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The male contraceptive pill
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There's a whole gamut of pills and devices to help women control their fertility, so what's being done to give men a bit more choice? One possibility is a pill.
Men's choices
At the moment about all that's available to men in the way of contraception is either the condom or the more drastic step of vasectomy. The third option is the rather unpopular technique of abstinence, which has never been a favourite among my male patients.
The contraceptive pill revolutionised life for women in the 1960s and is now used by millions of women around the world. But what about a pill for men? The answer is that plenty of researchers are racing to develop a male pill (it's a potentially lucrative business), but so far there's nothing like it in general use.
Hormone treatments
Early attempts to develop a male pill were based on using testosterone
Most of the early attempts to develop a male pill were based on using testosterone to trick the brain into turning off sperm production. But this hasn't been as successful as the female pill is in switching off ovulation. Results have been sketchy, and hormone treatment has proved ineffective in as many as one in five men.
More recent research has been based on the finding that another hormone also controls sperm production. This hormone is prolactin. It's familiar to women because it controls the production of breast milk, but it's also produced by men.
To act as a contraceptive, tablets that inhibit the production of prolactin must be taken every day along with injections or implants of testosterone - quite a commitment for young men, who are notoriously less reliable than women about taking medication.
Injections and patches
Other combinations have also been looked at, such as weekly injections of testosterone and daily progestogen pills. It may be possible to give the testosterone component using a skin patch instead of an injection.
Research in Manchester has combined desogestrel (also used in female contraceptives) and patches of testosterone. The desogestrel stops the production of testosterone in the testes, so stopping sperm production, while the testosterone patch provides the needed testosterone to the rest of the body (without this men would lose their facial hair and could develop breasts). However, the success rates in men who took the hormone combination were only around 60 per cent.
Side effects
All drugs have some potential side effects
All drugs have some potential side effects, and these have been a particular problem for hormone-based male contraceptives. It's hoped that by combining hormones, side effects of testosterone such as prostate problems, nausea, jaundice and headaches may be reduced. Another challenge is ensuring the effect is temporary or reversible.
A different approach
Scientists are also looking at different ways to stop sperm production. Two of many techniques being studied, but still in their very early stages, include disrupting protein signals between the cells that make sperm and stopping sperm being ejaculated out of the testis.
Would men want to take a pill?
Many women, used to bearing the brunt of decisions about contraception, may be a bit cynical about men's interest in taking a contraceptive pill. But in an international survey, two-thirds of men questioned said they would use the pill if it were available - and nearly all women trusted their partners to take it.
How far off is the male pill?
The biggest problem facing scientists at the moment is developing a male contraceptive that can be expected to work in every man all of the time. It's not good enough to reduce sperm counts from the normal levels of several million down to just a few - one sperm is all that's needed to create a new life.
Shortage of takers
A trial of the combination male contraceptive in the UK ran into problems when they couldn't find enough men to volunteer.
In 2003, researchers in Australia carried out a limited trial of a combination contraceptive that was 100 per cent effective and free of unacceptable side effects. Importantly, it was also reversible - normal fertility levels returned within a few months of stopping the treatment.
More recently, US and Italian researchers have been testing a way of preventing sperm from developing and maturing properly so that fertility is temporarily lost.
The word 'pill' is a misnomer as this form of contraceptive combines a testosterone implant and a three-monthly injection of progestin, a hormone used in female contraceptive pills. However, it's likely to be a long time before this treatment comes out of the research stage and into the chemists.
It's been estimated that there will be a commercially available male pill within the next few years. However, people were saying that ten years ago. Right now, there's nothing for men that's anywhere near as simple as the contraceptive pill for women.
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