40 Barren Years

still no birth control pill for men

by by Rebekah Bergman

illustration by by Annika Finne

In the 1950s a young woman at the drive-in with her beau would have been understandably anxious about the expiration date on the condom. In the wholesome era of “going steady,” sexually active women had few contraceptive options: an expensive diaphragm, the risky rhythm method, or—as some doctors recommended—the use of Lysol.

This September marked 40 years since the Food and Drug Administration deemed the female birth control pill (BCP) “safe.” In that time, the original Pill has spawned a family of offspring. One brand clears your skin, another takes away your period, a third may relieve the symptoms of premenstrual dysphoric disorder. Today’s fertile and liberated woman can hang up her poodle skirt for belt-sized pleather shorts with many more tools inside. She may complain of information overload but she can no longer say that Lysol is the only option and it burns.

The development of the Pill may have been a catalyst for women’s liberation, but the new medicine also shifted contraceptive use almost completely to the women. In the climate of Pill progeny, male-centered birth control methods have lagged far behind. According to Science Progress, there are 11 broadly defined categories of purchasable female-centered birth control. For men, there are only two—condom or vasectomy. The technology for a male counterpart to the female BCP has been a con-ceivable reality for many years. But there appears to be a jam in the bureaucratic pipelines preventing science from reaching the market all these decades later.

Tinkering with testosterone
“Contrary to popular belief, men are really not that different from women…The basic principles behind a male pill and a female pill share remarkable similarity,” Brian Nguyen, a Brown medical student concentrating in Women’s Reproductive Health, explained in an email.

The brain regulates the body’s hormonal environment. When a women’s body clears itself of estrogen and progesterone each month, the ovaries receive a signal to make more, leading to the release of an egg. The Pill pro vides an artificial dose of estrogen and/or progesterone to prevent this chain of signals from firing; the ovaries need not increase the hormone levels and ovulation stops.

For men, when the body’s testosterone levels drop, the brain sets off a similar reaction; the testes increase their hormone-production, which creates more sperm. A male BCP would keep testosterone at the basal level so the brain would not send signals to the testes. According to Nguyen the side effects for a male pill would be fewer than those of the female pill (no risk of blood clots or breakthrough bleeding for men), but could include decreased amounts of good cholesterol, acne, changes of mood and weight gain. The male hormonal method need not come in oral form. Injections of testosterone have already proven effective in China.

Similarly, Christina Wang, with whom Nguyen worked at UCLA, is creating a male contracep-tive gel for topical absorption through the arms, reminiscent of the once-weekly female birth control patch Ortho Evra. The main criticism of male hormonal methods is that they take too long to become fully effective. The medica-tions do not affect sperm cells already maturing in the testicles, which can remain active for up to 100 days. Simultaneous research is underway on methods that would fix this problem, including an injectible spermicidal foam. The research world is exploring many viable options but, as Nguyen notes, “it’s going to take more financial and public support to materialize anything onto the market.”

You can’t always get what you want
Flashback to the 1960s. Women generally needed little convincing when it was time to ditch their diaphragms for something easier and more effective. “There was tre-mendous demand for the new birth control pill, Enovid, when it first appeared in 1960,” Brown Associate His-tory Professor Robert Self wrote in an email. “Within a year, 400,000 women were using it regularly. By 1963, three million women were.”

But demand could not have been the only driving force behind the pill. After all, men have long asked for other options. Reversible and long-term male contracep-tives have been considered since 500 BCE when Hip pocrates wrote of decreasing sperm potency with heat. A 2005 article in human reproduction reported that in each of nine countries surveyed, more than 57 percent of men would consider a method of “male fertility con trol.” If demand alone could spark the genesis of a male method, the powers that be would have brought one to the economy years ago.

The appearance of the first female BCP was not a simple case of doctors and pharmaceutical companies supplying what women wanted. The development of the Pill finds its roots in 1916 with Planned Parenthood founder Margaret Sanger. As The American experience documented, Sanger had strong ties to the then-hip eu-genics movement. The first trials for the Pill, funded in part by Planned Parenthood, were conducted in Puerto Rico, Mexico, and Haiti, using techniques that, according to Professor Self, “would be considered morally questionable, at the very least, today.” The allied partnership between birth control advocates and eugenicists helped push the landmark medication forward.

The field of gynecology, which arose in the early twentieth century, also allowed science to more easily enter the unchartered world of female reproduction. As Ornella Mocsucci explains in The Science of Women, gynecology arose out of the notion that sex and reproduction were “more fundamental” to woman than man. Early gynecology, which had no complementary specialized field for male reproductive anatomy, identified women as a "special" group of patients separate from the "standard" group of males. In The Male Pill: A Biography in the Making, Nelly Oudshoom notes how subsequent fields of study, like sex endocrinology in the 1920s, continued this philosophy. Using females almost exclusively for their labo-ratory tests “enabled the medical profession to intervene in the menstrual cycle and menopause.” By 1960, the long history of the woman’s body as “the quintessential medical object” eased acceptance of an invasive medi-cation, the first to be approved for daily use by healthy individuals.

It takes two to tango
“The big step,” writes Nguyen, “is going to be getting the funding for these studies.” Right now, many of the clinical trials on the male BCP are in Phase II of the FDA approval process. This means the drugs are being tested on a sample of 300 or fewer men. In Phase III, the trials need to expand in scope and longevity to 1,000-3,000 individuals. This takes money.

American pharmaceutical companies continue to claim that the risks of a male drug outweigh the benefits. As Nguyen believes, the benefits of male BCPs, “cannot be measured in dollars and the pharmaceutical companies use dollars to motivate their pursuits.”

But this dollars-and-cents logic does not totally add up. Male BCPs could make tons of money for drug com-panies. In a Time Magazine article published in August 2008, Adam Goodman noted, “If even a small percentage of sexually active men agreed to try a new method of birth control, that would amount to a colossal number of potential consumers.” With the majority of men surveyed willing to consider male BCP, there is a ready market lying in wait for the pharmaceutical giants to come on in.

In 1996 a pill originally tested for use in hypertension was found to induce penile erections and thereby improve male sexual health. After a year on the market, sales of Viagra totaled one billion dollars. Contrast this circumstantial and largely accidental discovery with the deliberate, planned development of the many medications now available for female reproductive and sexual health. In a world where the anatomical reality is that women give birth, specialized doctors help women with our species’ reproduction. Medical history reveals a double standard in this specialization though; the fact that women reproduce justifies their exclusive accessibility to contraceptive drugs as if both a man and a woman were not involved in creating a child. When new reproductive technologies become feasible, the guinea pigs—until recently—have been female. For now, the science is safe and the demand is strong, but the gendered view of medicine leaves potential funders uninterested. Until this changes, the male BCP will have to content itself to remain in utero.

REBEKAH BERGMAN B'11 thinks that Lysol’s place is in the kitchen.