Delivering a new birth control option to men
The concept of a male contraceptive agent is attractive. Gunda Georg, head of the department of medicinal chemistry at the University of Minesota, has pioneered work with Ouabain, a heart stopping poison to target the testicular cells and control the production of Testosterone.
Men must love a company like Searle & Co which has championed the production of birth control pill. This company was the first one to be approved by the FDA to manufacture such product for the last 50 years and essentially this has allowed women to control their reproductive system.
Today more than 10 million women are using the pill as a form of protection and it is fair to state that 80% of all women has used it at some point in their life.
This ability to prevent pregnancy has given women a greater sexual freedom, allowing them to pursue their education and careers before the start of a family.
Men has also enjoyed more freedom in using condoms at time and ultimately a vasectomy as a more definitive procedure. None of the methods are absolute. Condoms have shown a failure rate of 2 to 10 %. Vasectomy may be near 100 % safe but not too many young men are willing to undergo such operation.
If men have limited options, women have enjoyed pills, patches, intra-uterine devices, and given the success of these hormonal base methods, it became natural to explore the same concept on a male contraceptive product.
A combination of synthetic hormones including Testosterone can convince the brain that there is sufficient and free circulating hormone in the blood stream to stop the testes from producing more. Keeping a minute dose intake of the hormone on a daily basis, will stop the production of sperm in the testes.
In a few months the man taking such medication will be unable to produce enough sperm and fertilize an egg. On the other side, if he stops taking the pill within a few months, the reversal effect will allow him to produce again the hormone regularly.
In the USA, 420 Volunteers couples have been chosen to have the men apply a gel of Testosterone and a synthetic sex hormone Progestine over their shoulders. In other studies outside of the USA, a contraceptive presented as a pill or as an injection could give men a wider choice. Unfortunately, the pill or the injection will fail to work for 2 on 10 men, a little like the condom.
With the use of Progesterone, a multitude of unpleasant side effects mimicking puberty like symptoms with mood swings and behavior changes, weight gain, acne, can be undesirable. Unfortunately, many of the cocktails prescribed contain Progestin.
A large study on the contraceptive was sponsored by the World Health Organization (WHO) in 2016 with early results showing the component working well. 96 % of the participants experienced a sperm count decrease and only 4 of the men participating found their wife pregnant, exhibiting a failure rate of 2 %.
In other countries, male contenders were submitted to a variety of techniques for sterilization going from a permanent and “traditional vasectomy” to a transient ”Vas deferent blockage” using different products like a polymer gel, RISUG, ECHO-VR but none of the VAS Deferent blockage have been used in the USA.
Finally targeting the Testes, by shutting down the testosterone production, or by using a non hormonal compound that could suppress the sperm production in the testes or using Ouabain which targets the cellular process in immobilizing the sperm. These 3 procedures are expecting FDA approval.
Testosterone has been used in contraceptives for women but has never been approved for males. The WHO study was shut down prematurely because the men experienced what the researcher Doug Colvard at CONRAD, a reproductive health non-profit organization in Arlington VA, described as emotional disorder, mainly characterized by agitation. In other similar groups some participants attempted suicide.
Potential contraceptives programs will need to be tested for long term effectiveness. We wish one day that man will be able to take advantage of a pill like any woman and perform in sexual activities without any risk of pregnancy.
May our kids benefit from such discovery.
Maxime Coles MD
1- Multinational male contraceptive study WHO. 2016
2- Journal of Medicinal Chemistry. Jan 2018
2- Discover Magazine. May 2018