Seven Takeaways from a National Meeting on Male Contraception
By Valerie Tarico, a Seattle-based psychologist, writer, and board member of ReproHub.
Imagine a future in which all people regardless of biological sex or gender have the means to manage their own fertility—to choose whether and when to co-create a child, and with whom. Right now men have very few and very antiquated options. Vasectomies are reliable but not reliably reversible. Condoms, which have been around for over 100 years, frequently fail unless they are used perfectly—who among us is perfect—and for some men they reduce sexual pleasure. Both are excluded from many insurance plans, even plans that ostensibly cover contraception.
A small but global cadre of researchers and advocates are working to solve these problems.
The Male Contraceptive Initiative hosted an international conference in Durham, North Carolina from April 28 to May 1. I attended on behalf of Reprohub, a Washington nonprofit that has been seeking to expand insurance coverage for existing male contraceptive methods and those that are in the research pipeline. We call it our “All For All” project, meaning insurance coverage of all contraceptive methods for all people regardless of gender or biological sex. If we can obtain language assuring that reimbursement includes all future FDA-approved methods, this increases the incentive for pharmaceutical companies to bring new male options to market.
Here are some key takeaways from the conference:
1. False perceptions create barriers.
Research shows consistently that men are interested in having more options, and women back them on this. Unfortunately, family planning often gets treated as a women’s issue and a women’s right rather than a human issue and a human right, so there is little investment in new options for men. Many people believe a false narrative that women wouldn’t trust men to manage contraception (many women already do even with the limited options available). They also believe that men don’t want better birth control. But that is false too; research shows millions do want options. Some men have female partners whose bodies get side effects from even the best contraceptives. Others simply want the means to manage their own fertility.
2. The male contraceptive sector is small!
In contrast to the hundreds of thousands of people who are involved in (female focused) family planning provision, reimbursement, advocacy, and research, the community of people working on male options is so small that they fit in one room. Around 300 people from across the country and from other countries converged on Duke University, where they fit in a single theater for the conference. Another 100 attended remotely. Most attendees were academics—biochemists, physicians, graduate students, and others working on male fertility and infertility—along with a few people from nonprofits, government agencies like the National Institutes of Health, small pharmaceutical companies with promising products like Plan A, and so forth.
3. Bringing a new contraceptive to market is a long, high-risk road.
Researchers working on contraceptive “discovery” first have to identify stages in the production of sperm and eggs that offer “targets” for intervention. They look for possible molecules—like hormones or proteins or elements like calcium and potassium—that play critical roles that can be altered. They have to find ones that, when targeted, won’t affect other parts of the body. Then they begin a long, expensive journey from basic research to “in vitro” research (in Petri dishes) to “in vivo” research (with lab animals) to human clinical trials that start small with a focus on safety. A potential contraceptive can fail at any stage in this process, and the vast majority do.
4. Low funding keeps progress slow.
Major drug companies tend to jump into the development of new contraceptives only when the early research is done—when a new potentially-profitable product has been somewhat “derisked.” Because of this, most contraceptive technologies now available to women first received basic research funding from USAID. In fact, over 40 percent of early funding has come from governments and another 40+ percent from philanthropy, with just 10-15 percent coming from pharma. With federal research funding being reduced or retracted, some research on contraceptive options has come to a halt in the last few months. Couples that were testing a new ring that prevents HIV and unsought pregnancy through the MATRIX program were told they can’t have the next round. Data that have been collected are sitting unanalyzed.
Even before the cuts made by the new presidential administration, research focused on male methods was just a few million dollars per year. The small scrappy Male Contraceptive Initiative (MCI) is the largest private funder now left in this space. MCI in turn has had just one primary donor. That donor has been supplemented by regular folks who are giving monthly as they can—amounts as small as $6/month from guys who really, really want this to happen.
5. AI and CRISPR have vastly increased the list of possibilities.
Drug discovery has changed radically in recent years, much accelerated by the desperate race for a COVID vaccine a few years back. More information, better tools, more computational capacity and ability to use virtual modeling before getting to expensive animal research…We are entering a new phase of opportunity.
Researchers have identified molecules that affect only the development of a sperm’s tail, for example, enabling them to create an intervention that disables sperm’s mobility. Some options can potentially be used intermittently a few hours before sex, meaning there would be no need to be consistent for months on end. For those who are curious, a 2023 list of ongoing research can be found at NIH. Another good resource for keeping track of products in development is the Contraceptive Technology Innovation Tracker.
6. Several countries in Africa are eager to develop pharma as an industry.
In Zambia, for example, the government sees this as an economic sector prime for development. They are working on providing the necessary regulatory quality control while the private sector ramps up. Both regulators and labs see male contraception as an opportunity precisely because it is underfunded in the West. Other Lower and Middle Income Countries (LMICs) may open up capacity to move this work forward over the next decade, and researchers in the European Union and elsewhere hope to collaborate with new partners.
7. Several new methods for men may be close to market already.
One temporary vasectomy alternative, Adam, by Contraline, and one that is easily reversible, Vaselgel, are already being tested by couples in clinical trials. So is a hormonal gel—NES/T—that men rub on their shoulders. Contraceptive research along the whole pipeline is a highly collaborative process, and these trials include couples from countries ranging from the U.S. to Chile to South Africa, Zimbabwe, and Australia. Men in California and Washington state have participated in recent clinical trials thanks to the Emerge Lab at USC and the Division of Metabolism, Endocrinology and Nutrition at the University of Washington.
Conclusion
Despite recent setbacks, the researchers, nonprofits, and pharmaceutical companies doing this work are determined to find a path forward sooner rather than later. Among the folks in that one room in North Carolina, there was a clear consensus that men want and deserve better. Researchers at the University of Washington, including Dr. Stephanie Page who presented the NES/T study at the conference, are key, persistent partners working toward this future.
1-minute overview of the Male Contraceptive Initiative:
More articles by Valerie Tarico for WIBM:
Thank you for the post. The other thing about vasectomy is that it is not "one and done" - the man should go in every year to make sure that he is still sterile.