As of 2021, there are only really two birth control options for men: condoms and vasectomies. Neither are great options. Condoms are unreliable, with a high recorded failure rate, and vasectomies are invasive and not always reversible (though there is a 95% successful reversal rate for operations done within 10 years of the first snip). Luckily, there are multiple new hormonal and surgical contraceptive methods for men currently in development. Here are a few of the coolest.
RISUG stands for Reversible Inhibition of Sperm Under Guidance. It’s a treatment that’s been under development in India for decades. The RISUG procedure involves the injection of a long acting substance into the vas deferens (the tube that carries sperm out of the testes). That one injection stops sperm from traveling through the vas deferens from ten to fifteen years, with a 98% efficacy rate (that’s more than condoms, in reality). There are no major side effects, and most impressively, if circumstances change, you can get another shot which reverses the effects. The product is not yet available, however, as long-term studies have not been done.
Transdermal gel-based hormonal contraceptive methods are also being studied, and have so far been shown to be fairly effective and popular. In 2014, one study of a method which used a combination of testosterone and Nestorone found that the majority of men were satisfied or extremely satisfied with the method, and would recommend it. The combination of testosterone and Nestorone reduced sperm counts to less than 1 million/ml in 88.5% of men (the normal count in healthy men is above 15 million/ml). This method does not offer complete protection, but the convenience and reversibility makes it a good option in combination with other treatments.
Two different hormonal oral contraceptives, Dimethandrolone undecanoate and 11β-methyl-19-nortestosterone (11β-MNT), are currently in development as well. Both treatments have studies showing them safe over the short term (about a month), with a few side effects varying with each treatment; this has been a major challenge for oral male contraceptives, as it’s easy to cause liver inflammation. Both treatments decreased levels of testosterone and gonadotropin, which are necessary for sperm production, without symptoms of testosterone deficiency or excess. However, both have only begun trials within the last two years, so don’t expect to be seeing these on shelves soon.
There are a few other methods being developed, including multiple injectable methods (which are easier to calibrate and work with for endocrinologists, but much more inconvenient for lay people), but the methods above are the ones currently looking promising.
One might ask, why has it taken so much longer to develop effective birth control for men than women. The answer is complicated; the relevant endocrinology in men is different and harder to work with, but part of the problem is also convenience and marketability. One part of the problem is not, however, that men are wimps who can’t handle side effects, despite rumors and jokes which circulated a few years ago after a safety committee halted a study of an injectable contraceptive due to high numbers of adverse side-effects (feel free to read more here).
We are ultimately making progress though, and someday we can expect to see male hormonal contraceptives on the shelves.