The coming advances in male contraception
Urologists should be discussing contraception with every male patient.
The Dobbs v. Jackson Women’s Health Organization Supreme Court decision in 2022 launched a new wave of restrictions on reproductive rights across the United States and emphasized the need for novel contraceptive options. Male contraception remains one of the most glaring gaps.
“We still have only two practical, safe and effective contraceptive options for men: condoms and vasectomy,” said Stephanie Page, MD, PhD, head of metabolism, endocrinology and nutrition and professor of lipid research at the University of Washington School of Medicine, and codirector of the UW Medicine Diabetes Institute in Seattle. “At their best, condoms have a 13% failure rate and use remains highly inconsistent, and vasectomy is not the ideal choice for too many men and couples. We may finally be getting some additional options in the next few years.”
Dr. Page will deliver a Hot Off the Press/State-of-the-Art Lecture on "Approaches to and Advances in Male Contraception in the Post-Roe v. Wade Era" 10:40-10:55 a.m. today in the Stars at Night Ballroom. Work in male contraception has taken on added urgency in light of the growing restrictions on abortion, contraception access and other elements of reproductive choice across a growing number of states.
The Dobbs decision sparked an immediate uptick in interest in vasectomies, but a permanent, irreversible contraceptive choice is far from ideal for many males. Novel methods now in clinical trials include a reversable vasectomy procedure as well as hormonal and nonhormonal drug approaches. A phase 1 retinoid receptor alpha antagonist trial is expected to complete data collection this summer and could report later in the year.
Scientific research in male contraception has lagged female contraception since the introduction of the first combined oral contraceptive pill in 1960 for a variety of reasons, Dr. Page said. The biggest barrier has been financial.
“Funding for male contraception research over the past few decades has come almost entirely from [nongovernmental organizations] and government,” she said. “That’s a start, but not sufficient to bring new products to market. And we hope that will start to change.”
Societal attitudes toward male contraception are also shifting. Growing economic pressures as well as shifting cultural expectations are pushing men to share responsibility for contraception and avoid unplanned births.
“Rates of unplanned births in the U.S. and around the world have remained stagnant over recent years despite increasing restrictions on abortion and access to contraception,” Dr. Page said. “Increasing access to contraception and increasing contraceptive choices are still the most effective means to reduce the need for abortion and unplanned pregnancy. Urologists should be discussing contraception with every male patient. Those conversations will get easier and more robust as we develop more contraceptive methods for men.”
