WE TESTED THE NEW ‘MALE PILL’
(and here’s what it did to our sex life)
FRAUGHT with worry, paramedic Ed was rushing alongside a trolley through hospital corridors when a poster on the wall caught his eye. Volunteers wanted, the A4 sheet declared. Researchers were looking for recruits to test what would be the first male hormonal contraceptive on the market. And the medical trial was set to start near his home in Edinburgh. Had he seen the poster just a day earlier, he wouldn’t have given it a second glance. But the reason he was in hospital on that summer day in 2019 made the notice seem more like fate.
Because Ed, now 32, wasn’t on the ward for work. Instead, he was watching over his beloved partner of eight years, struck down with sepsis — a life-threatening condition that came about after surgery to treat a freak side-effect of her contraceptive coil.
Proofreader Fiona, now 30, had been using the copper coil or IUd (intrauterine device) — a hormone-free contraceptive that sits inside the womb — for more than six years without any concerns when she went to the doctor complaining of what she believed to be period pain.
In fact, a 7 cm ( 3 in) abscess had developed in her pelvis near her fallopian tube. Similar to toxic shock syndrome, the infection could be linked to her coil, doctors told her. However, emergency surgery to remove both the abscess and the coil had resulted in sepsis, and her being rushed to intensive care. A traumatised Ed spent a fortnight at the bedside of his barely lucid girlfriend — more than enough time to concentrate his mind on who would take the lead on contraception in the future.
doctors advised that the coil was now too risky and, while Fiona had tried hormonal birth control in her teens and early 20s, she found the Pill brought on bouts of depression and tearfulness. So without these options, what could they do?
They could just have used condoms or
other barrier protection. But, keen to maintain a spontaneous sex life, ed saw little reason not to do what women have done since the 1960s. a long-term hormonal contraceptive he would take seemed to be a logical solution.
‘i thought, why shouldn’t i be taking responsibility if i can?’ says ed. clearly, he is devoted to Fiona. When he met her on a dating site in 2013, the site’s algorithm had them down as a 99 per cent match — while also noting the couple were ‘significantly less romantic than average’.
But while buying bunches of flowers might not be his style, ed believes taking on something as crucial as birth control was the ultimate romantic gesture.
When Fiona was safely back at their home from hospital, they discussed it. ed found she was keen for him to ‘take his turn’ and felt liberated by him offering to take over the burden of contraception. ‘i really do think a lot of guys don’t realise the daily commitment of managing birth control,’ says ed. ‘ But there’s no good reason why they shouldn’t have the option of doing so.’
ed is one of more than 100 men trialling a drug called Nesterone/ testosterone, tipped to become the first male hormonal contraceptive on the market.
it works by using a progestin — a synthetic hormone also used in female contraceptives — together with a synthetic testosterone to switch off a man’s natural testosterone production, thereby preventing sperm being made in the testes.
the synthetic testosterone also ensures the man’s libido and overall physical health is maintained. the result: no sperm in his semen but, researchers say, few other discernible effects.
Just as with the female Pill, the trial so far indicates it is reversible. Within a few months of halting the drug, volunteers’ sperm production returns to normal, just as a woman’s ovulation resumes after stopping the Pill.
The male ‘Pill’, however, turns out to be a gel, which ed has to apply daily. every morning around the same time, after showering, he applies the gel across his shoulder blades and chest, waits a minute for the residue to dry as the hormones are absorbed through his skin and into his bloodstream, and ‘that’s it, i wash my hands, put on my shirt and go about my day’.
sounds simple. so why has it taken so long for a male alternative to the Pill to arrive?
Dr John Reynolds-Wright, a clinical research fellow working on the edinburgh trial, says: ‘ efforts to create a male contraceptive in the same vein as the Pill were first made in the 1950s, but it’s trickier to make a male contraceptive than a female one, partly because if you give testosterone in a tablet form, it breaks down very quickly.
‘you’d have to give it six times a day to get an effective dose.
‘ in addition, in women a hormonal contraceptive works to prevent ovulation. ovulation only happens once a month, whereas men are producing millions of sperm daily. so you’ve got to have a drug that does more “work” to get the same effect and protect people from pregnancy.
‘a sperm count of less than one million sperm per millilitre of semen is considered effectively a contraceptive. there’s less than 1 per cent chance of pregnancy at that concentration — although lots of men on Nesterone end up with a sperm count of zero.’ one million sperm may sound a lot, but a healthy man will have more than 15 million per millilitre.
some men perceive taking a male ‘Pill’ as somehow unmasculine. so how does it feel to be ‘firing blanks’, as ed himsef describes it? he reports his masculinity remains intact.
as for matters in the bedroom? No ‘tangible changes’, reports ed. Fiona agrees: ‘our sex life is exactly the same.’
there is one difference: ed has to shower religiously before sex because if the gel were to rub off on Fiona’s skin she could absorb too much testosterone and her own hormone balance would be affected.
as for side-effects, ed adds: ‘i do occasionally get hot flushes and night sweats. and i’ve gained 3-4 kg [around 7 lb].’ the hot flushes are attributed
to his hormonal balance being slightly disrupted, just as women experience in midlife. Ed says: ‘I don’t mind having the odd hot flush if that’s the price for an absolutely easy, carefree sex life.’
As for any emotional fragility, Ed has taken to his ‘mood changes’ like a duck to water. ‘Anything hormonal is going to affect different individuals differently,’ he says. ‘But something like the gel should still be an option for men.’
Friends and family have been supportive. Several of Ed’s mates have ‘indicated they would be up for using the gel if they weren’t actively trying for children’. Ed and Fiona don’t plan to start trying for a family for several years.
So is the gel something you would trust a less mature man to use properly? Would a woman in a short-term relationship feel confident leaving the responsibility up to a casual partner?
‘I think it would have been deeply optimistic for the teenage me to think he needed to use a contraceptive every day,’ says Ed.
Fiona adds: ‘I suspect, if I were younger, I would want to be on birth control as well. When I was in my early 20s, I was on the weekly patch because I found it easier to remember than a pill. So if doing something daily was going to be tough for me to remember, it would have been much nicer for me to know both of us were doing it.’
Their participation in the 18month trial concludes in a few months — and they will no longer have access to the gel, so it will probably fall to Fiona to take some form of hormonal contraception.
‘I’m devastated,’ she says. ‘It’s been wonderful to have this time using something that works for us both. I have mood swings in the first few months of using hormonal contraception, so I am not looking forward to it. Aside from the coil, which is simply too dangerous for me to use again, the gel is the best contraceptive we’ve had. It would be my first choice if we could keep using it. It’s a shame to have to go back to second or third best after a really nice year where I haven’t had to worry at all.’
ED ADDS: ‘There could be some troubles ahead. I’ll have to be tactful because suggesting any arguments are down to the Pill will probably make things a lot worse.’ Experts hope the male ‘Pill’ might be on the market within the next five to ten years. Then, say Ed and Fiona, other couples can try the carefree contraception that has been such a lifeline for them. n The study at Saint Mary’s hospital, part of Manchester University NhS Foundation Trust, and the University of edinburgh is recruiting men between 18 and 50 in a stable relationship with a woman aged between 18 and 34. Call 0161 276 3296 (Manchester) or 0131 242 2669 (edinburgh).