
The male contraceptive pill could help men and women in heterosexual relationships take equal responsibility for contraception. PHOTO/COURTESY/NPR
For decades, the responsibility of contraception has primarily fallen on women, who often endure the side effects of various contraceptive methods. The limited availability and reliability of male contraceptive options have perpetuated this imbalance, leaving many women yearning for science to develop effective alternatives for men.
Existing male methods such as condoms, coitus interruptus, abstinence, and vasectomy are either temporary with limitations or permanent with associated stigmatization.
Efforts to develop male contraceptives, including hormonal pills and injections, have faced significant challenges. Dr Vincent Karuhanga, a general medical practitioner, says trials are underway to create a male birth control pill designed to block sperm release and prevent unwanted pregnancies.
However, these trials have encountered setbacks due to severe side effects. For instance, hormone injections involving progesterone and a form of testosterone were abandoned after men experienced acne, libido changes, and mood disorders.
Alternative methods
Dr Karuhanga highlights historical alternatives such as papaya seeds, used in Asia by both men and women as a temporary contraceptive method.
Additionally, certain drugs originally developed for treating prostate issues and blood pressure, such as Tamsulosin, Silodosin, and Nifedipine, have shown potential as male contraceptives.
For example, amsulosin and Silodosin can cause retrograde ejaculation or prevent semen release without affecting orgasm. However, these methods come with psychosexual side effects, including performance anxiety and erectile dysfunction.
Nifedipine, a blood pressure drug, has been found to impair sperm motility temporarily,rendering men sterile while on the medication.
However, experts such as Dr Milton Awundo, the director of technical services at Marie Stopes Uganda, caution against using these drugs for contraception due to potential long-term health risks.
Complexity
Dr Awundo says creating a male contraceptive pill is complex. Most female contraceptives work by suppressing ovulation, targeting the reproductive hormones. For men, a contraceptive would need to act on testosterone, the primary male hormone, and directly affect the testes, where sperm is produced. This could involve reducing sperm quantity or quality.
However, any such intervention must be reversible, allowing normal sperm production to resume once the contraceptive is discontinued. Current trials have struggled with these requirements, as some methods have resulted in long-term hormonal disruptions and impaired sperm quality.
Socio-economic perspectives
Dr Franklin Wasswa from Entebbe Hospital provides a socio-economic perspective on male contraceptives. He argues that even if an effective and safe male contraceptive is developed, its adoption might be limited due to a lack of incentive. He cites the Clean Sheet Pill, a non-hormonal contraceptive developed by the Parsemus Foundation, as an example.
Designed to block ejaculation, the pill failed to gain traction because many men saw little benefit in using it, given that they do not bear the physical burden of pregnancy.
In surveys, 30 percent of men stated they would never take such a pill. Dr Wasswa attributes this to the absence of strong child support laws in countries such as Uganda, which might otherwise compel men to share in reproductive responsibility.
Gender and family planning
Dr Wasswa emphasises that women have no choice but to take charge of contraception, as they bear the physical and social burdens of pregnancy and child-rearing. He points out that female contraceptives can target multiple reproductive hormones, making their design relatively straightforward.
In contrast, male contraceptives must act on testosterone, risking significant side effects like reduced bone density, muscle mass, and mental well-being.
Shared responsibility
Despite these challenges, Dr Awundo believes that family planning should be a shared responsibility between men and women. He notes that many Ugandan men have negative attitudes toward family planning and often leave the responsibility to women.
This reluctance extends even to using condoms, which remain one of the most accessible male contraceptive methods. Vasectomy, another reliable option, is stigmatised and often misconstrued as castration. As a result, men who opt for vasectomy often do so secretly.
Dr Awundo shares an example of a young man, 27, who had 14 children with multiple partners and two more on the way.
This man eventually opted for a vasectomy, illustrating that age and circumstances increasingly influence family planning decisions.
Dr Awundo encourages more men to consider vasectomy as a viable option, emphasising its reliability and safety. While science continues to grapple with the complexities of male contraceptives, the path forward requires both medical and societal shifts. Developing a reliable, reversible, and minimally invasive male contraceptive could transform family planning dynamics.
However, changing societal attitudes and addressing gender inequities in reproductive health are equally crucial. Until these advancements materialise, the burden of contraception remains disproportionately on women, underscoring the importance of ongoing conversations around shared responsibility in family planning.
Clinical trials
A 2019 clinical trial assesseda male birth control pill, which passed the first round of safety and tolerability tests.
Hormone testing suggested the drug lowered certain hormones, including testosterone, which reduces fertility. Another
2019 study found an injectable mixture of hormones could reduce sperm motility and clog the vas deferens. While no male birth control pill is available on the market, one might become available in the coming years.