but also keeps testosterone in your body.

This is by far the cheapest and effective method i have seen. The only reason I can see it is not in use is due to the FUD around recreational use of steriods.

Wouldn't that have a risk of permanent infertility at some point or indefinite reliance on TRT? There's also the issue of aromatization

>or giving up full agency over your life and freedom to care for the surprise child you will be shackled to for the next 18 years?

Has no one else done a write up on this besides Vice that we can read instead? I guess it's interesting hearing the perspective of someone who is barely old enough to have sex, but they wouldn't be my go-to source for journalism on the topic.

This sounds like something the NHS (or similar) could fund. $5-10m is not a lot of money if this actually works - they'd probably save that in reduced unwanted pregnancies.

Birth control for men will never work. It's just a matter of trust.

To put it in a way that HN users understand quickly: it's client-side input validation.

(Don't tell me how condom works, you know what I mean.)

Every time male contraception comes up, someone says this. It makes no sense. Men get vasectomies all the time and their partners trust them.

Birth control for women has the same issue, especially when self-administered.

Male birth control is for the man to ensure he is not a father.

Female birth control is for the female to ensure she is not a mother.

Condoms are for both parties to prevent pregnancy and to control STDs.

For a male using BC to not use a condom and 'interface' with a female not using BC, they would need a level of trust.

Personally, if I were single and wanted to remain a non-parent, I'd use male BC and a condom in every case. The chances of both forms of BC failing simultaneously is minuscule.

Is it just by chance that this was posted on April 1?

starts by talking of a method available since 1931, that is fully researched and ignored. then ignores it and focus on vasagel, making it look like vasagel is the thing tested since the 30s.

what kind of crappy, misleading writing is this? I used to like vice.

Either we aren't reading the same article or I'm misunderstanding it.

It starts off with the anecdote of having discovered the key parts of making the birth control pill possible, 30 years before it became available, as a preface to the rest of the article:

Where it's been 30+ years since the gel (now marketed as vasalgel) was invented in India.

I didn't find it misleading at all, but maybe I missed something?

Because the penis is privileged over the vagina.

Every woman I've ever been with has already been on BC, this is the same for all my guy friends. It's never something I've ever had to consider.

I think the article doesn't bother separating real motivations from stated motivations.

People want to have sex without consequences. That happens either in committed relationships or hookups. This gel does nothing for people who just want to hookup because of the risk of STDs. So you still have to use a condom anyway so why get the gel injection?

In committed relationships I could see it working. But committed relationships don't just spring up from nowhere. People who become committed probably started out doing this thing called dating where they tried to meet and sleep with people before settling down.

So women will use BC in both phases because it's the path of least resistance. I could see this working best as an alternative to vasectomy for a couple that is done having kids. But not as a replacement for condoms or female hormonal BC.

BC has side-effects, so currently the burden is placed on women. It's the path of least resistance simply because it is the status quo, but that's no argument for why it should continue that way.

Look, let's be honest. It falls to women because they have the most to lose. They are the ones who get pregnant. Of course men should be responsible. But the biological reality is what it is.

Let’s be honest. It’s difficult to argue that it doesn’t fall to women at least partially because this has historically been a men’s world and men cannot be bothered with researching male contraceptives if contraception has already been made Someone Else’s Problem. A male contraceptive with all the side effects of the pill would never become popular.

The reasons commonly reported by heterosexual men to not use condoms are not much different to the reasons reported by homosexual men, so I think there's something other than burden-passing at play here.

Hm, I don’t see how that follows at all. Gays don’t have the pregnancy issue so there’s no burden to pass.

The burden is largely on women because they suffer the larger (and more immediate) share of the consequences. How many women who don't want those consequences would trust a casual hookup who assured them that they are sterile, to the point where they'll not use their own birth control?

Ideally, both parties will use birth control.

>Ideally, both parties will use birth control.

This is what many people see to be missing. No method of BC, beyond total abstinence, is 100% effective. Mixing methods lowers the simultaneous failure rates to minuscule levels.

I didn't make an argument saying that the way it is, is the way it should be. I just said it is the way it is for reasonable reasons and I don't see how this new way could gain traction. Pushing up hill isn't a great strategy.

> So women will use BC in both phases because it's the path of least resistance.

I could see it from womens point of view as you can't always trust the other party (someone you just met) that they are indeed "on the gel", and you are the one getting pregnant if it's not the case.

This might be the big/determinant factor, but apart from that it's definitely not "least resistance" when factoring in side effects. It's tradition, but it doesn't have to be.

Condoms for STDs will always have a place, I agree.

There are many women who are reluctant to take hormonal birth control pills for a variety of reasons. It makes some gain weight or breast size. It makes some more emotional. It can increase risk for certain cancers. Among smokers it increases risk of blood clots and strokes. Some women believe (correctly or not) that taking the pill will affect fertility later in life. Mucking with one's endocrinology is serious business, and it's a serious choice for every woman thinking about getting on the pill. If there's this "perfect" side-effect free birth control for men, I know a lot of women who'd rather opt for that.

On the other side of it, condoms (and hormonal birth control pill for that matter) are not infallible. Plenty of guys want to have consequence-free sex with relative strangers and not have to worry about a condom breaking or b.c. pills being left in the hot sun too long or an unscrupulous woman turkey-bastering his sperm from a used condom or a blowjob.

I anticipate this being immensely popular if it's made available.

You missed a big reason for women not to take hormonal BC. Reduced or absent sex-drive. That's a large issue for a woman in a relationship and probably a large issue for single women as well.

I didn't bring it up because it's not a reason to prefer vasalgel over hormonal BC.

> There are many women who are reluctant to take hormonal birth control pills for a variety of reasons.

Your list had nothing to do with preferring male over female BC. It was talking about reasons women could be reluctant to use hormonal BC methods. I was simply adding a very large side-effect to the list of reasons a woman might skip a hormonal BC method.

Oh! Sorry, I totally misinterpreted your original comment. I thought you meant that women who have a pre-existing condition of low sex drive don't want to take the pill because they have no interest in sex and hence contraception. While true, it didn't make much sense in context. It being a side-effect of the pill makes much more sense.

Female hormonal BC can have a lot of bad consequences on the health (I know someone who died, one other who lost a lost of her hair, my girlfriend gets depressed, etc.) so I hope more couples would consider that.

Its interesting to think how hormonal BC has only been around for less than a century. What effects will the mothers (& grandmothers, since technically the mother's egg is already formed in the grandmother at birth) carry onto their children over further generations? I like to think we got a nice ancestry line happening from the last 2000 years with lots of physical activity and exposure to nature.

In contrast, every woman I've been with, with one exception, has been unable to take hormonal birth control without crippling side effects re: mood and mental health. I can't comment on what it feels like, but the side effects are emotionally taxing for male partners and are really good at killing relationships.

You seem dubious about the market size of this.

> This gel does nothing for people who just want to hookup because of the risk of STDs. So you still have to use a condom anyway so why get the gel injection?

Aside from the hookup crowd being the minority of the available market, this further reduces the probability of accidental pregnancy even for them.

> So women will use BC in both phases because it's the path of least resistance

Maybe, maybe not as sibling comments stress. Besides, this further decreases chances of pregnancy beyond female birth control alone.

> I could see this working best as an alternative to vasectomy for a couple that is done having kids

It's quite reversable (at least according to this article), so its market is reasonably far larger than that of a vasectomy.

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