Helping men choose a birth control option

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Despite limited contraceptives for men, physicians should still discuss existing options with men to help them make informed choices. 

When it comes to birth control options available for men, the pickings are slim, though there are some new options on the horizon, says Logan Nickels, PhD, director of operations and programs for the Male Contraceptive Initiative (MCI). The non-profit organization, based in Durham, N.C., focuses on advocacy and grant-making around reversible, non-hormonal contraceptive solutions for men.

Existing methods include condoms, vasectomy, and the withdrawal method, the latter of which Nickels says he wouldn’t recommend to anyone under any circumstances because it is not a foolproof method of preventing pregnancy. 

When helping men decide upon a contraceptive option, Nickels says physicians should make sure that men understand the implications of the method they choose.

Vasectomies, for instance, shouldn’t be undertaken as a temporary solution. 

While some are reversible, Nickels says “It’s really considered a non-reversible procedure. You shouldn’t go into a vasectomy with the idea that you’re going to then get it reversed. It should be treated as a semi-permanent surgery.”

For that matter, condoms are only between 85 percent and 98 percent effective at preventing pregnancy.

What’s most important, Nickels says, “Is finding ways for men to be a part of this contraceptive conversation, so that it becomes more of a two-way street.” 

While the options are limited for men, he says this doesn’t mean they have to be hands-off on ideas of contraception or family planning goals. 

Additionally, just because options are limited now, doesn't mean things will remain that way. There are several significant developments in male contraception that Nickels says his organization is excited about.

One such category is vas-occlusive products, such as Vasalgel, a hydrogel polymer that is injected into the vas deferens. 

“This creates a plug that prevents the passage of sperm through the reproductive tract,” Nickels says. 

That plug is designed to remain stable over a period of time, and when a man desires to return to fertility, a second injection dissolves that plug, restoring fertility completely.

Because it is categorized as a medical device rather than a contraceptive treatment, he anticipates it will actually hit the consumer market much sooner than hormonal options, perhaps as few as five years.

However, hormonal options for men are also in the works. One is a hormone gel that would be rubbed on the shoulders once a day. Several formulations of oral pills, similar to the birth control options for women, are also under development, and even an injectable option.

Hormonal birth control for men relies upon a steroidal mechanism to suppress spermatogenesis, Nickels says. It essentially prevents the man from creating new sperm, as long as the hormones are being administered. 

Several of these products are in clinical trials where they are studying their safety and efficacy but it could be as many as 15 or 20 years before these are available clinically.

“The endgame is that men and women alike have a slate of options, a menu of things that have various onset times, side effects, mechanisms of action so that if one option isn’t feasible, there’s something readily available next to it.”

Nickels says his organization is really interested to see what men are excited about and what they will use. 

“One of the key pieces right now is ensuring that men are engaged in the process and understand their options as well as their benefits, so that when new options become available, it won’t be such a sea change for men to be suddenly thrust into the world of contraception,” Nickels says.