After Roe, Men Might Finally Get Better Birth Control

Following the US Supreme Court’s Dobbs decision, which ended the federal right to abortion , attention has centered on women’s access to birth control options like Plan B , IUDs or tubal ligation , and hormonal contraception . But what about options for men? Men only have a few reliable choices: Use condoms or get a vasectomy. Condoms are the most accessible; they’re cheap, readily available, don’t require a prescription, and according to Planned Parenthood , are 98 percent effective when used correctly.

But they’re not always used correctly or consistently, so in real life they’re only about 85 percent effective. Plus, many men don’t like using them—and some would prefer an option that’s less likely to be fumbled or forgotten. While more men seem to be pursuing vasectomies in the wake of Roe v.

Wade ’s overturn, the procedure isn’t easily reversible. Contraceptive drugs—akin to the pill for women—still aren’t available for men. But the court’s decision could speed their development.

“The Roe situation has really brought more societal attention to the lack of male contraception,” says Heather Vahdat, executive director of the Male Contraceptive Initiative, a nonprofit based in Durham, North Carolina, that funds research into nonhormonal, reversible male birth control. “I think men are wanting to be more engaged partners, but they just don’t have the tools. ” About 4 percent of US men aged 18 to 45 have undergone a vasectomy, a surgical procedure which involves cutting the tubes that carry sperm to be mixed into semen.

And while it’s too early to see how the post- Dobbs numbers will compare with previous years’, doctors at some clinics that provide vasectomies say they’re seeing more demand. “We’ve definitely had more interest,” says Sarah Vij, director of the Center for Male Fertility at the Cleveland Clinic in Ohio. Previously, the center got about 15 to 20 requests for vasectomy consultations a week.

That number jumped to 90 in the week following Roe ’s overturn. It’s not clear how many of those men will actually go through with the procedure, but the stakes of an unwanted pregnancy are much higher in Ohio than they used to be. In 2019, Republican legislators passed a bill making abortion illegal past six weeks into a pregnancy, but a federal court had blocked its enforcement so long as Roe was in place.

The law went into effect in June , just hours after the Supreme Court delivered its decision. James Daitch, a doctor at Arizona Urology Specialists who performs vasectomies, says his practice has seen a 21 percent increase in calls for vasectomy consultations since last year around this time. “My feeling is that people are becoming more aware of vasectomies.

If I had to predict, my guess is that more men will be getting them than in the past,” he says. Arizona may also be facing tighter abortion laws. In March, Governor Doug Ducey signed a bill into law limiting abortion access to 15 weeks of pregnancy.

Arizona has a pre-statehood law that bans all abortions, but it’s been blocked by a court order for nearly 50 years. Earlier this month, the state’s Republican attorney general asked a court to reinstate the ban for all abortions except when the life of the mother is at risk. Daitch says men need to think carefully before undergoing a vasectomy.

The procedure, while quick and more than 99 percent effective, is considered a permanent form of birth control. A vasectomy can sometimes be reversed, but that involves a more complicated surgery and it doesn’t always work. It’s also expensive—around $5,000 to $15,000, according to the Urology Care Foundation—and not typically covered by insurance.

“If someone is going into a vasectomy, they should be sure that they’re done having kids,” Daitch says. (Medical guidance is often more restrictive for women seeking tubal ligation or sterilization , in which the fallopian tubes are blocked to prevent pregnancy. Doctors can refuse if they feel a patient is too young or hasn’t had enough children, or even require the consent of her partner.

) Reversible forms of male birth control are still experimental, but are getting closer to reality. Scientists have been trying to develop a male analogue to the pill for decades, but a major challenge has been finding something that is effective without too many negative side effects—a problem that has plagued women’s hormonal birth control, and is a barrier for some people who either cannot or choose not to use it. “I would say the biggest sticking point is the differences in male versus female physiology,” says John Armory, a professor of medicine at the University of Washington who is studying several male contraceptive methods.

Men make 1,000 sperm every second. By contrast, women make one egg per month. “It’s proven a lot easier to suppress that process than it has to turn off the factory of the testes that’s producing sperm,” he says.

One candidate being developed by researchers at the National Institutes of Health and the nonprofit Population Council is a hormonal gel that contains a synthetic progestin called Nestorone, which blocks natural testosterone and reduces sperm count. The gel also contains a replacement testosterone to help maintain normal sex drive and regulate other functions. Nestorone is already approved for use in Annovera, a vaginal ring for women.

It doesn’t work orally though, so for the male version, researchers formulated it into a gel. It’s intended to be rubbed on the shoulders daily, and absorbed through the skin. Like the pill for women, it needs to be applied at the same time every day.

The research team’s goal is to get sperm counts below 1 million per milliliter of semen, because previous studies have suggested that pregnancies are unlikely to occur at that level. (Normal sperm counts range from 15 million to more than 200 million sperm per milliliter. ) The gel is being tested in a Phase 2 clinical trial involving more than 400 couples.

Mitchell Creinin, the director of family planning at UC Davis Health, one of the trial sites, says the gel appears extremely promising; so far, it’s making sperm counts plummet and is preventing pregnancy. Men have been very enthusiastic about using it, he says. “One of the things that we’re seeing from this study is this realization of how important this is to men who are in relationships and care about their partner,” he says.

“I have been so impressed with how many men really want to step up as part of the relationship. ” Phase 2 trials test a drug for both efficacy and safety, typically in hundreds of volunteers, and look for harmful or unpleasant drug reactions. A previous Phase 2 trial of an injectable hormone-based contraceptive for men was stopped in 2011 because the drug had too many side effects , including muscle pain, increased libido, acne, and depression.

Its development was backed by the World Health Organization and CONRAD, a reproductive health nonprofit. For the gel trial, side effects might include weight gain and mood issues. “There are going to be a small percentage of men that are going to have some kind of side effects, but we know that’s true for lots of different female contraceptives as well,” Creinin says.

“We’re not looking for the product that will work perfectly for every single man; we’re looking for the product that is going to work very well for the majority of people. ” Next, the gel will need to go through testing in a larger Phase 3 clinical trial, which will likely include thousands of couples. It will also need a pharmaceutical company to manufacture and bring it to market, since NIH and the Population Council don’t have the ability to commercialize drugs.

(The NIH is also sponsoring early-stage trials of hormonal pills designed to lower sperm count by suppressing testosterone. ) Financing has been a major hurdle for male contraceptives: In recent years, pharmaceutical companies haven’t been involved in their research and development. Instead, philanthropic organizations and the public sector have been the main funders of such efforts.

But investment firms like Rhia Ventures, a San Francisco-based company focused on reproductive health, are trying to turn that problem around. CEO Erika Seth Davies says it’s important that nonhormonal forms of birth control are available for men. “In this post- Roe world, making sure that there is a robust offering of contraception and access to contraception is going to be imperative,” she says.

“We’re trying to make sure that there are more options available on the market, because the responsibility for pregnancy prevention has been squarely placed on women’s shoulders for so long. ” In addition to funding female contraceptive efforts, her firm is investing in Contraline , a Virginia-based biotech company that’s developing a reversible, nonhormonal form of male birth control. Contraline’s method involves a permeable hydrogel that’s injected into the vas deferens, the pair of tubes in the male reproductive system that transport sperm.

The gel is designed to block sperm without affecting sensation or ejaculation. The company is running a small Phase 1 trial in Australia to test the safety of the approach. Your Choice Therapeutics and Eppin Pharma are also pursuing nonhormonal forms of male contraception.

Your Choice is developing a pill meant to block sperm cell development, while Eppin’s method is meant to stop sperm from fertilizing an egg. But those companies have yet to move into human testing. One of the hurdles for all of these efforts will be getting regulatory approval for any product that clears Phase 3 trials.

No contraceptive drug for men has ever gotten to that stage, so the US Food and Drug Administration will have to decide what level of risk is acceptable. Women’s birth control pills result in about one death per 200,000 users, primarily from blood clots that can arise from using the pills. Men don’t have any of the physical risks of pregnancy , so calculating that risk-benefit calculation will be tricky, says Armory.

He thinks that’s one reason pharmaceutical companies have been reluctant to get involved in male birth control. But ultimately, more contraceptive options will benefit everyone, he says: “The market is huge—we’re talking about potentially millions of men. ” With the fall of Roe , Creinin thinks it’s time for the government to increase funding for male contraception research.

“We are on the precipice of change in societal norms,” he says. “Whatever product is first to market is going to be a social game changer. ”.