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Condoms and vasectomies remain pretty much the extent of birth control options for people who produce sperm, and both have problems. So why is almost all hormonal birth control aimed at those with ovaries? There have been some successes targeting the biological feedback process for hormones that regulate new sperm production, but progress is slow.

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Given the increased conversation around reproduction and reproductive responsibilities as of late, we thought it might be a good time to cover birth control-- for men! That's the topic of this week's Healthcare Triage.

[Upbeat theme music]

Have you ever wondered why there are several birth control options for women while only two options, condoms and vasectomies, exist for men?

Well, when researchers first started looking into hormonal birth control options for men, they found some success through targeting the biological feedback process for hormones that regulate new sperm production.

However, the work was halted after side effects related to mood swings and injection-related pain were reported.

You might be raising an eyebrow if you're a woman watching this video whose birth control options put you at risk for these same side effects and more, including increased risk for blood clots: Why the increased protection for trials of male birth control?

Unfortunately, the means by which birth control was developed for women has a somewhat unsavory history-- check out the Puerto Rico pill trials-- which eventually led to increased regulation of the process for bringing a contraceptive to market.

If some of the currently available contraceptives for women were trialed under these new regulations, they'd likely have never made it to market, either. This helps explain some of the delay in male birth control options.

Another challenge inherent to hormonal birth control for men is that it can take a few months to start working. And on the flip side, it then takes a few months to stop working once it's no longer being taken.

This is because a mature sperm takes somewhere around 72 days to develop. It takes time to stop production, and it takes time to ramp it back up, just like microchips.

Another challenge is that in clinical trials conducted so far, sperm concentrations were not fully suppressed in between five and ten percent of men, and the reasons for this remain unknown.

Mode of administration has been another issue. Most contraceptives tried in men to date have been administered via injections or implants.

Evidence suggests that men would prefer an oral option, but these have been given less attention due to things like the potential for liver damage and a possible need for multiple doses a day.

However, a 2018 study of a once-daily oral hormonal contraceptive for men reported that it was well-tolerated, and though sperm counts weren't taken, the contraceptive did effectively suppress the relevant hormone targets.

Non-oral options that don't require a doctor's visit are also under investigation. An NIH phase 2 clinical trial is currently examining a hormone gel for men that is applied daily to the shoulders and upper arms to be absorbed through the skin.

Participants are being recruited at 13 sites across four continents, with the estimated study completion date being December 2024.

In an interview with The New York Times, one of the lead investigators estimated the gel could be available in five years, but said this was an optimistic guess.

The company Contraline is developing what they call ADAM, an injectable gel that is inserted into the vas deferens-- a pair of tubes that transport sperm-- that could be effective for up to a year at a time.

No hormones are involved here. Sperm are simply blocked by the injected gel and then are naturally degraded and then absorbed. Clinical trials are anticipated to begin this year, 2022, so it will be some time before we know anything productive here.

Men will have to stick with condoms, vasectomies, or partners willing to take on all the birth control responsibilities. Given that the condom failure rate is estimated to be somewhere around 13 percent, and given that vasectomies aren't always successfully reversible, other options for men would be nice, for both men and their partners.

If you found this episode interesting, you might like this previous episode on medical abortion and emergency contraception.

We'd like if you'd like this episode, considered subscribing to the channel down below, maybe go on over to where you can help support the show, make it bigger and better. We'd especially like to thank our research associates, James Glasgow, Joe Sevits, Edward Liljeholm, and Brian Nam, and of course, our Surgeon Admiral Sam.