During high school, one of my friends always had an alarm that went off at 4pm, right when I would knock on her door to walk to swim practice with her. The alarm was named Fetus Deletus — it was her daily reminder to take her birth control pill. Even though she would always forget to pack something in her swim bag on our way out, her alarm made sure she never forgot to take her birth control.
Seeing how meticulous my often forgetful friend was with birth control, I always wondered why there was never a male pill. Why did female contraceptives require women to be more cautious and usually suffer multiple side effects? Why could I list numerous contraceptives for women but only think of condoms or vasectomies for men? Did society never feel a need to design other forms of male contraceptives?
I had no idea that male contraceptives were even being developed until I came across a podcast that discussed the history and efforts to create the male pill. In it, they described one of the earliest attempts of a male contraceptive with a pill called WIN18446. The pill was originally designed to treat worms in humans but was unexpectedly found to also suppress sperm counts. Observing no side effects among mice, researchers began to test humans. More specifically, prisoners, which they found to be ideal candidates for testing because of the surveillance systems. (which is very suspicious/unethical/etc…)
At first, the testing ran smoothly, until a few inmates began developing extreme symptoms, some even dying. The culprit was alcohol. WIN18446’s efficacy was due to its ability to block the conversion of Vitamin A to retinoic acid, which is required for spermatogenesis. However, by blocking this conversion, WIN18446 was also blocking alcohol metabolism pathways, which resulted in extreme reactions to even small amounts of alcohol. Upon discovering this caveat, research into WIN18446’s potential to be a male contraceptive folded rather quickly.
Although giving up alcohol could be hard, plus the fact that a slip up could have lethal consequences, I found it a bit funny how quickly researchers gave up on WIN18446. Women’s birth control has always come with a number of side effects including nausea, headaches, and depression, yet women have been willing to take this risk. This made me wonder, how would men react to similar symptoms as a side effect of birth control. Would they be as willing to take on these symptoms for a contraceptive?
In a study led by Hermann M. Behre, researchers investigated the side effects of a novel male hormonal contraceptive (norethisterone enanthate injection) and found similar risks of headaches and mood disorders, among other symptoms. Despite these effects, 75% of participants reported that they would be willing to use the contraceptive. This was a surprise to me. Obviously for women, without birth control, there is the weighty consequence of pregnancy and perhaps childbirth. For men, there is no pregnancy. Maybe fatherhood later down the road if the mother chooses, but not necessarily.
Taking these factors into account, I began to question the validity of this study. The study lasted from 2008 to 2012 with the trials lasting 36+ weeks for each participant. Out of the 320 participants, 20 participants left due to changes in mood or other adverse effects. When these individuals are taken out of the equation, how many of the remaining had side effects (and to what severity)? How would this affect the percent willingness to take the contraceptive? Even before the results, how were participants recruited? If the participants are volunteers, aren’t they more likely to be biased towards taking the contraceptive regardless of a few side effects? Unsure about the results of this study, I began to look into another research paper about men’s willingness to take a novel male contraceptive.
In the study, Dr. Brian Nguyen (one of the doctors leading efforts to phase out a nestorone topical gel contraceptive for men) examines the relationship between men’s willingness to try out a male contraceptive and their attitudes towards gender equity. Using the Gender-Equitable Men Scale (GEMS) to measure levels of gender equitable beliefs, his study found that men with more gender equitable beliefs were more willing to try out male contraceptives. 
This made sense. Unless men have learned to adopt more gender equitable beliefs, societal norms have always defaulted birth control as a woman’s responsibility because women have more to lose. Men do not often recognize the gravity of a pregnancy and the gendered expectations of childcare, so they do not seek contraceptives beyond those already available.
Dr. Nguyen points this out in the paper’s discussion. He writes how the future of contraceptive development cannot just focus on technological innovations, but must also concentrate on sociocultural change, “with specific emphasis on men’s views on gender roles and masculinity.” With current social expectations of men and women, there is a huge demand for birth control for women but little to none for men. As a result of these varying levels of demand, there is a cycle of inadequate development of male contraceptives and surplus development of female contraceptives that reinforces the unequal burden of pregnancy and childcare on women.
Although success has yet to be made with novel male contraceptives, continuing to raise awareness about gender inequity may be the answer to propelling its demand and development. The Dobbs ruling is another factor to consider, as increased risks for women could potentially incentivize men to seek contraceptives. (Or not… ) Whenever the new male contraceptive comes out, I am curious to how it will affect socio cultural gender norms.
References
Behre HM, Zitzmann M, Anderson RA, Handelsman DJ, Lestari SW, McLachlan RI, Meriggiola MC, Misro MM, Noe G, Wu FC, Festin MP, Habib NA, Vogelsong KM, Callahan MM, Linton KA, Colvard DS. Efficacy and Safety of an Injectable Combination Hormonal Contraceptive for Men. J Clin Endocrinol Metab. 2016 Dec;101(12):4779-4788. doi: 10.1210/jc.2016-2141. Epub 2016 Oct 27. PMID: 27788052.
Nguyen BT, Jacobsohn TL. Men’s willingness to use novel male contraception is linked to gender-equitable attitudes: Results from an exploratory online survey. Contraception. 2023 Jul;123:110001. doi: 10.1016/j.contraception.2023.110001. Epub 2023 Mar 15. PMID: 36924819.
Thanks for this blog post Emily! I think it really reminded me about how gendered even contraceptives can be, especially in reinforcing preexisting power dynamics like we explored in class today with Rich’s reading. The emphasis on sociocultural change from Dr. Nguyen’s research was also a great point to read about. I was inspired to look into current research for male contraceptives like you did and it turns out there’s an NIH post that highlights recent research in the development of a male contraceptive with findings published in Nature Communications earlier this year. It’s was a quick and cool read, here’s the link if anyone else is interested: https://www.nih.gov/news-events/nih-research-matters/male-contraceptive-disables-sperm
This is a really interesting topic that I had thought about before countless times. I think the most recent time when this question came to mind is when (I think last year) the doctors stopped the testings of a male contraceptive pill due to “observable mood changes.” This was especially important for me because as someone who is taking medication to control her non-sex hormones, I am extremely unwilling to take a pill that will change my whole hormone scale if I were to have a male partner. Yet, other than condom-like products, there are only a limited number of contraceptive options for females that are non-hormonal (even though your point on how there are still so many contraceptive options for females compared to males is funny). I don’t know when this situation would change, because technically what causing unwanted pregnancy is an egg AND a sperm. And they (I am personifying them 🙂 ) both should take some responsibility…
I love the title 🙂 and I have also always thought about what kind of birth control is offered for men besides condoms and vasectomies. It is shocking to me that it is only until pretty recently that clinical trials for topical male birth control is happening when birth control pills have been around for a while. Its also crazy how the side effects of birth control (which is a very long list) are typically ignored, while one bad thing in this study led them to give up (and I mean death is really bad, but still they should not have given up).
Your blog highlighting how women are expected to be responsible for not getting pregnant, reminds me of how women are typically not given anesthesia or numbing for insertions of IUDs (which I have heard are painful) while men who get vasectomies get local anesthesia and calming medications. The procedures are different, of course, but women are expected to deal with the pain of insertion while men are given multiple things to make the experience comfortable.