For decades contraception has fallen to the female in most couples, due to the effectiveness of female contraceptives and the lack of a satisfactory male alternative.
Current reversible methods consist of ‘pulling out’, which is not effective, or using condoms. Condoms, while very effective if used correctly, are not popular with most men as they affect sexual enjoyment. They, of course, still have a major role in prevention of sexually transmitted infection.
However, good news is on the horizon as three new methods of male contraception are currently being researched and are progressing well.
Nest/T gel
The gel contains Testosterone and Segestone which is a synthetic form of the female progesterone hormone.
A metered dose of gel is applied to the shoulders and arms daily and the progestin shuts down the hormones that stimulate testosterone production in the testes. Lowering testosterone production decreases sperm production.
The gel takes 6-12 weeks to achieve a lowered sperm count and takes the same time to reverse fertility if it is stopped.
You might wonder if lowering the testosterone level will have side effects such as decreased libido and erectile dysfunction, but that is why there is testosterone in the gel to keep hormonal balance.
A trial of 450 couples has just started with UK participants. As the current trial will take over a year, the gel is still years off coming to the market, but it looks very promising. Recruitment is ongoing for men aged between 18 and 50 who are in a stable relationship with a woman between 18 and 34. The number to phone if you wish to take part in the trial is 0131 242 2669 ( Edinburgh) or 0161 276 3296( Manchester).
Male birth control pill
It has proved difficult to develop a male contraceptive pill that decreases sperm but does not give unwanted side effects. However DMAU – Dimethandrolone undecanoate is showing promise. It works in a similar way to the gel as it has the properties of both progestin and testosterone. This drug has been well tolerated but more evidence is needed regarding its ability to suppress sperm production. This is definitely a work in progress.
Non-Surgical Vasectomy
- RISUG (Reversible Inhibition of Sperm Under Guidance)
This involves injection under guidance of a non-toxic synthetic chemical which is injected into the vas deferens (collecting tube from testis). It blocks the vas deferens and reacts with the sperm killing any that come into contact with it. It is effective almost immediately and it can be washed out if the man decides to have family later.
- IVD
This is a similar to RISUG but instead a plug is placed in the vas deferens. This blocks the vas and filters out sperm. It can be removed if family is planned. Further research is needed into the effectiveness and safety of this method but it looks promising.
Vasectomy
The other option for men who have completed their family is vasectomy. This involves cutting, blocking or sealing the vas deferens, thereby preventing sperm getting into the semen. It is considered 99% effective.
The procedure if performed under local anaesthetic usually, but sometimes under general anaesthetic. It is considered permanent, as it is difficult to reverse. Hormones are not affected so the sex drive remains and erections and ejaculation should not be affected.
Contraception is needed until testing confirms that there is no sperm in the semen. Two or more semen samples will need to be submitted to the laboratory to confirm all the sperm has gone, so it can take 4-6 months until fertility is curtailed.
If you would like to talk about any of these matters to a doctor, do get in touch.
EUROPEAN PHARMACEUTICAL REVIEW, April 2019, Second potential male birth control pill passes human safety tests, accessed 27th June 2019,<http://European pharmaceutical review.com/news/8607/second-
NHSINFORM, February 2019, The pill for men, accessed 27th June 2019,<http://nhsinform.scot/
SKY NEWS,25th June 2019, Male contraceptive gel:UK man among first in world to take part in trials, accessed 27th June 2019,< https://news.sky.com/story/
