The Pill for Men

Men’s contraceptive may be available in the coming years. Will men take it?

By Deborah Jeanne Sergeant

Contraception has largely been dependent upon women — they are the ones who have to come up with barrier methods: spermicidal preparations or hormonal implants, patches, injections, vaginal rings or pills.

But researchers want to change that.

Men’s oral contraceptive — dimethandrolone undecanoate (DMAU) — may be available in the coming years.

“Male contraception is probably the single best thing we can do for women’s contraceptive health,” said Hadley Narins, urologist with AMP Urology in Syracuse. “It’s nice to offer men the same sort of non-permanent but highly effective options women have available and give them more ownership of their reproductive rights.”

The Journal of Clinical Endocrinology and Metabolism recently published research indicating that initial tests involving a small population — 100 men aged 18 to 50 — for 28 days indicate no serious adverse events and the medication was “well tolerated.”

Eighty-two of the men completed the double-blind, randomized, placebo-controlled study.

DMAU suppresses testosterone in men’s testicles so their sperm do not develop. That impedes their ability to impregnate women.

“In a committed relationship where they’re not ready for a vasectomy and there’s no desire of using condoms and the woman doesn’t tolerate birth control, the onus isn’t all on women,” Narins said.

Beyond safety and efficacy, the successful use of DMAU also lies in compliance: will men take a daily pill that decreases testosterone, the main hormone that makes men masculine?

Physician James Greenwald, professor of family medicine at Upstate Medical University, isn’t sure.

“The side effects are going to be somewhat of an issue,” Greenwald said. “It’s going to be surprising to me if there are any men using this who are in a stable relationship. Different side effects like weight gain, perhaps transient loss of libido and changes in cholesterol would make it a concern, especially for people who are on it long-term.”

Though women’s oral contraception has been known for decades to cause weight gain, increased risk of stroke (particularly to those over 35 and smokers), and other negative side effects, it’s still the most popular means of contraception. About 25% of women who use contraception of any kind use the pill. The next closest reversible contraception method is the male condom (14.6%), followed by the intrauterine device (11.8%).

Greenwald suspects that the greatest interest would be men who want to delay fatherhood and those women who cannot tolerate hormone-based contraceptives.

Men taking medication like DMAU could relieve women from the risks of taking hormonal contraception. Not all women are good candidates for contraceptive medication or devices, and some couples don’t prefer spermicide or condoms.

Men would also gain more control over their paternity, since they don’t have to rely on their partner’s ability to remember to take a pill, use spermicide correctly or keep her other contraceptive delivery method up-to-date.

“As it is now, men must accept the word of their partners that they are practicing contraception,” said urologist David Gentile, with University of Rochester Medical Center.

“If there are any trust issues within a given relationship, this might prove reassuring to men,” he added.

Controlling conception can help new husbands delay starting a family, for example, even if their wives are more inclined to have a baby right away. Gentile thinks medication like DMAU can affect other age groups.

“It is not uncommon for me to see older men, perhaps divorced or widowed, who are very leery of establishing a new relationship because of fear of an unwanted pregnancy,” he said. “This would theoretically relieve that.”

Without having to use condoms, men could experience greater sexual spontaneity and, if they dislike condoms, more enjoyment. Men can delay paternity without canceling it altogether, as with vasectomy, which is permanent sterilization.

Gentile isn’t sure that men will view the man pill’s advantages as outweighing its side effects. He said that the research so far claims DMAU reduces testosterone without association with typical symptoms of low testosterone, such as low libido, erectile dysfunction, depression, and fatigue. Its effects are also reversible, unlike vasectomy.

“However I’d be concerned about the impact on cholesterol and the impact on bone health, reflected by bone mineral density,” he said. “I also find it hard to believe that there would not be strong objection by men to the almost certain emotional liability that would likely result from such low testosterone levels. Results at the gym will also be lacking, to which men would certainly voice objection.”

“On the whole I would not envision this drug taking off like the Viagras and Cialises of the world,” Gentile added.