Personalized pills, gels, jockstraps: are we closer to a male contraceptive? | Society

For Pierre Colin, 72, looking for a viable male contraceptive has lasted a lifetime. As for the female hormonal pill, which was prescribed (for married women only) to the NHS in 1961, the history of male contraceptive development is long and complicated.

When it came out, the pill became synonymous with a revolution of sexual freedom. At the time of her release in the UK, regardless of her marital status, in 1967, nearly 13 million women had used it – despite significant potential side effects, including blood clots and strokes . In Toulouse, geologist Colin wanted to adopt a male contraceptive to ease this burden. "My friends were active feminists, so we men wanted to do our part," says Colin. "We understood that it was not enough to talk about masculinity. we had to do something to help in relationships. "

While female contraceptives have proliferated, encompassing the pill, intrauterine devices (the coil), implants and spermicidal, male options are dual: condoms or vasectomy. Between 2006 and 2016, the number of vasectomies suffered in the UK decreased by 64%, making it by far the condom.

Trials of an injectable hormonal mixture of testosterone and progestins aimed at stopping sperm production started in the United States in the 1970s and gave promising results. In the early 1990s, the World Health Organization recruited 271 couples from seven different countries to participate in a similar trial. Again, the results were encouraging and resulted in only one pregnancy. Yet pharmaceutical companies were unwilling to invest the billion dollars (£ 770 million) needed to launch a drug in the development of the mass market, citing the uncertain and untested market.

Meanwhile, Colin had developed a natural method of male contraception with a local doctor. The "temperature method" involves wearing a jockstrap with an opening through which to push the testicles, apparently increasing their temperature from 34 ° C to 37 ° C – enough to stop sperm production. Users must wear the instrument for 15 hours a day and it takes three months for the temperature to increase reliably.

Colin estimates that more than 200 pairs have been sold. A plastic "ring" with the same effect is now available. "People are very interested in the thermal method because it is hormone-free," he says. "Many women reject the pill because of the side effects, so we wanted to take a different route."

This method can cause drowsiness, but no matter if it succeeds, it is symptomatic of research on male contraception.

"There is a joke in our field that a viable male contraceptive has been around for 40 years," says Dr. Logan Nickels. As director of operations for the Male Contraceptive Initiative (MCI) in North Carolina, Nickels has been at the forefront of the recent campaign to market a male contraceptive product. A non-profit researcher, MCI is developing non-hormonal methods, such as a reversible injectable polymer that blocks the vas deferens (the canal that carries sperm from the testes to the urethra) and compounds-based of plants, especially those made from the plant. Justica gendarussa. "I really think that in the last five years – and even more so in the last 18 months – there has been a huge change in the way the public talks about male contraceptives," Nickels said. "This is largely because younger generations are wondering why these contraceptives have not been developed yet. They want to be more involved in the conversation about family planning. "

Aaron Lockhart Jr., who is participating in a global trial of a men's gel hormonal contraceptive led by the University of Washington in Seattle, echoes this sentiment. "It has been more than 10 years since I watched my wife use different methods of contraception and they can wreak havoc on the woman's body," he says. "She is constantly negotiating the hormones that could work, so I thought it was time for me to take some responsibilities."

Tests for the male pill have proven difficult, due to differences in hormone metabolism in men and women, but growing hopes for this gel, which is already used as a treatment for testosterone deficiency in the United States. The alcohol-based solution itself applies daily, making it significantly more accessible than injectable methods, which required medical follow-up. "The demand for recruitment in this trial was very strong," says Lockhart: there were thousands of candidates for only 40 places. "Men should be more motivated to do that, to get rid of their fears about their manhood and virility, when in fact it has nothing to do with it."

Attitudes seem to change. A January YouGov poll showed that one-third of Britons would be willing to take a pill – the same proportion of women who use hormonal contraception – while nearly 80% of adults surveyed believe that shared responsibility for contraception is a positive development. A global survey of 9,000 men in 2012 showed that 55% of respondents would be willing to try "a new form of hormonal contraception".

"The reality is that 40% of all pregnancies in the world are unplanned, which represents a tremendous economic and societal burden," says Dr. Stephanie Page, head of the Freeze Trial in Seattle – not to mention the $ 25 million unsafe abortions that take place every day. year. "By not giving men options, we are preventing half of the population from helping to solve this important problem. A man can cause a lot of pregnancies, so this could have a lot of impact. "

For men and women, offering a choice of contraceptives is crucial, according to scientists, that it's about gels, pills or underwear. "There will not be a perfect contraceptive for all men and there will be no single contraceptive for one man throughout his life," says Nickels.

Options for men could include Colin's recently-patented underwear. "The thermal method is actually a phenomenon studied and if we can maintain this temperature long enough, it is a reversible means of contraception," says Nickels. "But we need to make contraceptives that will provide as few barriers as possible, while making them simple and fun. These kinds of things should not have an impact on everyday life or be difficult to use. "

Yet, without interest from pharmaceutical companies, it may take decades before a viable product is put on the market. "When women use contraceptives, they prevent the onset of a life-threatening illness: pregnancy," says Page. "But when men use contraceptives, the risk-benefit equation is different, because there is not necessarily an individual risk for the man. Studies may show that men are ready to take new contraceptives, but pharmaceutical companies still consider the potential market for these products to be a risk. "

Historically, however, male sexist attitudes have played a role in stopping the progression of contraceptive trials. In the 1970s, hormonal tests in Brazil were stopped because of the lowering of patients' potassium levels; the problem was solved, but no further testing took place, prompting the research manager, Dr. Elsimar Coutinho, to suggest later that the men were "very afraid of losing their manhood". In 2016, an injectable hormone test was stopped after the abandonment of 20 men due to an increase in libido, acne and depression – common side effects the woman's pill – leading to accusations of hypocrisy in men.

At MCI, Nickels uses crowdfunding online and grants to reduce the use of seed funding by pharmaceutical companies. "We hope that by using financing models such as philanthropy and other private investors, we will be able to find new ways to market these products, while ensuring that they remain reliable and scientifically sound." he declared. Last year, MCI raised $ 1.8 million; he hopes that with sufficient financial means to guarantee preliminary tests, he will be able to transmit his results to pharmaceutical products for later trials.

Despite the lack of funding, important developments are underway. In March, the US National Institute for Child Health and Human Development tested a hormonal pill, which prevented pregnancy and showed no significant side effects. "I hope this test will mark a turning point," said Diana Blythe, program manager. "We have a huge interest because there has been no change in male contraception in 50 years and now things are changing."

Next steps include longer trials on a larger group of men to check sperm reduction, and then recruiting couples to use the pill as the only method of contraception. Like many drug trials, the process will be long, costly and likely facing regulatory battles. The cost of the final product is still far from being considered. "I continue to depress everyone by saying that if it works really well – what we'll know in three or four years – phase three should be three to four times longer," says Blythe. "This whole process would take at least a decade, but every step forward is all the more important for that."

The people involved in the studies hope that their efforts will serve future generations. Nickels says that he often thinks about his five-month-old son: "The timeline of these options means that he will be one of the first users to have options in the market. I hope that I can prepare the ground for him and that his relations will be empathic, in which he can really discuss with his partner what is a key element of any relationship: decide if and when you want to have children. "

Lockhart, however, may be forced to make a decision earlier. "I'd like to use this method if it works," he says, "but I know the way to go is still long. So we will probably have our children in about five years, then Done, I'm just going to have the cup. Colin regrets that he did not have a vasectomy after the birth of his two children in the 1970s, because the science of male contraceptives has progressed much more slowly than expected. "I'm too old for that now," he said. "Contraceptives will be for my grandchildren to continue."