A contraceptive pill for men?

Why haven’t we got a contraceptive pill for men? Nelly Oudshoorn, Professor of Gender and Technology at the University of Twente in the Netherlands, attempts to provide some of the answers in this timely historical account.

In 1972, the World Health Organization (WHO) Male Task Force concluded that a long-acting gestagen to suppress pituitary gonadotropin secretion, and hence testicular activity, supplemented by androgen replacement therapy, was the way to develop a male contraceptive. But which gestagen, and which androgen, in what dose, and by what route of administration? These questions still remain, 32 years later, although the latest Australian study,1 has shown that three-monthly injections of 300 mg depot medroxyprogesterone acetate and four-monthly implants of 800 mg testosterone give excellent contraceptive protection for one year.

A male contraceptive implant might find a small niche market in the developed world, but in the developing world, where most of the world’s population lives, the logistics and cost of repeated implants or injections would probably make it a non-starter. Another worry is that anabolic steroids (aka androgens) are now internationally banned as performance-enhancing drugs, and hence any athlete taking a hormonal contraceptive would simply not be allowed to compete. The lack of interest shown by the pharmaceutical industry (wisdom in hindsight?) has been a major blow, as has the low profile of andrology as a medical specialty.

Nelly Oudshoorn concludes that we have failed to develop a male pill simply because “technological innovation in male contraception thus facilitates a situation in which hegemonic masculinities are destabilized and nonhegemonic masculine identities are articulated and gain momentum”. The truth is somewhat simpler.

A male pill is still not in sight, and the pharmaceutical industry will have to invest hundreds of millions of dollars to bring a three-monthly injectable hormone cocktail onto the market. Is it worth the investment?

Roger V ShortProfessor of Obstetrics and Gynaecology Royal Women’s HospitalMelbourne, VIC

1. Turner L, Conway AJ, Jimenez M, et al. Contraceptive efficacy of a depot progestin and androgen combination in men. J Clin Endocrinol Metab 2003; 88: 4659-4667.