Male birth control could actually occur. But do men want it?

On a recent In the morning in Los Angeles, Michael Medrano dabbed a cold gel globule the size of a tea spoon on his shoulders. These days, it's just another part of the routine: brushing your teeth. Apply deodorant. Comb hair. Dab the gel.

The gel, which Medrano describes as having the consistency of a hand sanitizer, contains testosterone and progestin, a hormonal composite that inhibits the body's natural sperm production. Massaged in his skin, it is the only means of contraception that he and his wife Julia will use for a year and a half.

A few years ago, Julia stopped taking Depo-Provera, an injectable form of hormonal contraception, which caused her to fluctuate the weight of her weight and rendered it, in the words of Medrano, "rather morose ". The condoms worked well, but Julia was afraid of slipping. up. So when Medrano discovered an article on Reddit recruiting participants for a clinical trial of this new type of male contraceptive, it seemed worth it. Julia, happy to be relieved of the burden of managing the couple's birth control, nodded.

Recently, some 400 other couples in nine cities around the world have also incorporated the gel into their daily activities. This is one of the largest surveys of hormonal male contraception ever performed. Like Medrano, they will use the gel instead of other contraceptives as researchers monitor the sperm count and any unintended side effects. If the gel comes on the market, it will become the first hormonal contraceptive for men – more than half a century after the approval of the first birth control pill for women.

It is a big "if", which is based on a tangle of scientific, social and bureaucratic complications. The gel itself dates back more than a decade, developed by researchers at the Los Angeles Biomedical Research Institute and the University of Washington. The groups have spent their careers looking for better birth control options for men, but none has reached the pharmacy shelves. But the gel called NES / T looks very promising. Researchers must now study how it works with Medrano and other couples in the wild, hoping to prove that male hormonal birth control finally deserves to leave the laboratory and integrate into men's lives.

The path of Hormonal male contraception begins in 1957, in the laboratory of Gregory Pincus, an endocrinologist who made himself known by studying the effects of hormones on conditions such as heart disease and schizophrenia. In 1951, encouraged by a friendship of feminist activist Margaret Sanger – and a small grant from the Planned Parenthood Federation of America – Pincus began researching how hormones could manipulate a woman's menstrual cycle and prevent her ovulation. He discovered that a combination of estrogen and progestin had made the case. His invention, dubbed Envoid, was marketed as a "menstrual regulator with a side effect of preventing pregnancy". In 1960, the FDA approved its use as a contraceptive, which would soon be known as the "pill".

In doing the research that led to the pill, Pincus also hoped to create a drug analogue for men. It seemed that just as a progestin could disrupt the woman's natural cycle, it could also disrupt the natural production of sperm. He and other researchers put this hypothesis to the test in the late 1950s, injecting doses of this drug into the men and women of psychiatric hospitals in Massachusetts (the ethical standards were less stringent at the time) to see if that could make men temporarily sterile. The results were inconclusive.

"As soon as it started, the women who funded the project …[Margaret] Sanger and [birth control pioneer Katharine] McCormick became furious. They just wanted it for women, "says Jonathan Eig, the author of The birth of the pill. "It's a brilliant design if you're trying to give women control. But over time, one of the side effects is that men do not even participate in the conversation. "

The interest in birth control among men has diminished, overshadowed by the overwhelming success of the pill. But some researchers have continued to work on this idea in the coming decades. The National Institutes of Health funded clinical trials throughout the 1970s, followed by multinational studies sponsored by the World Health Organization in the 1990s. In China, researchers experimented with gossypol, a derivative of plant, to reduce the number of sperm in a non-hormonal way. Another plant extract, ouabain, has also been considered (the compound is used by African hunters, who dip their arrows to stop the heart of their prey). In India, scientists have found promising solutions with an injection-based procedure called RISUG, sometimes called "nonsurgical vasectomy." None of these methods have been placed on the market.

Stephanie Page had just completed her medical training when, in 2002, she began her research on male hormone birth control. Now a professor at the University of Washington, Page oversees three studies of new contraceptive methods for men: a hormonal pill, which inhibits the production of sperm with a compound called DMU; an injection, modeled on the Depo-Provera vaccine for women; and the NES / T gel, which uses a type of progestin called nestone in combination with testosterone. Of the three, the gel is the most advanced, although Page warns that "drug development is not a start. This is not done overnight, or even in a few years. "

In many trials, progestin has been proven to stop sperm production. Testosterone is there to balance its side effects, such as loss of libido, hair loss or fatigue. Christina Chung-Lun Wang, researcher at Los Angeles Biomed and another senior researcher in NES / T clinical trials, said similar methods of male birth control had been tested as early as the 1970s, with "extremely positive" results. "So the goal now is to find a combination that is just as effective but with minimal side effects," she says.

The development of contraception for men is essentially a game of numbers, involving very large numbers. The fertility of a woman is cyclical; the target, a single ovulation. For men, sperm production is continuous. the targets are legion. "In an ejaculate, there are millions of spermatozoa, from 15 to 200 million per milliliter," explains Page. But fertility researchers have learned that it is not necessary to reduce sperm count in humans to zero – about one million sperm per milliliter of ejaculate was enough to make it a contraceptive. (Statistically, none of these millions of sperm will reach the egg.) The combination of testosterone and progestin may allow this reduction. It is also reversible; when men stop taking it, their sperm count should rebound. The biggest challenge is to get drug companies enough to fund R & D and encourage men to take such a drug.

Men simply have not been forced to look for a future where more birth control options exist. And it is unclear whether men would take a contraceptive pill or not: some surveys show that men are reluctant, while others suggest the opposite. Apathy is perhaps the most common feeling: a sense of complacency because women are leading the contraceptive show. "There is no real adherence from men responsible for birth control," says Eig, the author of Birth of the pill"And the pill is so financially successful that researchers are no more encouraged to study new forms of birth control for men."

Wang said pharmaceutical companies did not want "any interest in the industry" to fund new contraceptive methods targeting men. To develop the NES / T gel, she and Page have used funding from the National Institute of Child Health and Human Development and the Population Council, a non-profit organization that supports biomedical research. Other non-profit organizations, such as the Bill and Melinda Gates Foundation, have also allocated funds for research on male contraception. These groups focus on finding new ways to meet contraceptive needs; In the United States, almost half of all pregnancies are unplanned. This indicates the need for better and more varied options.

"The goal is not to remove what has already been accepted, but to provide another path, another choice," said Wang.

In Los Angeles, Medrano occasionally visits Wang to check his sperm level to monitor the effects of the NES / T freeze. not pregnant. Recently, he says that he thinks that the hormones make him "a little sullen", which made him more sympathetic with what Julia experienced with Depo-Provera.

When he talks about the gel to his friends and that he is taking part in a clinical trial, some of them seem surprised. Birth control, for men? They have never heard of such a thing. But then, says Medrano, the enthusiastic questions begin to arrive. "They all wanted to know what the side effects were," he says, "and when they could get it."

How we reproduce

Coming later this week:

• Childfree on Reddit – Because Apocalypse, that's why
• Inside secret groups of egg donations on Facebook