“They have two options,” Amory says. “They can have surgery on their scrotum or they can wear a sheath.” Well, when you put it that way . . .

Male birth control is the holy grail of reproductive health. For some, the idea is a conceptual novelty, calling into question societal norms and traditional gender roles. For others, it’s a matter of biology and body chemistry — the prospect of freedom from or introduction to new medicines and procedures. In any case, there’s no question that research and developments in this field, and in the realm of contraception in general, could affect world health and the environment.

In labs worldwide, including right here in Maine, scientists continue to hammer away at the conundrum of male contraception. I wrote on this topic once in 2005 (“Sex Machinery”) and again in 2007 (“The Boys and the Bees”); both articles suggested, based on research and interviews, that male birth control was just around the corner. In fact, no such product has reached the American market, and none is likely to in the very near future. But we are getting closer.

There are two types of male contraception: hormonal and non-hormonal. The former is somewhat analogous to female options, using a combination of progestin and testosterone. However, the problem with hormonal methods is that sperm counts are often not sufficiently suppressed. This isn’t surprising. Whereas men produce 1000 sperm per second, women generate just one egg per month (typically). “It’s proven easier to sort-of turn that off,” Amory says of the female function.

There are issues other than efficacy. As with hormonal birth control for females, male hormonal methods have negative side effects, including problems with mood, libido, and depression. These have proven insurmountable in many trials (which can sound suspiciously like, Messing with female hormones is okay, but male mood swings are unacceptable). Just as the Pill for women has some positive side benefits, such as a reduced risk of certain cancers, a male option would have to demonstrate similar pros. (A male contraceptive that reduced HIV transmission, like the so-called “Dry Orgasm” option described below, is one example of this.)

These complications have made drug companies reticent to fund the necessary research to make male contraception a reality.

“It’s just a really unrewarding area for a pharmaceutical company to get into,” Lissner says.

Amory agrees. “The big missing thing is not the government-sponsored research,” he says. “It’s pharmaceutical interest. The bottom line is there were companies interested five, 10 years ago but they’ve backed away.”

Some, like Lissner, think the “death knell” has sounded for hormonal methods. Others, like Robert Braun of Maine’s Jackson Laboratory, where male reproductive research takes place, believe “it’s too early to close the door on a hormonal contraception” (though he adds that the answer might lie in a combination of hormonal and non-hormonal methods).

This speaks to commercial prospects, both in the United States and abroad; in order for male contraceptives to move forward, researchers need big-money backing. If it doesn’t come from drug corporations, financial support needs to come from non-profits or private foundations. That’s why the Gates Foundation commitment could make such an impact. Right now, their approach focuses on female options. But “that may change in the future as they ramp up their activities in this area,” Lissner hopes.

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