Update on Male Contraception: Do Vasectomies Still Rule?

I know you’re wondering: What’s up with the male pill? Exactly where are we with male contraceptives other than condoms or vasectomy? Well, it’s a good time to ask as it’s now very clear that the desire for alternatives to vasectomy is great and growing. Studies of couples around the globe found that 25-75% of them would use a male hormonal contraceptive. That means that between 44 million and 130 million men in those nine surveyed countries alone would consider a male pill. That’s a need indeed!

A Storied Past

Contraception has been defined by innovations on the male side for almost 5000 years:

3000BCE: Evidence of condom use made from animal bladder or intestine or linen cloth in Crete and Egypt.

1800 BCE: Spermicides made by combining crocodile feces and fermented dough in Egypt

1830: First vasectomy performed in a human by R. Harrison in London. Its popularity rose dramatically after WWII. The first national program for vasectomy was launched in India in 1954

1855: The first rubber condom is made by…wait for it…Charles Goodyear, who later invented the rubber tire.

Over the last century, however female contraceptive innovations surpassed male contraception like it was standing still and female contraceptives are currently the preferred choice for most couples by a wide margin (5:1). What happened here? The most glaring issue is that funding has been sporadic as pharmaceutical companies haven’t been interested in developing male pills due to high development costs and the fear of lawsuits.

The Male Pipeline

Approaches to male contraception involve  stopping sperm production, rendering sperm immotile so they don’t move, or blocking the exit path from the testicle. They can be hormonal, non-hormonal or surgical in nature. There is currently one hormonal male contraceptive in clinical trials: a non-oral testosterone-progesterone gel applied to the skin daily to turn off or turn down sperm production. The goal is to reduce sperm to less than 1 million/mL in the semen. The questions are whether it can do this reliably in all men (remember the gold standard is vasectomy which is 99.99% effective) and whether hormonal side effects are tolerable: acne, moodiness, changes in sex drive or erections. After all, having significant sexual side effects from a pill that aims to take the worry out of sex kind of defeats the purpose, wouldn’t you say?

There is also good research developing on a sperm binding agent called Eppin that renders sperm immotile so they just sit there and can’t reach the egg to fertilize it. It’s being billed as “non-hormonal” and “reversible” but it has only been shown to be effective as an immunocontraceptive in monkeys (i.e., essentially a vaccine). It’s not clear to me how complete the sperm motility block generated with this pill can be, as we all know that sperm love to wiggle. Also, I am not entirely sure how reversible anything is with the human immune system as it literally remembers everything that it has ever seen. To date, this approach has not seen clinical trials. Lastly there is ADAM*, a non-hormonal, non-oral, hydrogel polymer “plug” that blocks the flow of sperm in the vas deferens without interrupting fluid flow. It is essentially a “screen door” for sperm and should be an improvement over the classic 100-year-old vasectomy, especially if it lives up to its promise of being reversible. It’s also in clinical trials right now. So, there’s a lot of window shopping in male contraceptive research right now, but no available product inventory.

Vasectomies Rule

So, it appears that we are left with the good ole’ vasectomy. Tried and true, nonhormonal and compliance-free, nothing on earth beats it in terms of reliability. In fact one of the reasons it’s so well-loved is that you don’t have to think about doing something every time sex is contemplated. All set to go, time after time after time. And, it has new and improved versions including the no-scalpel vasectomy, the Brosectomy® and the Nitrous-powered vasectomy, all developed with the goal of making the procedure as much of a “non-experience” as possible.

*Disclosure: I advise this company.