The Pill for Men

Men’s contraceptive may be available in the coming years. Will men take a daily pill?

By Deborah Jeanne Sergeant

Contraception has largely been dependent upon women — they are the ones who have to come up with barrier methods: spermicidal preparations or hormonal implants, patches, injections, vaginal rings or pills.

But researchers want to change that.

Men’s oral contraceptive — dimethandrolone undecanoate (DMAU) — may be available in the coming years.

The Journal of Clinical Endocrinology and Metabolism recently published research indicating that initial tests involving a small population — 100 men ages 18 to 50 — indicate no serious adverse events and the medication was “well-tolerated.”

Eighty-two of the men completed the double-blind, randomized, placebo-controlled study, which lasted 28 days.

DMAU suppresses testosterone in men’s testicles so their sperm do not develop. That impedes their ability to impregnate women.

Beyond safety and efficacy, the successful use of DMAU also lies in compliance: will men take a daily pill that decreases testosterone, the main hormone that makes men masculine?

Robert G. Fugitt, a urologist with Invision Health in Kenmore, sees a lot of male patients struggling with low testosterone.

“If there’s a significant reduction secondary to this pill, men would be reluctant to take it,” Fugitt said. “It depends upon how much testosterone decreases.”

Though women’s oral contraception has been known for decades to cause weight gain, increased risk of stroke (particularly to those over 35 and smokers), and other negative side effects, it’s still the most popular means of contraception. About 25% of women who use contraception of any kind use the pill. The next closest reversible contraception method is the male condom (14.6%), followed by the intrauterine device (11.8%).

Fugitt is not sure that contraception responsibility will readily shift from primarily women to men.

“From a historical standpoint, contraception has been the female aspect with the pill and I think it’s so ingrained that it will take a lot of positive reinforcement before men will do it,” he said.

Once an FDA-approved and effective male oral contraceptive is available, Fugitt said he could picture men choosing that over vasectomy if they want to preserve their paternity options, such as newlyweds wishing to delay starting their family.

Without having to use condoms, men could experience greater sexual spontaneity and, if they dislike condoms, more enjoyment.

Men taking medication like DMAU could relieve women from the risks of taking hormonal contraception. Not all women are good candidates for contraceptive medication or devices, and some couples don’t prefer spermicide or condoms.

Men would also gain more control over their paternity, since they don’t have to rely on their partner’s ability to remember to take a pill, use spermicide correctly or keep her other contraceptive delivery method up-to-date.

But will men remember to take a daily pill if skipping a dose bear sfewer consequences for them?

“I know men who forget to take medication for significantly life-threatening things,” Fugitt said. “It’s human nature. You see women carrying around their packet of contraceptives in their purses. In 20 years, will men carry it around in their pockets?”

He views the possibility of male oral contraceptives as a “medical and sociological phenomenon” and that likely, urologists would discuss and prescribe it to men once the medication is available.

David Gordon, licensed clinical social worker with a practice in Amherst, focuses on working with couples on relationship issues, as well as anxiety and depression. He views the success of an effective male oral contraceptive as relying upon the relationship.    

“Trust, transparency and open communication are critical to solid relationships and often becomes a barrier when it comes to issues of sexuality and contraception,” Gordon said.

Women have been mainly the ones responsible for contraception. Gordon added that transferring that to men represents a challenging cultural shift. But “shared responsibility could certainly strengthen relationships,” he added. “Men have long had to trust a woman’s word when it comes to her willingness to take this on, trust her commitment and honesty to avoid unplanned pregnancy.” Gordon said.