If you’re having sex, chances are you’re thinking about birth control. But besides condoms, most of what’s out there is made for women. What’s a man who wants control over his reproductive health to do? Male birth control hasn’t historically gotten the scientific attention or cultural buy-in of the pill, but progress is happening. Birth control for men — including, yes, a male birth control pill — is on the horizon. It’s just not here quite yet.
Although there’s currently no hormonal medication approved by the FDA, male birth control options do exist. Here are ways you can keep yourself protected while science works its magic, and what the future of male birth control could look like.
There aren’t any birth control pills for men, despite studies finding that up to 83% of men would gladly take them.[1] Funding has been difficult to get for male contraceptives, and many of the attempts made thus far had too many side effects for the trials to continue, even though the male birth control side effects are often the same as those for women: mood changes, weight gain and acne.[2]
One promising male birth control pill is DMAU, or dimethandrolone undecanoate, which works by blocking sperm production. Like the female pill, DMAU is taken orally every day, though it’s possible it’ll also be offered as an injection. In a recent trial, 80% of the participants were satisfied after taking DMAU for 28 days and 54% said they would use it as their primary method of birth control.[3] More studies are needed before the FDA would approve a pill like DMAU, but it’s a major step forward.
A second pill passed human safety tests in 2019.[4] With an even less catchy name than DMAU, 11-beta-MNTDC works in much the same way: by combining a male hormone with progestin, one of the two hormones found in combined contraceptive pills for women.
These days, new types of birth control pills go through rigorous testing before being approved by the FDA and stocked at your local pharmacy — but this wasn’t always the case. Due to morality laws in place in the early and mid 1900s, testing birth control just wasn’t possible.[5] One early trial was disguised as a “fertility study,” while a larger trial took place in Puerto Rico, where the women taking the experimental medication weren’t told they were taking experimental medication or that there could be dangerous side effects. Three of the women died during the first phase of the trial.
After the “success” in Puerto Rico, a second trial was done in American mental asylums, where both men and women were given the pills without consent. The first birth control pill, Enovid, was approved in 1957.[6]
Modern standards of ethics and safety mean science must move much slower. Only seven years passed between the fertility study and Enovid’s approval, whereas over seventy years of progress in female birth control have given us no hormonal options for men.
You may have heard of the male birth control Vasalgel, a type of RISUG or reversible inhibition of sperm under guidance. Think of it like Vasectomy Lite — and notice the “vas” in both words. Because this isn’t a gel that’s applied to the penis the way that spermicide gel (more on that later) is put into the vagina, but rather a polymer gel that’s injected into the vas deferens. It blocks the flow of sperm rather than decreasing its production so theoretically has fewer side effects, and is the one male birth control option that’s both long-term and reversible.
The male birth control gel was successfully tested on male rhesus monkeys[7] and received a $200,000 grant for preclinical studies in 2019, but has yet to advance to human trials.
There are two types: male and female condoms. The male condom goes over the penis and the female condom goes inside the vagina.
It’s the male condom that gets most of the attention, as it’s easy to use, relatively inexpensive and up to 98% effective when used correctly. As a bonus, condoms can also protect you from some sexually transmitted infections.
Spermicide does what it says on the tin: it kills sperm. You can ge it as a gel, cream, foam, suppository and even tablet, and it needs to be inserted into the vagina before sex to work. Spermicide is available at most drug stores and doesn’t require a prescription so it’s easy to get, but not the most effective type of birth control. It’s best used alongside a barrier method like a condom.
There’s also a vaginal pH regulator gel called Phexxi which immobilizes sperm rather than killing it, but it’s prescription-only so a man isn’t able to purchase it.
The opposite of intercourse, outercourse is sexual activity that doesn’t include penetration. Though the term “penetrative sex” tends to be used for anal or vaginal penetration and doesn’t include oral, outercourse doesn’t include oral either — instead, it’s everything from kissing to cuddling to mutual masturbation.
The withdrawal method, also called the pull-out method or pulling out, is a birth control method where the penis is removed from the vagina prior to ejaculation. The idea is to have penetrative sex but keep sperm out of the vagina. It’s got a few obvious benefits: it’s free, doesn’t require supplies or a prescription and has no side effects.
The downside is it’s not particularly effective. Making sure you pull out at the right time is tricky, and pre-ejaculation fluid can also contain sperm. To make the withdrawal method safer, consider having emergency contraception available as a back-up and pair pulling out with a barrier method like condoms.
Also called the fertility awareness method (FAM) or the rhythm method, natural family planning involves monitoring a woman’s fertility throughout her cycle and scheduling sex for the days when she’s least likely to get pregnant. This might sound even riskier than pulling out, but natural family planning can actually be up to 99% effective when done consistently (and correctly).[8]
There are three main FAMs — menstrual cycle length, daily body temperature readings and changes to cervical mucus — and someone can use one or all of these methods. The “up to 99% effective” figure requires using all three; if you only use one, the effectiveness drops to about 76-88% depending on the method you pick.[9]
Because natural family planning is based around when ovulation happens, it’s not really a birth control method for men — but it’s always good to treat contraception as both partners’ responsibility.
The most effective male birth control is a procedure called the vasectomy. Also known as male sterilization, this birth control surgery is over 99% effective but takes time (around 3 months) and quite a bit of commitment. And although the vasectomy is often described as reversible, whether it actually is depends on several factors like how long ago you had the surgery.
Unlike the male birth control pills currently being researched (which limit sperm production) and spermicide (which kills sperm), a vasectomy keeps sperm from entering your semen. This is done by cutting or blocking the vas deferens, a tube in your scrotum that carries sperm up to the penis. The vas deferens is where the vasectomy gets its name.
Vasectomies are an outpatient procedure, meaning you don’t have to stay at the hospital overnight but rather just for the length of your appointment. The actual surgery takes less than 20 minutes.
Can a man take birth control pills? Yes, but you really shouldn’t — at least if you’re a cisgender man. If you’re a transgender man, you can continue taking your prescribed hormonal birth control even if you’re also undergoing testosterone hormone therapy.
Female birth control works by introducing synthetic versions of two hormones that already exist in a cisgender woman’s body: estrogen and progestin. Artificially changing the levels of these hormones can stop or reduce ovulation, thicken cervical mucus (creating a barrier keeping sperm out) and thin the uterine lining, so eggs are less likely to attach and grow.
Because cisgender men can’t get pregnant, there’s no benefit to taking the pill. If you swallow one or two by accident, you’re unlikely to notice any effects — good or bad. But a male regularly taking female birth control pills will eventually have some estrogenic side effects ranging from softer skin to reduced libido and possibly breast tissue development.
Transgender women shouldn’t take birth control pills either. The estrogen dose is much lower than in the hormones a doctor would prescribe for transitioning but carries a much higher risk of deep vein thrombosis.
There are medications and treatments that can cause fertility issues in men — testosterone therapy and cocaine use, to name a few — but they shouldn’t be used as birth control. For men, fertility generally has to do with sperm count. Anabolic steroids, some anti-inflammatory medicine used to treat rheumatoid arthritis and Crohn’s disease, chemotherapy and herbal remedies like Tripterygium wilfordii can all halt sperm production.
There has been some interest in TRT (testosterone replacement therapy) as male birth control, due to studies linking high testosterone levels with low sperm count.[10] However, TRT isn’t approved to be used in this way. With something as important as birth control, you should never use an unapproved method.
[1] Martin, C.W., Anderson, R.A., Cheng, L., Ho, P.C., van derSpuy, Z., Smith, K.B., Glasier, A.F., Everington, D. and Baird, D.T. (2000). Potential impact of hormonal male contraception: cross-cultural implications for development of novel preparations. Human Reproduction, 15(3), pp.637–645.
[2] Gava, G. and Meriggiola, M.C. (2019). Update on male hormonal contraception. Therapeutic Advances in Endocrinology and Metabolism, 10, p.204201881983484.
[3] Nguyen, B.T., Farrant, M.T., Anawalt, B.D., Yuen, F., Thirumalai, A., Amory, J.K., Swerdloff, R.S., Bremner, W.J., Liu, P.Y., Blithe, D.L., Page, S.T. and Wang, C. (2020). Acceptability of oral dimethandrolone undecanoate in a 28-day placebo-controlled trial of a hormonal male contraceptive prototype. Contraception.
[4] Endocrine.org. (2019). Second potential male birth control pill passes human safety tests | Endocrine Society. [online] Available at: https://www.endocrine.org/news-and-advocacy/news-room/2019/endo-2019--second-potential-male-birth-control-pill-passes-human-safety-tests.
[5] Liao, P.V. and Dollin, J. (2012). Half a century of the oral contraceptive pill: historical review and view to the future. Canadian family physician Medecin de famille canadien, [online] 58(12), pp.e757-60. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520685/.
[6] Blakemore, E. (2019). The First Birth Control Pill Used Puerto Rican Women as Guinea Pigs. [online] HISTORY. Available at: https://www.history.com/news/birth-control-pill-history-puerto-rico-enovid.
[7] Colagross-Schouten, A., Lemoy, M.-J., Keesler, R.I., Lissner, E. and VandeVoort, C.A. (2017). The contraceptive efficacy of intravas injection of VasalgelTM for adult male rhesus monkeys. Basic and Clinical Andrology, 27(1).
[8] NHS Choices (2019). Your contraception guide. [online] NHS. Available at: https://www.nhs.uk/conditions/contraception/natural-family-planning/.
[9] Plannedparenthood.org. (2019). Planned Parenthood. [online] Available at: https://www.plannedparenthood.org/learn/birth-control/fertility-awareness.
[10] Soler, C., Kekäläinen, J., Núñez, M., Sancho, M., Álvarez, J.G., Núñez, J., Yaber, I. and Gutiérrez, R. (2014). Male facial attractiveness and masculinity may provide sex- and culture-independent cues to semen quality. Journal of Evolutionary Biology, 27(9), pp.1930–1938.
