Is male birth control finally here?

Typically, the burden of birth control falls on whoever has a uterus, but it seems like that might change — and soon! Guest: Annalisa Merelli, contributing writer at STAT. For more, go to ⁠⁠http://vox.com/unexplainable⁠⁠ It’s a great place to sign up for our newsletter, view show transcripts, and read more about the topics on our show. Also, email us! [email protected] We read every email. Support Unexplainable by making a financial contribution to Vox! ⁠⁠bit.ly/givepodcasts⁠⁠ Learn more about your ad choices. Visit ⁠⁠podcastchoices.com/adchoices Learn more about your ad choices. Visit podcastchoices.com/adchoices

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• 1:18Speaker 02

  For as long as I can remember, I've heard this vague promise that someday there will be a birth control pill for men. And meanwhile, I've heard endless stories about the struggles that people with uteruses have to navigate: the pill, the shot, the ring, hormonal IUD, copper IUD. Trust me, it was the most pain I've ever experienced in my entire life. And the inevitable side effects. Even with all of these options, almost every person who takes birth control I know has faced some kind of pitfall at some point while figuring out what's best for them. And that responsibility is normally up to whoever has the uterus.

• 2:01Speaker 02

  But I learned recently, it seems like things might finally be changing.

• 2:07Speaker 02

  Birth control options for people with sperm are here.

• 2:13Speaker 03

  I've found out that there's actually quite a few options that are being studied, tested, and very in various stages of testing, but we might be getting commercial availability if all goes well, which is a very, very big and heavy if. We may get commercial availability, you know, in a matter of a few years. Like, it's not really in the remote future.

• 2:37Speaker 02

  I called up a health reporter, Annalisa Morelli, who wrote about the drugs and devices in development right now for STAT. For a while, the drugs in development always halted. Some were met with side effects. Others never made it to human trials. But for the first time in history, some of the options are looking really viable. And there's a lot of confidence that they'll go to market. And I wondered, like, is this for real? Today, will male birth control work? And do people really want to take it? I'm Amy Padula. This is Unexplainable.

• 3:28Speaker 02

  Do you think this is something that will happen in our lifetime?

• 3:32Speaker 03

  Oh, for, I mean, for sure is never. You should never say that with science, but I think it's very likely. I was just talking to one of the developers of two of the methods. They're thinking three years, two, three years. There is a couple others that are going to enter phase three trials. So again, we're talking a handful of years, and potentially several options might be available.

• 4:00Speaker 02

  Before we keep going, I want to break down what these trials mean.

• 4:07Speaker 02

  It's kind of like drafts of a story. Phase one trials, draft one, let's say, look at safety and dosage within a small group of participants. Phase two looks at how the drugs work in a larger group. And then phase three confirms how effective the drugs are, watches for side effects, and then compares the new treatment to other proven forms in larger studies. And by that point, we really have a solid sense of what the drug does and how it performs. Final draft, essentially. The male birth control methods in development right now are in phase two, which is much further than they've been in a long time. The last time one of the options made it to phase two was back in 2011. But the options being tested right now,

• 4:52Speaker 02

  so far, are working. And they're showing a lot of promise. Which is good. Because the options on the table for male birth control today are really limited.

• 5:06Speaker 03

  They can use condoms or they can get a vasectomy. Condoms, I think many of us are familiar with. There's an issue of reliability, right? Even in the best case scenario, they're fallible, they can break. But you know, add to that human error and you're talking about, depending on the study, about like 13% to 18% rate of failure. Very high. And then when it comes to vasectomies, vasectomies can be very effective. They do fail upon occasion, but very, very rarely. They are also, which not many men or people know, reversible, especially if you do that within the first five years. However, there are a number of downsides. Number one,

• 5:51Speaker 03

  you may not want to undergo a procedure of that type. Two, it is not guaranteed that it can be reversible. So if you're a younger man, you may not just want to run the risk. And number three, it can be expensive. And unlike contraception for women, contraception for men in America is not free and not covered by the Affordable Care Act. So you, you know, some of the men that I spoke with when I wrote about male birth control would have been happy to get a vasectomy and then found out it was going to be, depending on their insurance status, could be running to thousands of dollars. And the reversal is expensive, can be expensive even more so than the vasectomy, and it might be hard to find someone to do it. This all makes vasectomy like a bigger decision for someone who is,

• 6:37Speaker 03

  let's say, done or never wants to have children or is sure never want to have children. There's not anything remotely comparable to all the range of options that women have. And I am aware as anyone that I want to say none of the options that women have is ideal, but most of them do the job and work and are reliable, which is something.

• 7:03Speaker 02

  So, Annalisa says there's a couple interesting options in these clinical trials, and we're going to break them down into two groups.

• 7:12Speaker 03

  There are medications and there are devices. And the reason why I'm breaking them down this way is that because of the way the FDA approval process works, devices are faster to get approval and to get cleared than medications. And so some of the products that have been, seem to be a little bit behind in the testing phase, because they aim to be cleared as devices, will have a likelihood to come in on the market sooner than medications.

• 7:51Speaker 02

  The first one is a hormonal gel. It's called N E S T.

• 7:56Speaker 03

  Which stands for Nesterone and Testosterone, and these are the two components of this gel. It's a gel that men have to apply, I believe it's either on their arm or on their shoulder, daily. Raising testosterone, this sort of leads to infertility. They have completed their phase two studies a while ago. I've spoken to one of the people who took part in the studies. They liked it very much. It was very effective. It has some downsides. One is that you need to apply it every day. So it requires very high compliance.

• 8:33Speaker 02

  There's a couple of lifestyle issues with this gel, though.

• 8:36Speaker 03

  The other downside is that testosterone gel testosterone transferred to other people when you have a gel put on yourself. And so, say, you can't touch a child if you've just applied testosterone. You have to wait a few hours. You can't cuddle with a partner if you've just put on your testosterone gel because she will have effects from the exposure to those levels of testosterone. This essentially means when I was talking to the person when they went to trial, who, by the way, was 100% on board. This man was saying, if I had to choose between no birth control and putting this gel on my arm every day, I'll put my gel on my arm every day. Like, he was sold on it.

• 9:18Speaker 03

  So, the person that I spoke with was saying that because of the fact that he couldn't really have skin contact with someone else after he put on the gel, this made him essentially plan his day out, right? So he would put it on in the morning if he knew that he was seeing his girlfriend later in the day. Or if he was staying at home that morning, then he would put it on at a time where he knew he could be away from skin contact with people for a little while, which is a bit of a downside, I suppose. He said it was manageable. In fact, he said that when the, he was in the face of study, when the study ended, he wished he could continue and he immediately looked for another trial that you could participate in.

• 10:06Speaker 02

  Were there any side effects with that trial?

• 10:09Speaker 03

  You know, not really, not really. One of the men I spoke with said initially he was a little bit fatigued, but he couldn't really put it down to the jelly self. He said it might be something else going on in his life. One of the reasons why the hormonal birth control trial was halted is that the mental health side effects were really felt by men. And when I was talking to men and asking them, well, would you take a birth control pill? And what would make you not want to take it? Depression, anxiety, like the increasing, the mental health side effects were really the one thing that men were aware of. And we know this exists in women's, for women who take birth control pills as well, but

• 10:53Speaker 03

  I thought it was remarkable how really... That specific seemed to be the one where they drew the line. I didn't hear men talking, for instance, like weight gain or other things that you may think about. Mental health really was a top concern.

• 11:08Speaker 02

  Another option is something called Y C T five two nine, a non hormonal birth control pill for men. Basically, it stops the receptors of vitamin A and the testes, which are essential for making sperm. So while you're on it, you don't make any. You're sort of temporarily infertile.

• 11:26Speaker 03

  This has had a lot of success in the trial, so far as we can tell. The science behind it was just published in several papers. It's sort of like an innovative way of thinking about suppressing fertility. From what I hear, men who are participating in the trials are pretty happy with it. They wish to continue when the trial ends. It's still, it still needs to go to like a larger size trial, but the expectation of the company that's developing this are pretty good and high.

• 12:03Speaker 02

  And there's a different pill in development. It's sort of like the on demand option. It's called N L S one thirty three, and you take it ninety minutes to three hours before intercourse.

• 12:15Speaker 03

  The way that it works essentially stops men from ejaculating. You have intercourse as you were going to, but you don't ejaculate essentially. You don't produce. This doesn't mean that you don't have orgasms. It just means that you don't ejaculate. And that way, nobody gets pregnant. The medication is a combination of two existing drugs that do different things.

• 12:38Speaker 02

  The drug works by stopping a receptor that plays a role in sperm production.

• 12:42Speaker 03

  The idea is that it would be similar to Viagra. You'd go to the doctor, you'd have a prescription, you have a few pills on you, and then you take them when you need them. Essentially, the way that I think about it is it's a more reliable alternative to a condom. This is not going to alter your fertility permanently. It's something that you have to do every time. Upon occasion, it's on demand.

• 13:06Speaker 02

  And then there's a fourth option, an injectable implanted gel.

• 13:11Speaker 02

  It's called ADAM, a set it and forget it option.

• 13:15Speaker 03

  These are the other group that I was mentioning, which are devices. So one is ADAM, which is a hydrogel. So hydrogels are like gels that are injected in the body. They can be done for a lot of things. They are not rejected by the body as an external tissue. Or so, so there's no, there's no issue of having reactions to them or anything like that. And what a hydrogel does in this case, it sort of creates a seal that is small enough that the head of the sperm literally will not go through. The other thing that I think about is like, oh, it's like a male IUD.

• 13:54Speaker 03

  But I'm told far less painful than an IUD insertion for many reasons, including the male anatomy, they would have it easier. But essentially it creates this barrier. There is another product, which is called Plan A, that another company is doing, which doesn't need to be dissolved. So it's longer active, it will last for a few years. It's basically like a hormonal birth control that releases a steady amount of hormone in your bloodstream and it lasts up to five years.

• 14:29Speaker 02

  So an abundance of methods, it seems.

• 14:34Speaker 02

  One thing I learned that surprised me was that there was a male birth control pill in the works at the same time the female birth control pill was in development, like back in the 1950s. And that made me think, why has it taken this long to develop these new drugs? We'll dig into it all after a short break.

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• 18:54Speaker 01

  Could you two, please, dump some hormones?

• 18:58Speaker 05

  So these drugs are in various stages right now. It seems like we're further ahead, though, in these trials than we have been in the past. Why is that?

• 19:07Speaker 03

  So I believe that the number one reason why we don't have middle birth control is today, you know, in 2026, is cultural. We belong to a society that believes pregnancy is a woman's responsibility. Maybe because men are not used to being compliant with medications. They're not used to having to account for pregnancies. But there's been a skepticism that men would be reliable. And so that if a man were taking birth control, the question was always, would a woman trust it? Would you want to trust that they're taking it for real when they're supposed to? If it has any side effects, would women really not want to take birth control themselves?

• 19:51Speaker 03

  Or would they want to take birth control? Birth control was a woman's game. You know, there are products that exist. Are they great? No. Do women still use them? Yes. You know, so even then, there's not even a great incentive to make it better products. Because, you know, what we have is fine. You know, nobody is going to invest large sums of money to go through the complicated process of making sure that something works for birth control, which is a pretty, you know, pretty high bar when it comes of, uh, you know, even when it comes to like head cold, trials, recruiting people. It's not necessarily so easy to recruit someone. Be like, do you want to try and see if maybe you get pregnant, maybe you don't? There's a second reason, which is business.

• 20:35Speaker 03

  You know, the, all of the innovations in birth control and reproductive health that has been made in recent years are all typically funded by nonprofits, grants. Even the ones that I've mentioned are, uh, receiving, receiving grants. Because big pharmaceutical companies sort of stepped away. You know, they had, you know, some of the products, they had the pill, you know, talk about a real, like a money maker, right? And then, you know, those were developed and then the patents expire. And then it just doesn't make that much money. And so it's sort of like not really been an area of great, uh, business appeal. Um, now what has changed, uh, are a number of things.

• 21:19Speaker 03

  So number one, uh, men, some of the sort of research and development and even thinking about male birth control was getting momentum right as the AIDS epidemic. And so there was such a push, understandably, towards using condoms that that kind of became the default.

• 21:41Speaker 02

  I just wonder, what has kept a lot of these methods in testing and not made it to market?

• 21:47Speaker 03

  Well, I think right now the push is stronger. The attention is greater, there is dedicated research. There's been a change. There's been a shift in how we think about contraception and male responsibility in contraception. And this is social and it's personal. Many more men than ever before want to be responsible and want to be in charge and have agency over their fertility. I believe this is a result of a change in legal landscape in many ways. While also noting that we're still, it's still, you know, some of the products that I spoke with will still tell me that, you know,

• 22:29Speaker 03

  we'll get into, you know, phase three trial when we get the funding. They're still not being like flashed with tons of funding and investment. It's still not getting to that desirable level. But I think the things that changed are several, as I said, they're the culture, but they're also in America legislative. So one is the reversal of Roe v. Wade.

• 22:55Speaker 03

  The Dobbs decision was a massive catalyst and in the interests that men have in, in birth control. And I know this because every organization that I spoke with who's developed, or a company who's developing birth control, told me that the interest they got in clinical trials since Dobbs just skyrocketed. If you no longer have choices to terminate pregnancies, you now live in a society in which two people are responsible for it. And it's easier to hold men accountable in a way that wasn't until too long ago. And so you suddenly have men who... Have shifted.

• 23:37Speaker 03

  I don't wanna necessarily frame it only this way because obviously there's always been men who have been aware and allies and willing to participate in being responsible in their sexual life. But that said, you know, you suddenly have men who see not having birth control, not so much as like, this is not my job and I'm free of a burden, but as I don't have agency. I don't have agency of my own body and my own fertility. Because pregnancy is so much more invasive and, you know, so much more of a burden on the woman than it is on the man. There's a cultural movement which is of much bigger awareness of the challenges that women face through their entire life dealing with fertility.

• 24:21Speaker 03

  And, you know, the side effects, the birth hormonal birth control, it can have, her skin is breaking, she's gaining weight, she feels depressed. And so I've spoken with men who told me, you know, my partner, my girlfriend, my wife has been taking hormonal birth control for a decade. She's tired of it. I think it's my turn. Like, there is that really encouraging willingness to share the burden and to understand that, you know, avoiding a pregnancy, an unwanted pregnancy, it's not just a woman's responsibility, it's a responsibility of both partners. And I think that's an important cultural shift.

• 25:01Speaker 03

  Another thing that I've heard mentioned more than once is that sometimes couples, typically American couples, in connection with the Dobbs decision, both partners want to take birth control at the same time. Both partners, they wanna be that sure that there are no accidents of pregnancies. And, you know, to another data point that can support the impact of the Dobbs decision, there was a survey that was done asking men if they'd be up for taking male birth control. And in some countries, I believe Nigeria, I might be wrong, but I believe it's Nigeria, it was up to like more than 70% men were like, sure, sign me up. In the United States, it was relatively low, it was 39%.

• 25:43Speaker 03

  And then they redid the same survey after the Dobbs decision. And in a matter of a year, I believe it was 49%. I think the men who are open for it are also. Likely in a position to be trusted to do it.

• 25:59Speaker 02

  So what would it really take for these drugs to go from the lab and to the market? Like, are we close?

• 26:06Speaker 03

  Uh, money. And obviously, there's a number of other things. But the money, you know, sufficient, sufficient funding would make sure that there are the next step of trials are done or paid for, and then all the research can be done. Assuming those are successful, then the products can go into the market. And we're relatively close. I believe, you know, the on-demand pill and Adam, it might be a matter of a couple of years. Like, really close.

• 26:33Speaker 02

  Do you think we're really at a moment in reproductive healthcare history? That's the beginning of a new era?

• 26:39Speaker 03

  I hope so. My most hopeful self thinks of this as a cultural counterweight to the political

• 26:54Speaker 03

  sort of rolling back of reproductive health, funding and money and options. It seems to me like this is like a small, but important sort of cultural change. You know, large pharmaceutical companies aren't so interested in investing in reproductive care. And that remains true. It's also true that if the interest and if the market matches what has been studies and surveys, like this is a huge, huge market. We're talking like billions of people. So there is a hope that that too will perhaps then move financial interests, which unfortunately are always at the base of, you know, spreading,

• 27:39Speaker 03

  having more option, having more research, more availability.

• 27:44Speaker 02

  Birth control for people with sperm is just about, almost, but not quite here.

• 27:53Speaker 02

  I was struck by some pretty wild data. Since Roe v. Wade was overturned back in 2022, vasectomies increased by one-fifth in the country, according to a study done in 2023.

• 28:05Speaker 03

  I want to stress how heartening the conversations that I've had with men who participated in the trials have been. Nature is designed the way that it is. There's some things we cannot avoid. People who have uterus get pregnant. The burden will always be on the body that carries the pregnancy. But the level of awareness and willingness to do as much as possible to share the responsibility really struck me, and I found it, again, very hopeful.

• 28:33Speaker 02

  This promise, 80 years in the making, finally seems within reach.

• 28:49Speaker 02

  This episode was produced by me, Amy Padula. It was edited by Joanna Solotaroff, mixing and sound design from Christian Iella and music from Noam Hassenfeld. Melissa Hirsch checked the facts. Jorge Just is our editorial director. The team includes Sally Helm, Meredith Hodnot, Christian Iella, Noam Hassanfeld, and Bird Pinkerton. Got out of the train at 190th Street Station and started walking down the long pedestrian tunnel, looking for any kind of cue. Sun never shines. Shadows run from themselves. And then she heard a beep.

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  As always, thank you to Brian Resnick for co-creating the show with Noam and Bird. If you'd like to support this show and the journalism that Vox does, we would love it if you would become a member. It's really easy to do. Just go to vox.com/members. You'll get access to all of Vox's journalism. And for those of you who have emailed us to let us know that you signed up because of unexplainable, thank you. If you can't join our membership, that's okay. If you wanted to leave us a nice review on your podcast platform, five stars or a written review, we would appreciate it a lot. Or you can tell someone in your life that they should listen to the show. Those things make a real difference. Unexplainable is part of the Vox Media Podcast Network, and we'll be back soon with another

• 30:16Speaker 02

  episode about everything we don't yet know.