A contraceptive revolution

In 1961, the female contraceptive pill was introduced to British women by the NHS. While this has proven to be a reliable and convenient oral contraceptive method, scientists have now turned their attention to producing a male contraceptive method of the same success.

When I was studying History of Medicine for my GCSEs, we were divided into groups and asked to rank the significance of various medical achievements, including the contraceptive pill. While the group of girls ranked the pill as one of medicine’s most important achievements, groups of boys (including myself) didn’t yet understand why our colleagues ranked it so highly. As well as revealing our ignorance of women’s issues, it reflects how the burden of contraception has thus far fallen largely on women. Though male contraceptive options do exist, they pale in comparison. Condoms are unpopular, and not entirely effective, and withdrawal attempts are even less reliable. Vasectomy is your best bet for successful results, but has the slight catch of being permanent. Consequently, there’s been significant interest in finding a male analogue to the pill.

 The burden of contraception has thus far fallen largely on women

In an ironic twist, ultrasound has been suggested as a contraceptive method. Instead of developing a picture of a foetus, ultrasound would target the testes to stop sperm production. The idea was first proposed in the 1970s, and gained traction in 2012 as experiments showed it to be an effective rat contraceptive. However, subsequent primate and human experiments proved to be ineffective, as contraceptive effects wore off after around two months. Combined with fears of ultrasound inducing permanent infertility, its use was shelved indefinitely.
Attention shifted as more promise was being yielded from a ‘contraceptive jab’ which was being pedestalled as the figurehead for a male contraceptive revolution. The jab consists of two hormone injections taken every two months; a long-acting progestogen that stops sperm production by acting on the pituitary gland, and a testosterone injection to counter the side effects of taking progestogen (due to progestogen reducing testosterone levels).

In 2016, results of a Phase II study consisting of 320 men were published. It stated that it was 98.4% effective in preventing pregnancy, and that over 75% of those men would continue using the contraceptive. An unquestioned success, right? Not so much. In the trial, 45.9% of men developed acne, around 20% reported mood disorders, and the sperm count of 5% of men didn’t recover to pre-trial levels after a year. Overall, 20 men dropped out of the trial, prematurely bringing it to a grinding halt. Despite ostensibly positive results, sperm biologist Professor Allan Pacey of the University of Sheffield commented that, “it has to be well tolerated and not cause further problems. For me, this is the major concern of this study”. It wasn’t enough to simply be effective, it had to be user-friendly.

It wasn’t enough to be effective, it had to be user-friendly

As a response to these issues, a gel was developed using the same hormones, but that is instead rubbed on the upper arm and shoulder daily. Each gel application would be effective for three days, and by adding more staggered hormone treatments, it would allow for testosterone to remain circulating in the blood longer than the bulk of bimonthly injections that quickly leave the body. Interestingly, this was picked as The Boar’s potential 2018 science breakthrough, as the trial will hopefully begin this year.

However, like with most things in life, the pill has a nuanced legacy. The power of giving women reproductive autonomy shouldn’t be scoffed at, just as an indignant 15-year-old me did. Having the ability to control when they give birth helped women to take control of their sexuality, and their lives. Whilst it is disingenuous to make similarly lofty claims for men, there’s no denying the potential for improved contraception to enable men to better control when they have a family.

But the pill isn’t perfect. A marked disparity exists between a 0.3% failure when it’s ‘perfectly used’, and a ‘normal usage’ failure of 9%; it’s easy to skip, forget, or even lose access to taking regular doses. Additionally, the pill has a considerable list of potential side effects including period pain, weight gain, mood swings, and migraines. A male contraceptive would at least allow couples to share this burden, and possibly even negate the side effects entirely due to the emphasis of developing male contraception that doesn’t have such extreme side effects. Having contraceptive treatment, consequence free, would truly be revolutionary.