World Contraception Day, a global event that informs and promotes birth control, took place on 26 September. This year's World Contraception Day provided an opportunity for the debate on the male pill to be reignited. While most of the responsibility continues to rest with women, men are increasingly being encouraged to take a more active role in contraceptive practices, but it still seems to be a taboo for many men.
A survey on contraception, conducted by Solidaris in 2017, revealed that nearly 7 out of 10 women in Belgium report using contraception. Of those, nearly all of them admitted that they alone were responsible for birth control in their relationships.
The study showed that only three out of ten Belgian men took responsibility for contraception, 60% of which cited condoms as their means of contraception, and nothing else. When they were asked about the male pill, nearly four out of ten men said they were ready to take it, while three tenths said that they did not know what it was, and the last three tenths said that they did not want to hear about it.
Contraception remains a difficult topic for both men and women. Young people, however, are less uncomfortable about the subject and more clued-up. 8% of 17–20-year-olds broach the topic of contraception even in a casual relationship, but after 20 years of age, this figure does not exceed 5%.
More worryingly, 21% of 41–55-year-olds never ask their partner about contraception, while fortunately, this is barely 4% in 17–20-year-olds.
Male contraception options are not widely discussed. It is true that women have the advantage of being able to consult specialists, gynaecologists, or general practitioners specialising in planning, while men do not have dedicated professionals they can contact in Belgium. They often rely on their partner, family or friends, who are also poorly informed and trained.
However, the idea of a male pill is not something new. The first publication concerning the suppression by hormones of spermatogenesis, or the manufacture of spermatozoa, dates back to 1939.
History of the male pill
In the United States, in the 1950s, Gregory Pincus—one of the inventors of the female pill— also successfully did tests on men. With the emergence of the feminist movement in the 60s and 70s, some men also began to question the patriarchy and wanted to take their fertility into their own hands.
Elsewhere, trials have been conducted on men to assess the feasibility of male contraception. In the 1970s, China faced a serious problem with overpopulation, and so launched a large-scale trial on thousands of Chinese men. The trial had to abandoned, however, because of serious side effects, especially liver damage.
In France, it was not until the late 1970s and early 1980s, that the first real steps towards a hormonal contraceptive for men were taken. A double "treatment" consisting of a weekly pill and a gel to be applied to the body was developed.
Very quickly, however, doctors began to see side effects similar to those caused by pills for women, such as breast enlargement, weight gain, and irritability. Not to mention that as the gel rubbed off on their female companions, the women saw their testosterone levels in the blood increase, and therefore also their body hair.
In the mid-80s, the AIDS pandemic complicated the situation and brought a halt to this modest research. It was not until the early 2000s that experts started to refocus on the subject of male contraception.
Yet as early as 1990, the WHO launched its first major global study on male contraception, with the use of testosterone injections. It quickly found a very high efficiency, comparable to the intrauterine contraceptive device or coil (IUD), of 95%. A second study had shown even better efficacy.
What happened to the research?
So why did we stop there? Was it because of the taboo? Are men too fragile? Is there too little to gain? It is probably a combination of all of these factors, experts suggest.
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According to Dutch researcher Nelly Oudshoorn, men are afraid of a decrease in their libido. However, this is an unfounded concern since chemical contraception increases testosterone levels. Oudshoorn also points out that there are not enough male ‘guinea pigs’ who are willing to take the risks in a large-scale trial.
In addition, the pharmaceutical industry is much more cautious about potential complaints. At the time when female hormonal contraception was being tested, the legal, ethical, and scientific context was much more flexible. In addition, the profit margin on male contraception is currently not worth the effort.
And then, some prejudices still exist: if the pill exists for women, why bother with a pill for men? Some men have even claimed that it is taking power away from women.
Whatever the reasons behind male aversion, advances in science are making it increasingly likely that a safe and effective male pill will soon be widely available. Educating men about it will then be the next big challenge.