Editorโs Note: This story originally appeared in Volume 5 of B.H. Magazine. To get your copy (and access to future issues), subscribe here.
It began with a love of hormones. As a physiologist, Professor Robert McLachlan was fascinated by them. And when you consider that men produce a thousand sperm per second, the concept of a hormonal male contraceptive proved a complex challenge worthy of pursuit.
Early studies in the 70s had focused on testosterone shots, but the dose was too high and some men had no libido. So, to keep them happy, healthy, and horny, they added progesterone โ it was a winning combination.
McLachlan conducted trials. He looked at implants of testosterone and DMPA, a long-acting progesterone used in women that provided them with 12 weeks of protection against pregnancy. The results were encouraging. His expertise was then enlisted in a major international study sponsored by the World Health Organisation (WHO) in 2011. Instead of an implant, they trialled an injection.
Every eight weeks, more than 300 men in monogamous relationships around the world received a shot of testosterone and progesterone. For 95% of participants, the combination worked to suppress sperm counts incredibly well. The hormonal contraceptive was proving to be effective, autonomous, and reversible once stopped. The science was robust, and the issue of a male hormonal contraceptive largely solved. But then some men began reporting symptoms.
There were mood changes, even increased libido. Some experienced acne, others gained a little weight. One man in the group became suicidal. 75% of the men wanted to continue, knowing the drug worked and they could finally shoulder the burden of contraception for their partners. But WHO smelt a risk. They shut the trial down and pulled funding, panicked by the idea that healthy men could report depression as a side effect.
The researchers rallied. Any of the symptoms could happen to normal menโฆ how could the drug be to blame? But it was too late. Pharmaceutical companies followed the path of WHO, erased from view like ten-pins cleared from the lane. The death knell on male contraceptives had sounded.
Over a decade since the collapse of the industry, McLachlanโs optimism in male contraceptives has all but faded. โYouโre writing a very sad story,โ he admits over the phone. โThis doesnโt have a happy ending.โ Mention โnovel male contraceptivesโ to some and theyโll conjure images of science fiction. For most people, though, itโs not a question of โwhatโ but โwhen.โ In 2025, shouldnโt such a thing exist already?
To understand the long-standing struggle to develop male contraceptives, you first have to understand the science. When it comes to male birth control, research is largely split between hormonal methods and non-hormonal developments that block sperm production, sperm transmission, or sperm function.
Hormonal methods have been in development since the 1960s. Much like the female pill, they work by giving men the hormones required for fertility โ namely, testosterone. These synthetic hormones enter the bloodstream and trick the body into thinking itโs producing too much sperm. The result? The brain sends a message to the testes to turn off and stop making sperm.
Granted, men need a lot more hormones. A woman might make 50 micrograms of oestrogen a day compared to a manโs 6,000 micrograms of testosterone. The reproductive physiology is different, but thatโs not to say a hormonal male contraceptive is impossible. Rather, the regulatory bars it would be expected to pass are too high. As Professor McLachlan explains, โIf you came to me with a female [contraceptive] pill now, you couldnโt get it past the gates.โ
And herein lies the challenge: if youโre not treating a disease, how then do you calculate risk? And in the minds of pharmaceutical companies, why would healthy men tolerate side effects?
To give male contraceptives a winning shot, researchers are proposing a new lens to view the concept of risk. Rather than assess it against the individual, risk should be viewed in relation to the couple. Dr John Amory, a professor of medicine at the University of Washington and key researcher in the field of male contraception, worked with bioethicist Dr Gina Campelia to propose such a view. โIโve heard it said that if one guy dies, then you havenโt got a product and thatโs not really right,โ says Amory. โWomen die from their birth control. Thankfully rarely, but the risk is about four per million.โ He argues that if the risk of a male contraceptive is less than four deaths per million, youโre then reducing the risk for the couple.
Even outside the realm of side effects, the benefit to the couple by introducing male contraceptives is impossible to ignore. โI donโt buy into this argument of, โOh, well men arenโt the ones getting pregnant so therefore they canโt be subjected to side effects.โ I think thatโs ridiculous, because they are impacted,โ says Dr Liza OโDonnell, senior research scientist at the Hudson Institute of Medical Research.
In Australia, unplanned pregnancy remains a public health issue.
A 2022 report from womenโs healthcare company, Organon, found 40% of all pregnancies are unintended and accrue an average cost of $36,384. Aside from the economic benefits that come with ensuring all pregnancies are planned and people have the spacing they want, data suggests men are twice as likely to report mental health problems like depression in the setting of unplanned pregnancy. By making an impact on unplanned pregnancy, male contraceptives ultimately impact the health โ both economic and mental โ of the whole family.
Heather Vahdat spent much of her career travelling around India and Kenya, bringing contraceptive options to women in need. Working for the not-for-profit FHI 360, she kept hearing the same response no matter which country she found herself in: โWhat about male methods?โ
It was only some time earlier that male contraceptives had even entered Vahdatโs radar. Then, an investigator with FHI 360, Dr David Sokal, mentioned trying to raise interest and funding for their research. Vahdatโs reaction was one of shock. Wasnโt contraception a female-only thing? And if such a thing were to exist, would women even trust men to use it?
Her doubts were a by-product of her own work experience. The women Vahdat served were in inequitable relationships and often the contraceptives provided were those that could be hidden from their partners. โWe were so myopically focused on that, it was almost like men were the bad guys,โ recalls Vahdat. โIt was not intentional, but we would distil men down to the lowest common denominator.โ
It wasnโt until she found herself in a slum in Delhi, talking to a family about their reproductive health, that Vahdatโs view changed completely. โThe husband is being quiet and he just looked over and said, โI wish there was something I could take so she didnโt have to have the side effects.โ I was like, โSir, you are this archetype we, the global health sector, assumed wouldnโt be supportive or interested.โโ
Now working as the executive director of the Male Contraceptive Initiative (MCI) โ a not-for-profit started in 2014 to advocate for greater choice and provide funding for international research on non-hormonal male options โ Vahdat knows raising public awareness for these methods is as big a challenge as the issue of funding.
To look at history is to see contraception being the burden of women.
In China, there are records of people drinking liquid mercury to make their uterus uninhabitable. In ancient Egypt, women made a paste from crocodile dung and honey that they inserted into the vagina before sex, hoping it would block sperm (yikes). The argument has long been made that thereโs simply no market for male contraceptives: effective female methods already exist, and men arenโt willing to share the responsibility of birth control. But at a time where womenโs reproductive freedoms are under threat around the world, contraception is an issue of global importance โ and men want to be included.
The fact that pharmaceutical companies believed there wasnโt a market for male contraceptives is laughable. A 2024 study conducted by Steve Kretschmer found a high demand amongst men, with 61% expressing interest in trying novel male contraceptives. Women also demonstrated a high level of trust in their male partnerโs use of contraceptives to protect them from pregnancy. โThe numbers are ridiculous,โ says Dr Amory. โThereโs four billion men on this planet. Even if half of them are of reproductive age and have a partner who is, thatโs two billion men. Tell me of a bigger market?โ
After the Dobbs Supreme Court decision to overturn Roe v. Wade in 2022, effectively removing the constitutional right to abortion in the United States, the demand for male birth control was even greater. As Dr Stephanie Page, a professor of medicine at the University of Washington and principal investigator in the trial of male hormone-based gel NES/T, explains: โWe had an uptick in recruitment in men coming in saying they just wanted to do something; they wanted to help, they wanted to be part of the solution, they wanted to protect their partners.โ
The decision even led to an 850% increase in searches for โwhere can I get a vasectomy?โ โWe underestimate men if we donโt think thereโs a significant number out there who actually want to be part of the solution,โ says Dr Page.
Itโs a long-standing joke amongst researchers that male contraceptives have been five years away for the last 50 years. Despite advancements in science and technology, the goalposts keep shifting โ more regulations, greater need for transparency, astronomical costs. But if it all suggests a male contraceptive is simply too difficult to bring to market, the overwhelming tone is one of optimism. โOur job is to create a technology thatโs so compelling that pharmaceutical companies are hitting each other over the head to try and get it,โ Dr Amory explains.
In the 1960s, his grand mentor treated a bunch of men with a compound called WIN 18.446 that was found to greatly suppress sperm production. The only drawback was that men couldnโt drink when they took it as it made them violently ill. It led Dr Amory to work on developing retinoic acid biosynthesis inhibitors that donโt interfere with alcohol metabolism, allowing men to drink while on it. Dr Amory sees it coming to market in the form of a daily pill that takes three months to kick in and three months to recover from (i.e. get sperm counts back up). โBut it wouldnโt affect hormones, which I think is key towards acceptability,โ he says. โA lot of those side effects are from hormonal changes. In this instance, youโre basically not interfering with hormones.โ
Other developments are also looking promising. In Melbourne, a hydrogel-based contraceptive known as ADAM is being billed as the โno scalpel vasectomy.โ Itโs inserted into the vas deferens, where it then hardens to prevent sperm from getting through before dissolving on its own in roughly two years, making it a long-lasting option. Then there is Dr Page, who is working on NES/T, a hormonal gel thatโs rubbed into a manโs shoulders or arms daily. Itโs based on a combination of testosterone and a progestin called nesterone. Unlike most methods that require men to visit a clinic, the gel is self-applied in the comfort of their own home.
Having just completed a phase-two trial, Dr Page is confident in the method. โThere are some men who, for whatever reason, donโt like the smell or donโt like the way it feels on their skin, but itโs a very small number,โ says Dr Page. โMost of the men are satisfied and for those who finish the study, a lot have lamented the fact they canโt continue to use it. The women are probably even more excited, frankly, because itโs just so nice to feel they donโt have to be doing whatever they were doing before.โ The key now is securing enough funding for the pivotal phase-three study.
With researchers all working on various methods in the race to see male birth control hit the market, youโd imagine the space to be a competitive one. But as men will learn, contraceptives are a highly unique experience and the need for choice is crucial to personal satisfaction. โItโs not going to be for everyone,โ Dr Page explains. โBut that doesnโt mean itโs not going to be for anybody. Thatโs the way I think about it: we just need to have a whole menu of different choices for men like we do for women, and that will really engage men in contraception which is something we so badly need.โ
American biologist and โfather of the pill,โ Gregory Pincus, believed a male version of the contraceptive is inevitable. But before such a thing could be developed, Pincus claimed it would first need to overcome โthe attitude of men.โ Today, men donโt want to be the forgotten half of contraception. โItโs an issue of menโs reproductive rights,โ says Dr OโDonnell. โThey should have the choice to be able to control their own fertility.โ
If youโve enjoyed this feature on male contraceptives, consider a few more of our favourite stories โ direct from the pages of B.H. Magazine:
- Pumped Up & Dangerous: The Hidden Epidemic Of Steroid Abuse
- Run Clubs Are No Longer About Chasing Pace โ Theyโre About Chasing Connection
- Man At Work: A Conversation With Alexander Volkanovski
- The Island That Ruined Me: Three Unforgettable Days In Kokomo
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