How a male pill can boost gender equity
Beyond vasectomy and condoms, there has been little innovation in male contraceptives, with women bearing the burden of birth control. Research on the development of a pill for men promises to change the status quo.
At present, there is no pill for men and new advancements in male contraceptives remain elusive.
Photo: 邱 严
Well over half a century ago, the commercial release of the first hormonal contraceptive pill was a game changer in reproductive health. The drug, Enovid, was originally developed for menstrual regulation but approved by the United States Food and Drug Administration (FDA) in 1960 for contraceptive use.
The ripple effect was huge, touching nearly all areas of society, including shifting attitudes to gender roles, sex, and relationships. It became a necessary tool for family planning and public health alike.
As of 2019, the United Nations reports that globally 922 million women of reproductive age, or their partners, use contraceptives of some kind, which includes 151 million women on the pill.
But despite the profound reproductive freedoms ushered in by the pill for women, entrenched barriers to contraceptive equity and, by extension, gender equity remain. Contraception remains chiefly women’s responsibility and most forms of contraception are designed for women. At present, there is no pill for men and new advancements in male contraceptives remain elusive, with the two main available options being anything but modern: use a condom or have a vasectomy.
It follows that the onus remains on women when it comes to issues like family planning, or prevention of unwanted pregnancies, rather than viewing it as a shared commitment or the responsibility of the man, too.
But what if men had more options? What could a new type of male contraceptive mean for gender equity?
Developing new male contraceptives
Heather Vahdat, executive director of the Male Contraceptive Initiative (MCI), a US-based non-profit that offers funding for research focused on developing new male contraceptives, says research on male contraceptives is poorly financed compared to other drug development, with the global pharmaceutical industry ceding interest and control to non-profits and governments.
"People would say men wouldn't use new contraceptives and women wouldn't trust them, but there was no data to prove this."
She says an added deterrent is the perception that men would be uninterested in a contraceptive outside of condoms or a vasectomy, and that women wouldn’t trust them to take a daily pill. “People would say men wouldn’t use [new contraceptives] and women wouldn’t trust them, but there was no data to prove this. It’s a choice [male contraceptives] that we decided to ignore for decades,” Vahdat explains.
Indeed, entrenched social norms and gender stereotypes reinforce the view that reproductive health issues are female-centric. “It really isn’t male versus female contraception, it’s just contraception,” Vahdat says, explaining that we need to reframe sexual intercourse as a shared responsibility of the couple.
“They can protect themselves, as individuals or as a couple, from unintended pregnancy,” she says. “If that means both use contraception then that’s great. If it means the woman is having side effects and wants the man to take control of the contraception, then that’s great. It’s not an either-or [situation] and that is one of the barriers people have to overcome.”
Akash Bakshi, chief executive officer of YourChoice Therapeutics, a company based in San Francisco, California, that is developing a male birth control pill, says if it were easy to develop new male contraceptives then “it would have been done”. He agrees the reasons for the delay are largely social rather than pharmacological.
“People will frequently say they are concerned whether there is a market [for male contraceptives], but I don’t necessarily believe that was the real reason to not develop a product,” Bakshi says. “Look at the number of folks developing products in rare diseases, where the patient population is so small.”
Nevertheless, Vahdat says there has been a lot of promising work in the development of male contraceptives. “With some of the research and studies being done right now, which will ultimately go through the regulatory process, some of these advancements could be five to 10 years away,” she says. “Of course, a lot of people balk at that because there’s this saying [in the contraceptive world] that 'male contraception is 10 years away for 50 years’. But we have really demonstrated progress now.”
Male interest in new contraceptives
Research continues to probe attitudes to male contraception among men. A 2023 study published in the International Journal of Environmental Research and Public Health examined the willingness of men in Spain and Mozambique to use a contraceptive pill based on a set of factors: the cost of the pills, efficacy, level of side effects, and context. Men in Spain reported that concerns over side effects were the biggest issue, while the respondents in Mozambique cited the broader question of context—concerns such as the likelihood of contracting disease and having to stop using condoms.
Crucially, the idea that men aren’t interested in taking contraceptive medications isn’t necessarily borne out by research data. Earlier this year, MCI collaborated with The Bill & Melinda Gates Foundation to co-fund an international market research study on the demand for male contraceptives. It surveyed about 15,000 men and their female partners in Bangladesh, Côte d’Ivoire, the Democratic Republic of Congo, Kenya, Nigeria, the United States, Vietnam, and India's Maharashtra State and Uttar Pradesh State. The results from all the surveyed countries showed relatively high demand for any new male contraceptive methods that may be available.
In Bangladesh and Nigeria, 76% of male respondents said they would adopt a new method within a year of its availability. At 39%, respondents in the US were the least likely to embrace a new male contraceptive method within a year.
When it comes to the idea that women wouldn’t trust male partners to use a new kind of contraception, the survey shows 86% of female respondents in Vietnam agree or strongly agree with the statement “if my partner told me he was taking a contraceptive I would believe him”. The statement is supported by 85% of women in Bangladesh and 81% of women in Nigeria.
There is also a compelling example of men taking preventive daily pills related to their sexual health—namely pre-exposure prophylaxis (PrEP) drugs to prevent HIV infection. This medication has been widely adopted and accepted by members of the greater LGBTQ+ community, particularly gay men, who have historically been at elevated risk for HIV.
Combating contraceptive inequities
In many countries where contraceptive need is high, equitable access remains elusive. A 2022 study in The Lancet that looked at attitudes to contraceptive methods, prevalence, and demand in 204 countries and territories from 1970 to 2019 found that sub-Saharan Africa and South Asia account for more than half of the women who lack access to contraceptives. Will any newly developed male contraceptive be made available to people who live in regions that need it the most?
Vahdat says ensuring equitable worldwide distribution of male contraceptives remains an area of concern. Given that the pharmaceutical industry has largely sidestepped contraceptive development, there is a risk that it may piggyback on investment by philanthropic or government sectors and charge end-users a higher fee. As has been experienced time and again with various vaccines and other health interventions, high-income countries would end up having greater access to a resource that could greatly help end inequity in others.
For its part, MCI has a ‘global access clause’ in all its grants. Vahdat says this alone may not resolve issues related to global access, but it may at least encourage those developing male contraceptives to find ways of making their discoveries more widely available. “[Contraceptives are] a globally necessary product and should be treated as such,” she says.
New innovations in the works
There is a promising and wide range of male contraceptives under development right now, including hormonal and non-hormonal options. Bakshi, of YourChoice, says his company has been working on a daily non-hormonal oral contraceptive pill that would also serve as a “women’s health product” as it transfers the pressure and responsibility on to the male partner.
Bakshi hopes his company “is the first to get an approval for an oral non-hormonal contraceptive”. In tests with mice, the drug has been found to be 99% effective—better than the female contraceptive pills currently on the market—and human clinical trials are on the horizon.
Bakshi believes there is a broad audience for this kind of pill, from men who already have all the children they want, to those who might find the idea of a vasectomy scary or unappealing, or prefer an easily reversible method in case they decide to have children later on.
There are various male contraceptives under development, including an on-demand pill men can take shortly before sex.
Photo: Louis Reed
Researchers at Sacyl Pharmaceuticals are hoping to reach a similar market with an “on-demand” contraceptive pill that men can take shortly before sex, as needed. A 2023 study published in Nature Communications found a single dose renders male mice temporarily infertile.
"Imagine a man who is 17 or 18, he would have to take it [birth control pill] continuously for 50 years, depending on the situation. With this on-demand contraceptive, it’s dependent on the situation. It’s a really revolutionary idea."
Like many scientific developments, it came about by accident. The researchers were initially attempting to isolate soluble adenylyl cyclase (sAC), a regulatory protein found in almost all cells, when they realised that mice can be genetically manipulated to lack sAC, leading to infertility. After a full day, the mice sperm returned to normal movement.
Weill Cornell Medicine co-authors Dr Jochen Buck, Dr Lonny Levin, and Dr Melanie Balbach, who discovered that the drug prevents sperm from pushing forward, say this could be a major breakthrough in male contraceptive development. “Our approach is special because of the on-demand nature—men only take it shortly before intercourse,” Balbach says.
An on-demand contraceptive like this means infertility is temporary and reversible. If a male user or a couple want to return to family planning, they could stop using the drug.
“Melanie, with her experiment, broke the dogma—we were under the assumption that you would have to suppress sAC all the time,” Buck says. “This is a totally different story from taking a drug continuously. Imagine a man who is 17 or 18, he would have to take it [birth control pill] continuously for 50 years, depending on the situation. With this [on-demand contraceptive], it’s dependent on the situation. It’s a really revolutionary idea, that a man would only take a contraceptive when he needs it.”
Levin says the compound they are working on is not perfect yet—right now it’s “gold” but he wants “double platinum”. Research is ongoing and human clinical trials may be likely in the near future.
A look to the future
Levin says he hopes male contraceptives “will change the conversation around reproductive rights and family planning”.
Balbach agrees: “I would really like to see change, in that it is not the female’s responsibility [alone] to have it [contraception] covered. I want it to be more equally distributed, the burden of contraception, on both sexes.”
Vahdat, of MCI, has a cautiously optimistic vision for the next 10 years.
“Once you start to see a turnaround, and results [a male pill approved and on the market], you’ll have people engaged in the conversation. You’ll have interest from VC [venture capital] folks. That’s the conversation I want to have—‘isn’t this cool, what’s next?’”