Male contraceptives, also known as male birth control, are methods of preventing pregnancy that are used by males or people who produce sperm.[1] The main forms of male contraceptives available today are condoms, vasectomy, and withdrawal, and these methods combined make up less than one-third of global contraceptive use.[2][3][4][5]

New forms of male contraception are in clinical and preclinical stages of research and development, but as of 2024, none have reached regulatory approval for widespread use.[6][7][8][9] Surveys indicate that around half of men in countries across the world are interested using a variety of novel contraceptive methods,[10][11][12] and men in clinical trials for male contraceptives have reported high levels of satisfaction with the products.[13][14] Modelling studies suggest that even partial adoption of new male contraceptives would significantly reduce unintended pregnancy rates around the globe,[15] which remain at nearly 50%, even in developed countries where women have access to modern contraceptives.[16][17][18] Unintended pregnancies are associated with negative socioeconomic, educational, and health outcomes for women, men, and the resulting children (especially in disadvantaged communities),[17][19][20][21][22][23][24] and so the development of new male contraceptives has the potential to improve racial, economic, and gender equality across the world.

Currently available methods

Vasectomy

Diagram of an open vasectomy

Main article: Vasectomy

Vasectomy is surgical procedure for permanent male sterilization usually performed in a physician's office in an outpatient procedure.[25] During the procedure, the vasa deferentia of a patient are severed, and then tied or sealed to prevent sperm from being released during ejaculation.[26] Vasectomy is an effective procedure, with less than 0.15% of partners becoming pregnant within the first 12 months after the procedure.[27] Vasectomy is also a widely reliable and safe method of contraception, and complications are both rare and minor.[28][29] Vasectomies can be reversed, though rates of successful reversal are variable, and the procedure is often costly.[25][26]

Condoms

A rolled-up condom

Main article: Condom

A condom is a barrier device made of latex or thin plastic film that is rolled onto an erect penis before intercourse and retains ejaculated semen, thereby preventing pregnancy.[30] Condoms are less effective at preventing pregnancy than vasectomy or modern methods of female contraception, with a real-world failure rate of 13%.[27] However, condoms have the advantage of providing protection against some sexually transmitted infections such as HIV/AIDS.[31][32] Condoms may be combined with other forms of contraception (such as spermicide) for greater protection.[33]

Withdrawal

Main article: Coitus interruptus

The withdrawal method, also known as coitus interruptus or pulling out, is a behavior that involves halting penile-vaginal intercourse to remove the penis out and away from the vagina prior to ejaculation.[34][35] Withdrawal is considered an less-effective contraceptive method, with typical-use failure rates around 20%.[25][27] However, it requires no equipment or medical procedures.[34]

Contraceptive Failure Rate[27][note 1]
Method Typical use Perfect use
Vasectomy 0.15% 0.10%
Condoms 13% 2%
Withdrawal 20% 4%

Research into new methods

Researchers are currently working to generate novel male contraceptives with diverse mechanisms of action and possible delivery methods, including long-acting reversible contraceptives (LARCs), daily transdermal gels, daily and on-demand oral pills, monthly injectables, and implants.[36][37][38] Efforts to develop male contraceptives have been ongoing for many decades, but progress has been slowed by a lack of funding and industry involvement. As of 2024, most funding for male contraceptive research is derived from government or philanthropic sources.[39][40][41][42]

Male contraceptives can work by blocking various steps of the sperm development process, blocking sperm release, or interfering with any of the sperm functions necessary to reach and fertilize an egg in the female reproductive tract.[43] Advantages and disadvantages of each of these approaches will be discussed below, along with relevant examples of products in development.

Block or interfere with sperm production

These methods work by preventing the testes from producing sperm, or interfering with sperm production in a way that leads to the production of nonfunctional sperm.[44] This approach can be accomplished by either hormonal or nonhormonal small-molecule drugs, or potentially by thermal methods. The effectiveness of contraceptives in this group can be easily assessed microscopically, by measuring sperm count or abnormalities in sperm shape, but because spermatogenesis takes approximately 70 days to complete,[45] these methods are likely to require approximately three months of use before they become effective, and approaches that halt sperm production may result in reduced testicular size[citation needed].

Hormonal contraceptives

Hormonal contraceptives for men work similarly to hormonal female methods, using steroids to interrupt the hypothalamic-pituitary-gonadal axis and thereby block sperm production. Administering external androgens and progestogens suppresses secretion of the gonadotropins LH and FSH, which impairs testosterone production and sperm generation in the testes, leading to reduced sperm counts in ejaculates within 4–12 weeks of use.[46] However, since the contraceptives contain testosterone or related androgens, the levels of androgens in the blood remain relatively constant, thereby limiting side effects and maintaining masculine secondary sex characteristics like muscle mass and hair growth.[46]

Multiple methods of male hormonal contraception have been tested in clinical trials, and although one trial was halted early, leading to a large amount of press attention,[47][48][49][50][51] most hormonal male contraceptives have been found to be effective, reversible, and well-tolerated.[52][53][54][55][56][57]

In clinical trials

As of 2024

Some anabolic steroids may exhibit suppressive effects on spermatogenesis, but none are being investigated for use as a male contraceptive.[67]

Non-hormonal contraceptives

Non-hormonal contraceptives for men are a diverse group of molecules that act by inhibiting any of the many proteins involved in sperm production, release, or function. Because sperm cells are highly specialized, they express many proteins that are rare in the rest of the human body.[68][69][70] This suggests the possibility that non-hormonal contraceptives that specifically block these sperm proteins could have fewer side effects than hormonal contraceptives, since sex steroid receptors are found in tissues throughout the body.[71] Non-hormonal contraceptives can work by blocking spermatogenesis, sperm release, or mature sperm function, resulting in products with a wide variety of usage patterns, from slow onset to on-demand usage.[72] Contraceptives targeting mature sperm functions could even be taken by both sperm-producing and egg producing people.[73][74] Challenges of non-hormonal contraceptive development include bioavailability and delivery past the blood-testis barrier.[75]

In clinical trials

As of 2024

In preclinical development

As of 2024

Thermal male contraceptive approaches

Main article: Heat-based contraception

Prolonged testicular heating has been shown to reduce sperm counts,[95][96][97] but no modern clinical trials have demonstrated the safety, contraceptive effectiveness, or reversibility of this approach. Various devices are in early preclinical stages of development, and some approaches are being used by men through self-experimentation.[98][99] The mechanism by which heating disrupts spermatogenesis is still not fully understood,[100] and there are concerns that prolonged heating could increase the risk of testicular cancer (since natural cryptorchidism carries a high risk of testicular cancer[101]) or that heating could damage sperm DNA, resulting in harm to potential offspring.[102]

Block sperm release

These approaches work by either physically or pharmaceutically preventing the emission of sperm during ejaculation, and are likely to be effective on-demand.

Vas-occlusive

Main article: Vas-occlusive contraception

Vas-occlusive contraception provides a contraceptive effect through physical blockage of the vas deferens, the duct connecting the epididymis to the urethra. While a vasectomy excises, or removes, a piece of each vas deferens and occludes the remaining open ends of the duct, vas-occlusive methods aim to block of the duct while leaving it intact. Vas-occlusive methods generally aim to create long-acting reversible options, through a second procedure that removes the blockage.[103] However, full reversibility remains questionable, since animal and human studies have shown sperm abnormalities, incomplete recovery of sperm parameters, and the development of fertility-impairing antibodies against one's own sperm after blockage removal.[104][105][106][107][108][109]

In clinical trials

As of 2024

In preclinical development

As of 2024

Barrier methods in development

Research into new, more acceptable designs of condoms is ongoing.[127][128]

Block functions of mature sperm

These approaches work by blocking functions that mature sperm need in order to reach and fertilize an egg in the female reproductive tract, such as motility, capacitation, semen liquification, or fertilization. Drugs or devices that target mature sperm are likely to be effective on-demand (taken just before intercourse), and could even be delivered either in sperm-producing or egg-producing bodies, leading to unisex contraceptives.[73][74]

In preclinical development

As of 2024

Acceptability

Although some people question whether men would be interested in managing their own contraceptives[151] or whether women would trust their male partners to do so successfully,[152] studies consistently show that men around the world have significant levels of interest in novel forms of male contraception[153][154][155][10][156][157] and that women in committed relationships would generally trust their male partners to manage the contraceptive burden in the relationship.[153] Additionally, males participating in various contraceptive clinical trials have reported high satisfaction with the products they were using.[63][13][14]

Among men

Studies on potential uptake indicate that in most countries, more than half of men surveyed would be willing to use a new method of male contraception.[158][154][155][159][160][161] Interestingly, some of the highest rates were reported in low-income countries like Nigeria and Bangladesh where 76% of men surveyed indicated that they would be willing to use a new method within the first 12 months that it is available.[155] This is particularly compelling given the previously mentioned estimates that a mere 10% uptake of new male contraceptive methods could avert nearly 40% of unintended pregnancies in Nigeria.[15] Across the world, many young and middle-aged men especially want the ability to control their own fertility, and are not well-served by existing family planning programs.[162]

Although a phase II trial for an injectable male contraceptive was halted in 2011 by an independent data safety monitoring board due likely to rare adverse effects experienced by some participants,[163][164] leading many popular articles to suggest men could not tolerate side effects similar to those that many women endure on hormonal birth control,[165] in reality more than 80% of the study's male participants stated at the end of the trial that they were satisfied with the contraceptive injection, and would be willing to use the method if it were available.[166] Subsequent hormonal male contraceptive clinical trials have progressed successfully, showing high levels of efficacy and acceptability among the participants.[13][14][63][167]

Among women

It is sometimes assumed that women won’t trust men to take contraceptives, since women would bear the consequences of a missed dose or misuse.[152] Of course, male contraceptive options would not have to replace female contraceptives, and in casual sexual encounters both partners may want to independently control their own contraceptive methods. On the other hand, some long-term couples might want only one partner to bear the contraceptive burden. Indeed, there is evidence that a large proportion of women in relationships in many countries around the world would trust their partners to take a potential male method,[168][155] and many women want more male partner involvement in their own reproductive health services.[169] Further, current contraceptive use data show that more than a quarter of women worldwide already rely on male-controlled methods for contraception,[170] and this figure could grow as more male contraceptive methods become available.

Potential benefits

On unintended pregnancy rates

Despite the fact that modern pharmaceutical contraception has been available to women since the 1960s,[171] 40-50% of pregnancies are still unintended worldwide, leading to an approximate total of 121 million unintended pregnancies annually.[172][173][174] Importantly, most studies on unintended pregnancies only measure the female partner's feelings about the pregnancy, and so pregnancies that were unintended by male partners may be significantly under-reported.[175] Unintended pregnancies have been shown to be linked with a wide variety of negative outcomes on mental and physical health, and educational and socioeconomic attainment, in both parents and the children born of unintended pregnancies[17][19][20][22][23][24] Surprisingly, although the rate of unintended pregnancies (per 1000 women of childbearing age) is higher in developing countries,[173][176][177] the percentage of all pregnancies that are unintended is actually higher in developed countries.[173] This fact suggests that the current suite of contraception tools is insufficient for successfully preventing unintended pregnancies, and research indicates that unmet need for modern contraception is the cause of 84% of unintended pregnancies in developing countries.[178] In the United States, which has a higher unintended pregnancy rate than many other developed nations,[179] one important reason that women cite for nonuse of contraceptives is concerns about the side effects of existing products.[180] Therefore, the introduction of new contraceptives is likely to decrease the stubbornly high rate of unintended pregnancy.[15] Indeed, modeling shows that approximately 5% of unintended pregnancies in the USA and South Africa, and 30-38% of unintended pregnancies in Nigeria could be prevented with male contraception uptake of only 10% in those countries,[15] which is a very low estimate of male uptake, according to newer acceptability research in these countries.[155] In absolute terms, this modelling suggests that novel male contraceptives could avert roughly 200,000 unintended pregnancies per year in both the USA and Nigeria.[15]

For men

Fathers with unintended births report lower proportions of happiness than in fathers with intentional births[181] and unintended fatherhood in men's early 30's is associated with a significant increase in depressive symptoms.[182] In addition, men in insecure financial situations are more likely to report a recent unintended pregnancy,[183] and supporting and raising a child brings significant costs that can exacerbate financial insecurity.[184][185] More broadly, access to effective and reliable contraception would advance men's ability to "maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities" in accordance with the principles of Reproductive Justice.[186]

For women and gender equity

Family planning has been found to be associated with overall well-being and is one of the most efficient tools for women's empowerment.[187][188][189] Positive outcomes of effective birth control include improvements in women's health, self-agency, education, labor force participation, financial stability, as well as decreases in pregnancy-related deaths.[190][191][192] It can be anticipated that these positive social and health impacts already associated with use of female contraception will be further realized with the addition of more male methods, since new male contraceptive options would not come at the expense of women’s reproductive autonomy; women would still be able to take advantage of all of the contraceptive methods available to them, or choose to have both partners use their own contraceptive methods at the same time or rely solely on their male partners’ form of contraception.

Interventions targeting male engagement as partners in reproductive health and family planning services have shown positive outcomes related to promoting more equitable gender norms in the context of family planning,[193] and increased joint decision making in couples. It is reasonable to assume from these data that increasing male involvement as family planning users will further improve gender equity.[194]

For transgender, nonbinary, and intersex people

While this article has used the term "male" contraception for clarity, these contraceptives are most accurately described as "sperm-targeting" contraceptives, since they would work effectively in any body that produces sperm, regardless of that person's gender identity or external genitalia.[73] Transgender, nonbinary, and intersex people are underserved by current contraceptive options. For example, many trans men can become pregnant (both intentionally and unintentionally),[195] but may prefer not to use estrogen- or progestin-containing hormonal birth control (both because of the social classification of these hormones as "female sex hormones" and because of a fear they will interfere with masculinizing hormone therapy, although the American College of Obstetricians and Gynecologists states that these hormonal contraceptives have little effect on masculinization.)[196][197][198] Trans women who have not had gender-affirming genital surgery may have similar unmet contraceptive needs as cisgender men, since gender-affirming hormonal therapy is not effective contraception.[198] Nonbinary and intersex people may be less likely to use current methods of birth control, since they are popularly categorized by the labels "male" and "female", which may not match an individual's gender identity or may invoke feelings of gender dysphoria.[197] This dynamic may contribute to the higher rates of unintended pregnancies seen in the LGBTQ+ community as compared to heterosexual peers.[199][200][201]

For children

Novel male contraceptive options are predicted to reduce the incidence unintended pregnancies,[15][202] and being the product of an intended rather than unintended pregnancy has been shown to correlate with improved health and wellbeing outcomes in children.[21][191][203][204] Additionally, reduced family size correlates with improved educational outcomes,[205] and children born after the introduction of family planning programs in the USA experienced a reduction in poverty rates, both in childhood and adulthood.[206]

For racial and socioeconomic equality

Unintended pregnancies rates increase as income decreases, both between countries[207] and between socioeconomic and racial groups within a given country.[179][208]  Women of color, especially Black women, in the United States and other developed countries have dramatically higher rates of death during and after birth and worse maternal health outcomes.[209][191]  Since unintended pregnancies can have negative effects on an individual's physical and mental health, educational attainment, and economic prospects, these higher unintended pregnancy rates likely contribute to the persistent socioeconomic gaps within and between societies.[17][19][20][21][22][23][24]   It’s therefore possible that the introduction of new male contraceptives would not only mitigate gender inequities, as discussed above, but racial and income inequities as well, by providing more ways for individuals to avoid unintended pregnancies.[15]

Economic

In addition to the personal financial savings of avoiding unintended pregnancy mentioned above, on a societal level, contraceptives are a public health intervention with a high return on investment: for every dollar the United States government spends on family planning programs, it saves $7.09, for a total of over $13 billion per year.[210] Unintended pregnancies in the United States are estimated to cause $4.5 billion in direct medical costs.[24][22] New male contraceptives are likely to prevent some unintended pregnancies[15] and therefore reduce these costs.

On abortion rates

61% of unintended pregnancies end in abortion,[211] whereas only 20% of all pregnancies end in abortion,[212] and the incidence of abortion is similar in countries where abortion is illegal and countries where abortion is legal.[211][213] Importantly, increases in the prevalence and uptake of modern contraceptives have been shown to decrease unintended pregnancy and abortion rates when fertility rates are constant.[214][215][216] This suggests that the introduction of new forms of male contraception could prevent a significant number of abortions.

History

A variety of plant extracts have been used throughout history in attempts to prevent pregnancy, though most were used by women, and the efficacy and safety of these methods is questionable.[217][218][219] Condoms have been in documented use since at least the 16th century.[220]

Past research efforts

Many researchers have attempted to develop male contraceptive products over the last hundred years. A selection of these efforts (that are no longer in development as of 2024) are listed below.

notes

  1. ^ The percentage of users of each method who will experience an unintended pregnancy in the first year of use of the method.

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