LA LIBRE | Has the time for revolution arrived for male contraception?
ORIGINALLY POSTED ON: LA LIBRE
Long limited to condoms and vasectomy, male contraception could soon be enriched with new options. Several methods are now in advanced clinical trials, paving the way for a more balanced sharing of responsibilities between men and women.
For decades, male contraceptive treatments were almost the stuff of science fiction. But recently, several methods have reached a key milestone: Phase 2 of human clinical trials. Hormonal gel, reversible injection, non-hormonal pill… These are all avenues that could, in the medium term, revolutionize the balance of responsibility regarding contraception.
An unfinished revolution
Modern contraception underwent a major transformation in the 1960s with the arrival of the female pill. For the first time, women had an effective means of controlling their fertility, with immense social consequences: greater personal autonomy, easier access to education and employment, and a transformation of gender relations. Since then, the options have multiplied: IUDs, implants, patches, vaginal rings… Conversely, for men, the landscape has remained stagnant, with no major innovations in over sixty years.
“For more than half a century, female contraception was considered a sufficient solution, almost a panacea,” observes Dr. Darlene Walley, CEO of NEXT Life Sciences, a California-based company that develops male contraceptive methods. “But today, we realize that the side effects are far from negligible,” she adds.
Why do women bear the brunt of the burden?
This imbalance is not only technical, it is also historical and social. The pill was conceived as a tool for female emancipation, but it has also, de facto, shifted the responsibility for contraception onto women.
As a result, it is mostly women who bear the brunt of the constraints, including the sometimes severe side effects of hormonal contraceptives. But a change is taking place. “Young men today want to participate in family planning,” emphasizes Darlene Walley. “They see their partners suffering from the side effects, and currently they only have two unsatisfactory options: condoms, with a significant failure rate, or vasectomy, the reversibility of which is far from certain: it is long, expensive, and only successful about half the time.”
Akash Bakshi, CEO of YourChoice Therapeutics, another American company also working on male contraception, confirms: “A large majority of both men and women now believe that contraception should be a shared responsibility.”
Are the men ready to get involved?
One of the arguments often put forward is behavioral: men are supposedly unreliable in this area. But the data paints a different picture. Studies converge and suggest that the majority of men would be willing to try a new method. A large international survey of nearly 19,000 men in several countries shows that more than three-quarters of them say they are ready to use a contraceptive pill.
On the ground, the interest already seems tangible. “We have received tens of thousands of requests from men wishing to participate in our clinical trials or to be informed of the availability of these products,” explains Darlene Walley.
On the women’s side, according to the same study, trust is also high: more than 80% say they trust their partner to use contraception correctly. “A male pill also offers a form of psychological security: it allows men to know that they themselves have taken action to avoid an unwanted pregnancy,” says Akash Bakshi.
Promising avenues, but considerable challenges
While the company seems ready, the challenge remains scientific. “We’re not talking about acting on one or two eggs per month, but on millions of sperm produced continuously throughout life or almost. The biological challenge is totally different and very complicated to address,” explains Nadja Mannowetz, scientific director of YourChoice Therapeutics.
Research is exploring several strategies. The first involves blocking sperm production through hormonal treatments. However, the side effects observed in women undergoing hormonal treatments raise concerns. Another approach relies on mechanical methods, physically preventing sperm from being released.
It is in this category that one of the most advanced candidates falls. This contraceptive relies on the injection of a hydrogel into the vas deferens, acting as a filter. “The gel blocks sperm but allows other fluids to pass through. And above all, the procedure is reversible,” explains Darlene Walley. Unlike a vasectomy, the procedure is quick and minimally invasive. “Everything is done in an hour, without a scalpel or needles, under local anesthesia applied to the skin.”
A radically different approach is also under development: an on-demand pill, taken before sexual intercourse, which temporarily prevents ejaculation without altering the pleasure and sensations of orgasm. “The idea is to offer different options, as is already the case for women,” explains Darlene Walley. “Some will prefer a long-term solution, others a one-off approach.”
Other teams are working on non-hormonal pills that directly target sperm production. YourChoice Therapeutics’ pill is based on a small molecule administered orally. “Our molecule blocks a receptor essential for triggering sperm production,” explains Nadja Mannowetz. “In humans, we observe an effect after two to three months, and fertility returns within a similar timeframe after stopping treatment,” she specifies. And unlike hormonal approaches, this strategy does not interfere with testosterone and directly targets the cellular mechanisms of male fertility.
Regulatory and societal obstacles
But even if clinical trials of these male contraceptives prove conclusive, numerous obstacles to their market launch remain. The main one is regulatory: health authorities evaluate contraceptives based on the benefit-risk ratio for the user. However, unlike women, men are not exposed to the medical risks of pregnancy, which makes the acceptability of side effects much more stringent. Added to this are challenges related to adherence, and a persistent fear that these treatments could induce irreversible infertility. Thus, even the most optimistic scenarios predict their commercialization for several years. If the ongoing trials confirm their efficacy and safety, it seems unlikely that these new male contraceptives will arrive in Belgium before the end of the decade.
While the challenge remains scientific and regulatory, the overall issue is primarily societal. Offering men reliable, reversible, and acceptable options could profoundly transform the dynamics of contraception, not by replacing existing methods, but by expanding the range of choices. It remains to be seen how this balance will evolve. “We are on the cusp of profound change. For the first time, men will have real options. And this could finally allow us to share the burden of contraception,” concludes Darlene Walley.