Problem page – Male contraceptive pill

Dr Margaret answers emailers’ embarrassing problems
in this monthly problem page.

Male contraceptive pill

Dear Dr Margaret
When will there be a contraceptive pill for men?

I don’t know for certain when there will be a male contraceptive pill, but a lot of research is going on. The female contraceptive pill contains hormones that can be taken by mouth. For men, the research is focusing on hormones given by injection, in the form of patches or implants, as well as a pill that is swallowed. If all goes well, some type of male hormonal contraception might be available in about 5 years time.

Research so far
Last year, scientists in Australia reported the results of a trial of a male hormonal contraceptive in 55 men. The men received an injection of progestogen hormone every 3 months. This hormone turns off the normal signals that control sperm production. However, it also switches off production of testosterone (the normal male hormone), causing loss of interest in sex. There is no point in trying out a contraceptive in men if they have no interest in sex so, to prevent this happening, the men were also given an implant of testosterone (the male hormone) every 4 or 6 months.

Within 3 months, the men stopped producing sperm and, over the following year, none of their partners became pregnant even though they were not using any other form of contraception. At the end of the study, when they were no longer given the hormones, the men started to produce sperm again after an interval of about 3–4 months.
These results are very encouraging. The medication seemed to work as a contraceptive, and was also reversible.

A bigger study, involving 350 men, is now being carried out in several countries. In the UK, 40 men will be taking part and the research will be done at the Royal Free Hospital in London. This study is using slightly different hormones – an implant of progestogen with testosterone injections.

Disadvantages
With any new medication, side-effects are always a worry. So far, possible side-effects seem to be weight gain, acne and sweating. Some men also experienced changes in sexual desire and depression. The researchers believe these effects are mainly related to the testosterone, so they may try to adjust the dose of testosterone to reduce them. Another disadvantage of this type of contraception is that, unlike condoms, it does not give any protection against sexually transmitted infections.

Women’s views
A total of 1,894 women attending family planning clinics in Scotland, South Africa and China were asked whether they liked the idea of a male pill; 60% thought that women have to bear too much responsibility for contraception at present; 87% thought the male pill is a good idea; and only 2% said they would not trust their partner to take it.

Men’s views
A male contraceptive pill is no use if men won’t take it. According to the results of a survey of men in Scotland, South Africa and China, most would welcome it. They said they would prefer a pill to an injection type of contraception.

Sources of information
Bouloux. P-M. Birth of the male pill? Hospital Doctor 2004;17 June:27–8.

Glasier AF et al. Would women trust their partners to use a male pill? Human Reproduction 2000;15:646–9.

Grimes D et al. Steroid hormones for contraception in men. Cochrane Database Systematic Reviews 2004(3):CD004316.

Martin CW et al. Potential impact of hormonal male contraception: cross-cultural implications for development of novel preparations. Human Reproduction 2000;15:637–45.

Turner L et al. Contraceptive efficacy of a depot progestin and androgen combination in men. Journal of Clinical Endocrinology and Metabolism 2003;88(10):4659–67.