At Last, The Pill For Men

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The sexual revolution, part 2, has begun at last, according to a new study out of Australia. For one year, 55 men took an experimental birth-control drug. All of them had fertile partners; none of the women got pregnant. David Handelsman, the reproductive-health specialist who oversaw the study, says the men reported no serious side effects other than a slightly elevated libido, which some people pay good money for, after all. "We have developed the first reliable and reversible means of male contraception," Handelsman claims.

Realistically, it will take at least five years and many more (and larger) studies before a male birth-control drug hits the market. What makes this a revolution is that drug companies are finally involved in backing those studies. With their investment, men are tantalizingly close to having a choice besides condoms and vasectomies. The questions now are whether men will want the responsibility and whether women will trust them to take it.

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In any case, scientists have been working overtime to provide the option. While women ovulate only once a month, men produce millions of sperm every day, which poses big challenges for a male "pill." Birth-control pills for women are effective almost immediately. For men, it takes longer for a drug to start working and to wear off — about three months in Handelsman's study.

Handelsman and other researchers are using a dose of the hormone progestin to turn off sperm production. The problem is that this also suppresses testosterone production. So in order to avoid unpleasant side effects like lethargy and sexual dysfunction, most recent trials also gave men testosterone supplements. In Australia the men were injected every three months with progestin, and every four months they received a small testosterone implant under the skin of the belly, according to the study, published in the October Journal of Clinical Endocrinology & Metabolism.

Implants? Injections! In surveys on contraception, men say they would prefer a pill, but researchers point out that an implant or an injection is far more reliable. Most women have trouble remembering to take the pill. "If we were inventing a female contraceptive right now, it wouldn't be in pill form," says Handelsman. Further research needs to be done to ensure that the added testosterone won't lead to prostate problems. Ideally, the treatment for men would involve only rare visits to the doctor and no injections. "In general, when you're going to do a male work-up, the last thing you want to do is show him a needle," says Dr. Susan Benoff at New York University medical school, who is researching an injection-free option.

Male motivation, or the lack of it, has a lot to do with why a pill for men has been so long in coming. Since the 1930s, scientists have known that testosterone supplements can lower sperm production. In the '70s they began tests to make a male pill. "In truth," says Handelsman, "[it] really should have been invented in the '60s." But nothing stalls science faster than questionable demand. The belief was — and often still is — that men are just not interested in controlling their fertility. "Even at the best of times, most men are not great at thinking through the consequences of their actions," opined London's Guardian in a story that took note of the Australian study. By that logic, though, men shouldn't be flying fighter planes either. In fact, recent surveys have shown that significant numbers of men are interested in a contraceptive drug. Two European firms, Organon and Schering AG, are backing trials around the world.

"I think that we are a little unfair to men," says Mirjam Mol, vice president of Organon's reproductive-medicine program. "The men in our study are very motivated." Will women trust men to take their medicine? Says Dr. Regine Sitruk-Ware, an endocrinologist at the Population Council, an international reproductive-research organization: "Really, it's for reasonable people in a stable relationship."

Quentin Brown, 45, a contractor, is participating in a hormone-based trial in Los Angeles. "If you talk to the guys I grew up with, the guys I deal with in business, most of them would look upon this option very favorably," he says. "I don't know why no one asked them." Our society has decided to hold men financially responsible for their fertility, so men should have as many options as possible to act responsibly, he says. For the past year, Brown has had an implant in his right bicep, with no problems and no pregnancies. "I have a son. I have two nephews. I hope that in four or five years this gives them an option. Even with a condom, you never know when someone's going to say, 'I'm pregnant, and it's yours.'"