Why is Australia still waiting for a male contraceptive pill?

There will eventually be a contraceptive pill for men, but it will have to overcome “men's attitudes”, says American biologist Gregory Pincus.

Pincus, the 'father of the pill' for women, made that prediction during a visit to Sydney – in 1964.

The pill had arrived in Australia just three years earlier and brought with it the sexual revolution. Since then, hormonal levels and mix have improved and long-acting contraceptives such as implants and IUDs have increased women's options.

But six decades after Pincus' ruling, vasectomies and condoms remain the only contraceptive options for men, leaving women with the financial burden, mental burden and side effects of preventing unwanted pregnancies.

In that time, promising products have emerged, but despite regular headlines that a pill is just around the corner, none have yet reached the market.

Some blame double standards and sexism in medicine. Trials have been canceled due to side effects similar to those experienced by women, including mood swings, acne and decreased libido.

In 1964, Pincus had been experimenting with sperm-inhibiting pills for six years.

“One of the biggest problems standing in the way of scientists is the attitude of men in general,” he said. “Many were afraid that a contraceptive pill would disrupt their sex drive. (That) cannot be considered acceptable.”

'It's just like the IUD, for men'

While gender-related barriers remain, some think attitudes are finally changing. And there are (again) promising hormonal and non-hormonal products on the horizon.

Louise Keogh, professor of health sociology at the Melbourne School of Population and Global Health, says she is cynical but still hopeful that men will one day have access to reversible contraception.

“Every five years there's a new drug, it works, it stops sperm production or there's some other mechanism,” she says.

“The pattern seems to be that they come to court, then side effects and 'delayed return of fertility' are reported, and they give up.

“The side effects are often very similar to what is reported for women. Mood swings, weight gain, acne… I don't understand why a delayed return of fertility would be a deal breaker.

“So I'm very cynical when I hear about a new lawsuit because I've heard it so many times.”

In 2016, the trial of an injection that reduced sperm count to prevent 96% of pregnancies was canceled due to too many side effects. Some men suffered from acne, weight gain or mood swings.

There were more serious problems – one man developed severe depression and another became suicidal (the female contraceptive pill can also cause depression) – but other studies have been stopped because men found the side effects of safe and effective treatments 'unacceptable'.

That could be one reason why the pharmaceutical industry has historically shown a “lack of interest,” Keogh says, even though studies have shown that enough men would be interested to make a contraceptive commercially viable.

Contenders include ways to suppress sperm production, motility (the ability of sperm to move efficiently) or the ability to fertilize an egg, and ways to prevent sperm from leaving the vas deferens.

Researchers tested testosterone and progestin, a 'switch' that stuns sperm, and a polymer that blocks the fallopian tubes.

Researchers from Dundee University have been working on a range of options, with help from grants from the Bill and Melinda Gates Foundation. They've tested thousands of already approved drugs and say they've found effective ways to “stop sperm.”

The biotech company Contraline is testing an injectable, non-hormonal hydrogel that blocks the path of sperm. “It's just like the IUD, for men,” the company says.

The US National Institute of Child Health and Human Development is conducting clinical trials including a hormonal gel that men rub into their shoulders to reduce sperm production. The National Institutes of Health tested a drug on mice that prevents sperm from moving.

Social changes

Family Planning Australia (FPA) medical director Dr Clare Boerma says there have been “major shifts” in attitudes among men and in society in general. Traditionally, contraception was seen as women's responsibility, especially within relationships, so women bore the side effects and costs.

But the number of vasectomies is increasing. FPA's services are flourishing and now have a waiting list, says Boerma.

Medicare statistics compiled by Vasectomy Australia show a 75% increase over the decade to 2022-2023, from 22,213 in 2013-2014 to 38,875.

“We hear from both men and women that there is a need for more options for men… some men find the idea of ​​a vasectomy terrifying,” says Boerma.

“Societal views are changing and there is probably more demand for it now. The more options, the better.”

Last year, a Senate inquiry into universal access to reproductive health care found that male contraceptives were “an effective method of preventing pregnancy.” It noted that women bore disproportionate responsibility for contraception.

“As a result, women tend to bear higher financial costs as well as the associated health burdens that may arise, such as common negative physical side effects and the consequences of contraceptive failure,” the report said.

The government is currently considering the report.

“All too often, the burden and responsibility for contraception falls solely on women,” said Ged Kearney, Minister of Health and Aged Care. “It is important that both men and women have a range of contraceptive options.”

Boerma says that when and if a male pill finally becomes available, it will raise a series of new questions and conversations around responsibility, trust and consent.

“And the motivations for someone to tolerate side effects… the question was whether the motivators would be different and whether women would trust their partners (to continue using the contraceptive),” she says.

“It's a new space: developing a drug to prevent a condition in someone else.”