The reason there are no birth control pills for men. The effects considered unacceptable for them, tolerated in the case of women

Birth control pills are made only for women and are known to have a number of unpleasant side effects. But these side effects tolerated in women were the reason why these pills were never designed for men.

Contraceptives for men are in trials

A safe and effective male pill would have the potential to finally free women from the responsibility of contraception and prevent millions of unwanted pregnancies each year. A drug called thioridazine taken for schizophrenia was found to have a “dry orgasm” effect, which could be a starting point for a male contraceptive pill. But some men found the idea of ​​an invisible orgasm extremely unattractive. For some men, the so-called “clean sheet” pill was considered emasculating. Eventually, the method the researchers were studying lost funding, and the researchers gave up on the idea.

There are currently no birth control pills for men

Currently, the male contraceptive pill has yet to materialize. This week, research in mice identified a promising new target — a molecular switch that can paralyze sperm for two hours, rendering the person taking the pill temporarily infertile. But while the protein has been hailed as promising, it still has a long way to go before it is approved for use in humans.

In fact, finding effective drugs has never been a problem.

Many male contraceptive methods have been proposed over the past half century, including some that have reached human clinical trials. However, each of them eventually reached a dead end – even those that are safe and effective have been rejected due to unwanted side effects. Several male pills have been rejected on the grounds that they lead to side effects that are extremely common among women who take these female birth control pills. Although the symptoms are tolerated in the case of pills for women, in the case of men, they were considered unacceptable, says the BBC.

Ethics were not always considered

To understand why side effects are so much less acceptable with male birth control pills, it's helpful to go back to when the combined female pill was first developed – in the late 1950s. At that time there were no formal standards adopted on a large scale for clinical trials, and the drug (a combination of estrogen and progesterone in relatively high doses) has been tested in a series of controversial experiments in several countries, such as Puerto Rico. Only 1,500 women were involved, and although half of the participants dropped out and three died, the drug was approved by the US Food and Drug Administration in 1960.

Then, in June 1964, everything changed. An international confederation of medical associations, the World Medical Association, has recognized the need for a new code of medical ethics – particularly after the Nuremberg trials, in which some doctors were accused of committing medical crimes in Nazi Germany.

The Declaration of Helsinki was a code of medical ethics designed to protect participants in medical research. It included provisions that scientists should put study participants first and consider whether the potential benefits to these people outweigh the risks of harming them.

The male version is not safe, while the female version is accepted

Modern versions of the combined birth control pill are considered safe for most women, although in rare cases they can lead to high blood pressure and blood clots. However, they can also cause a number of less serious side effects, including mood swings, nausea, headaches and breast tenderness. There is even some evidence that they can change your body shape.

Which brings us to the next reason why male birth control pills are held to a higher standard—both in terms of acceptable side effects and overall safety: to state the medically obvious, men cannot get pregnant.

“I think you have to think about how ethics committees weigh the risks and benefits of a study because, although a couple is involved, it is the female partner who bears the physical risks of a possible pregnancy. On balance, the unpleasant side effects are (more) acceptable,” says Susan Walker, associate professor of contraception and reproductive health at Anglia Ruskin University in the UK.

Attempts since the 70s

In the US, about 700 women die each year from complications related to pregnancy and childbirth, while about 50,000 develop “severe maternal morbidity” — significant short- or long-term health effects. Worldwide, approximately 295,000 women die during and after childbirth.

Of course, men don't face these risks if they choose to have unprotected sex, so the safety standards for any contraceptives they might take have to pass a higher bar.

Hormonal male birth control pills have been developed in several versions dating back to the 1970s, when researchers injected volunteers with testosterone every week for several months and then checked whether this affected sperm production. One of the first tests found it to be extraordinarily effective – with just five pregnancies after the equivalent of a person using the method for 180 years. Further studies looked at whether this could be further improved by adding a second hormone, such as progestin – a synthetic version of the female reproductive hormone progesterone.

Hormone therapy scared men

However, there was one problem: hormone therapies have a multitude of well-known side effects—many of which are known to women who take the birth control pill. Testosterone alone can lead to acne, oily skin, and weight gain, among other things, which led to early termination of some trials.

There have been very successful trials of male hormonal contraceptive injections,” says Walker, who gives the example of the birth control shot, which has been shown to be nearly 100 percent effective in suppressing sperm concentration. “It worked extremely well, but was discontinued due to concerns about side effects such as mood swings and skin changes – which didn't come as much of a surprise to those working on female contraceptionshe said.

A possible method could be accepted

However, a number of non-hormonal contraceptive options for men have also been proposed, including a vaccine that targets a protein involved in sperm maturation and a type of temporary vasectomy, reversible sperm inhibition under guidance (RISUG).

RISUG involves injecting a synthetic polymer into the tube that carries sperm out of the testicles – the vas deferens – to block sperm from escaping. It was originally developed as a way to sterilize water pipes, but was later adapted to be safe inside the human body. It is currently in phase III clinical trials in India – the final stage of testing before a treatment is approved.

However, as with the male birth control pill, even non-hormonal contraception can be unappealing to some men.

I think it's true that in my experience talking to men about this, men are concerned about future fertility and unknown side effects that may not become known until years after using a product. They are worried about the effect on their performance, how they feel about sex,” says Walker.