The Pill: The Male Version

In 1960, the female contraceptive pill changed the world. Would a pill for men do the same?

The oral contraceptive pill was approved by the U.S. Food and Drug Administration on May 9, 1960, liberating millions of women from the burdens of unplanned pregnancies and allowing them to enter the workforce in ever-greater numbers. In the 50 years since, various male contraceptive techniques have been touted but none have made it past clinical trials. The problems is that it's easier to control the development of one egg per month than it is to control the production of about 100 million sperm cells per day.

Nevertheless, a recent study showed that monthly injections of testosterone were an effective male contraceptive among Asian men. Combining testosterone with progestin works better for Caucasian men. A just-launched clinical trial will test applying gels to the skin as way to deliver contraceptive hormone treatments. Instead of hormone treatments, some researchers are suggesting that an anti-sperm vaccine might be developed. There was a flurry of interest in 2007 when the pharmaceutical company GTx suggested that its nonsteroidal selective androgen receptor modulators might be turned into a male oral contraceptive pill. Still, on the 50th anniversary of the Pill, it seems that a new male "Pill" is five to 10 years away—and always will be.

But is there a real need for the equivalent of a male contraceptive pill in the first place? After all, men can use condoms to prevent pregnancy and, if they decide that they've finished having children, they can choose a vasectomy. A vasectomy is done by cutting the vas deferens, the small tubes that conduct sperm out of the testes. About one in six American men have had a vasectomy. A new option is the Pro-Vas which involves closing off the vas deferens with a tiny titanium spring clip which can be later removed if the user decides he wants his fertility restored. 

This makes "Don't worry babe, I've had a vasectomy" the most compelling line most men can currently offer about their own fertility—of lack thereof—in the heat of the moment, but women are surely mindful that the males sometimes lie. Would women trust men to take a daily contraceptive pill? A 2009 survey in Britain found that women thought their partners could not be trusted to take the contraceptive pill regularly. But an international survey of 4,000 men and women done in 2000 found that two-thirds of men said that they would use a male pill and nearly all of the women said that they would trust men to use it. If it turns out male contraception can be delivered via an implant, like the female contraceptive Norplant, women could demand to see the implant site before engaging in sex.

Women have more than a dozen contraceptive options besides the Pill and since they are the ones who get pregnant, they arguably have a much stronger motivation to use contraception than men have. However, recent figures show that in the United States half of all pregnancies are unintended, with 44 percent resulting in live births, 42 percent aborted, and 14 percent miscarried. On the basis of those figures, it's fair to conclude that it's not just men who are irresponsible about using contraception.

What about other forms of sexual irresponsibility? For example, a somewhat dodgy 2004 British survey of 5,000 women found that 42 percent of them said they would lie about contraception in order to get pregnant. On the other hand, an unscientific poll over at the website CafeMom found that 80 percent of respondents said that they absolutely would not lie about contraception as a way to have a baby. That leaves 20 percent who said that they definitely would lie, might lie, or are not sure.

An even more disturbing recent poll found that 43 percent of unmarried young males who say that it is important to avoid pregnancy right now, would be pleased if they found out today that their partner was pregnant. Perhaps such a pregnancy is seen as confirming a guy's virility. Only 20 percent of the unmarried women said they would be pleased to find out they were pregnant.

One significant problem with the Pill is that it lowers libido in some women. It's pretty safe to say that if the male version carried even a slight risk of lowered libido or erectile dysfunction, it would be a complete flop. (Testosterone contraceptive therapy tends to increase libido. Just saying.) In any case, a 2007 Zogby poll found that just 14 percent of Americans might be interested in taking or might insist that their partners use a male pill in the first year of its release. Thirty-seven percent said that they would wait a year to see if it's safe before considering it. However, an international poll found that a majority of men would be interested in using some form of hormonal male fertility control.

With the risk of unintended pregnancies further reduced, male contraceptive pills would let men and women feel just a bit freer to pursue sexual opportunities, but its advent would not result in the same kind of vast, and mostly liberating, social and economic changes that the female Pill engendered 50 years ago.

Ronald Bailey is Reason's science correspondent. His book Liberation Biology: The Scientific and Moral Case for the Biotech Revolution is available from Prometheus Books.