On a recent morning in Los Angeles, Michael Medrano killed a teaspoon of large cold gel on his shoulders. These days it's just another part of the routine: Brushing teeth. Apply deodorant. Comb hair. Dab gel.
The gel described by Medrano as a consistency of hand cleaners contains testosterone and progestin, a hormonal composite material that suppresses the body's natural production of semen. Massaged into his skin, it functions as the only contraceptive he and his wife, Julia, will spend for the next 18 months.
A few years ago Julia stopped taking Depo-Provera, an injectable form of hormonal birth control, which had gained its weight to fluctuate and made her in Medrano's words, "kind of moody." Condoms worked fine, but Julia was worried about slipping. So when Medrano encountered a speech on Reddit that recruited participants for a clinical trial of this new form of contraception, it seemed worth a shot. Julia, happy to be relieved of the burden of managing the couple's birth control, agreed.
Recently, about 400 other couples in nine cities around the world have similarly worked on the gel in their daily routines. It is one of the greatest studies of hormonal contraception by the mother ever. Like Medrano, they use the gel instead of other contraceptives, while scientists monitor their sperm counts and any unforeseen side effects. If the gel makes it to the market, it becomes the first hormonal contraceptive for men ̵
It is a great "if" and it depends on a tangle of scientific, social and bureaucratic complications. The gel itself is more than a decade in the creation, developed by researchers at the Los Angeles Biomedical Research Institute and the University of Washington. The groups have used their career chasing better contraception for men, but no one has made it on the pharmacy shelves. But the gel-called NES / T looks very promising. Now, scientists just need to study how it works with Medrano and the other couples in the wild, and hope to prove that hormonal male contraception also deserves to move out of the lab and into men's life.
The pathway to hormonal contraceptive men begins in 1957, in the laboratory of Gregory Pincus, an endocrinologist who made his name to study the effects of hormones on disorders such as heart disease and schizophrenia. In 1951, encouraged by a friendship of the feminist activist Margaret Sanger – and a small grant from the Planned Parenthood Federation of America-Pincus, began exploring how hormones could manipulate a woman's menstrual cycle and prevent ovulation. A combination of estrogen and progestin he found did the trick. His invention, called Envoid, was marketed as a "menstrual regulator with a side effect to prevent pregnancy." In 1960, the FDA approved its use as a contraceptive which would soon become known as the "pill".
During the research that led to the birth control pill, Pincus also hoped to create an analogue of the drug for men. It seemed that, as progestin could interfere with a woman's natural cycle, it could also interfere with the natural production of semen. He and other researchers put this hypothesis to the test at the end of the 50s and injected both men and women into Massachusetts psychiatric hospitals with doses of the drug (ethical standards were looser at that time) to see if it could make men temporarily sterile. The results were unimaginable.
Arielle Pardes covers personal technology, social media and culture for WIRED.
"As soon as it started, the women who funded the project [Margaret] Singer and [birth control pioneer Katharine] McCormick, were furious. They just wanted it for women," says Jonathan Eig, author of Pillens birth . "It's brilliant design if what you're trying to do is put control in the hands of women. But over time, one of the side effects is that men don't even participate in the conversation."
Interest in male contraception dropped, darkened of the pill's overwhelming success. But some researchers continued to work on the idea over the coming decades. The National Institutes of Health supported clinical trials throughout the 1970s, followed by multinational studies sponsored by the World Health Organization in the 1990s. In China, researchers with gossypol, a plant derivative, experimented to lower the sperm nonhormonally. Another plant extract, ouabain, has also been considered (the composition is used by African hunters who dive their arrows in it to stop their bytes' hearts). In India, researchers have found promise for an injection-based procedure called RISUG, sometimes called a "non-surgical vasectomy". None of these methods have made it to the market.
Stephanie Page had just completed her medical education when, in 2002, she began examining male hormonal contraception. Now a professor at the University of Washington, Page monitors three studies of new contraceptive methods for men: a hormonal pill that suppresses sperm production with a compound called DMU; an injection modeled after the Depo-Provera shot for women; and the NES / T gel that uses a type of progestin called nesterone in conjunction with testosterone. Of the three, the gel is furthest along, but Side warns that "drug development is not a start. It does not happen overnight, or even in a few years."
In many attempts, Progestin has been shown to stunt sperm production. Testosterone is there to balance its side effects, such as loss of libido, hair loss or fatigue. Christina Chung-Lun Wang, a researcher at Los Angeles Biomed and another principal researcher in NES / T clinical trials, says that similar methods of male contraception have been tested as far back as in the 1970s with "overwhelmingly positive" "results. "The goal now is to find a combination that will be just as effective, but with minimal side effects," she says.
The development of contraception for men is basically a speech game involving very large numbers. A woman's fertility is cyclical; goal, a single ovulation. For men, sperm production is continuous; the goals are legion. "In a ejaculate, there are millions of sperm-15 to 200 million per milliliter," says side. But fertility researchers have learned that a man's sperm does not need to be lowered to zero. A figure of about 1 million sperm per milliliter of ejaculate is low enough to count as contraception. (Statistically, none of the millions of sperm will reach the egg.) The combination of testosterone and progestin can achieve this reduction. It is also reversible; When men stop taking it, their sperm must jump back. The biggest challenge is getting pharmaceutical companies interested enough to fund R&D and getting men to take such a drug.
Men have simply not had to push for a future where there are more contraceptives. And it is not clear whether men will take a pill: Some studies show that men are reluctant while others suggest the opposite. The most profound feeling can be apathy – a sense of complacency because women run the contraception program. "There is no real purchase when it comes to men taking responsibility for birth control," says Eig, the author of Pill's Birth "and the pill becomes so successful that there is not much incentive for researchers to investigate new forms of contraception for men too. "
Wang says there is" zero industrial interest "from pharmaceutical companies to fund new contraceptive methods that target men. To develop the NES / T gel, she and Page have claimed funding from the National Institute for Child Health and Human Development and the Population Council, a nonprofit that supports biomedical research. Other nonprofits, such as the Bill and Melinda Gates Foundation, have also earmarked funds for research on male contraception. These groups are focused on finding new ways to meet contingency needs; In the United States, almost half of the pregnancy is unplanned. It signals the need for better and more diverse opportunities.
"The goal is not to remove what has already been accepted, but to give another avenue, another choice," Wang says.
In Los Angeles, Medrano makes occasional visits to see Wang checking his sperm levels controlled to monitor the effects of the NES / T gel. So far everything seems to work as planned – Julia is not pregnant. Recently, he says he thinks that the hormones make him "a little moody," which made him more sympathetic to Julia's experience with Depo-Provera.
When he tells his friends about the gel and participates in a clinical trial, some of them seem surprised. Birth control, for men? They had never heard of such a thing. But then, Medrano says, the tense questions begin to roll in. "They all wanted to know what the side effects were," he says, "and then they could get it."
How we reproduce
Coming later week:
- Childfree on Reddit-Because Apocalypse, that's why
- Inside the Secret Facebook Egg Donation Groups