Daily Mirror (Northern Ireland)
Whatever happened to the male Pill?
Twenty years ago scientists confidently promised an effective male contraceptive pill within a decade. So where is it? Norman Miller investigates
Since its appearance 60 years ago, the Pill has given women freedom to enjoy sex without worrying about pregnancy. Then, back in the late 1990s, major producers said a male equivalent would be on the market within five years. The British Family Planning Association was only a tad less optimistic, predicting seven to 10 years. So where is it?
Dr Sarah Welsh, a specialist in gynaecology and sexual health, has been trialling a compound called DMAU (Dimethandrolone undecanoate) as the key ingredient in a once-daily pill that suppresses two male hormones – follicle-stimulating hormone (FSH) and luteinizing hormone (LH). This cuts production of testosterone, the male hormone that drives sperm production, while leaving enough to maintain male characteristics, such as body hair.
“Research has been slow,” says Dr Welsh. “And when we got to human trials, men complained of side-effects such as weight gain, mood swings and acne. But many women have these exact side-effects on the Pill and have put up with them for years.”
Juggling hormones
“Hormone-based contraceptives have the advantage that reversibility has been clearly established,” adds
Professor Stephanie Page at
University of Washington School of Medicine. “There is also considerable understanding of potential side-effects – similar to those some women experience.”
For example, although highly effective, today’s most common form, the combined Pill, which uses artificial versions of the female hormones oestrogen and progesterone, comes with rare but serious side-effects (thrombosis, stroke) and unwanted masculine traits (deeper voice, excess body hair). It is not an option for women over 35, smokers or anyone carrying excess weight.
Many experts say the female Pill would be unlikely to pass today’s safety requirements.
False dawns
When it comes to creating one for the boys, one problem is that Mother Nature doesn’t offer a level playing field for fertility.
While the female Pill has to block just one or two eggs a month, men produce hundreds of millions of sperm every day. And shutting that production line without significant side-effects has led to decades of dead-ends.
In the 1950s, before the female Pill came along, US researchers found a compound called WIN 18446 that rendered male rats temporarily infertile with no apparent side-effects. So they decided to test it on inmates at a prison in Oregon. Their sperm counts plummeted with no clear negative effects – and bounced back once they stopped taking the tablets. So why didn’t it hit the market? WIN 18446 turned out to be a very, very bad mix with alcohol.
Leap forward to the 2010s and there was a male Pill that used a combo of hormones.
Alas, human trials were halted in 2016 after a fifth of participants suffered muscle pain, skin disorders or depression.
The right balance
The hormone-based male Pill relies on the idea that giving an extra shot of testosterone kids the testes into stopping sperm production.
But it’s a delicate balancing act – you need enough to trick the body, but too much risks damage to the prostate gland, cardiac system and liver.
Adding the female hormone progesterone to the cocktail helps, reducing the amount of testosterone needed to cut sperm production.
But dosage is crucial – too much can lead to side-effects such as breast growth.
In response, a team led by Professor Christina Wang at UCLA’S David Geffen School of Medicine has come up with a compound called 11-BETA-MNTDC – a modified form of testosterone that combines the action of both a male hormone and a female one like progesterone. Phase 1 trials have been completed successfully, while Wang is also confident about a complementary project involving a contraceptive gel.
Professor John Howl and Dr Sarah Jones at the Wolverhampton University have found another avenue using “bioportides”, bioactive cell-penetrating peptides that get inside sperm and turn off their ability to swim, almost instantaneously. So could men be able to pop a pill a few minute before sex, for those unexpected encounters?
“Oral delivery is the holy grail,” says Professor Howl. “But it might be that some other mode is more suitable. It could be a dermal implant, a nasal spray or a lubricant.”
The Wolverhampton team is confident enough to have taken out a patent on it, while seeking funding for human trials. So far, tests have only been on bulls.
Confidence is a preference
It seems no one has made it over the finish line yet. Certainty of two things has hindered efforts to find an effective male Pill, argues Dr Welsh, who co-founded “cool” condom brand Hanx.
“It’s possible pharmaceutical companies don’t think it would make enough money – and that men wouldn’t be trusted to take it.”
Professor Page is more optimistic. “Women are keen to have options men can use, so whether that’s a pill or a gel it doesn’t matter, as long as they’re safe and effective,” she says.
“I know a lot of women who’d not feel comfortable trusting their partner to remember to take it – but also many who would trust their partner to take a contraceptive over themselves!”
The male Pill has to block production of hundreds of millions of sperm a day