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MCIP and the Male Contraception Coalition drew lots of comment at this month's Association of Reproductive Health Professionals conference, with our lifesize "Average Joe" poster reminding everybody that men are the other half of family planning.
Dr. Trent MacKay's subsequent "Lunch and Learn" seminar on male contraceptive research was one of the best-attended lunchtime breakout sessions, with clinicians and researchers sitting on the floor and spilling out the door – those in the photo were just the beginning! Dr. MacKay gave an overview of his NIH department’s research program and fielded lively questions on the pros and cons of hormonal methods. MCIP’s director Elaine Lissner chimed in on some of the research outside NIH, as well as the need for more funding for programs like Dr. MacKay’s if we want to see these methods make it from the lab to market. The general consensus reflected research findings that a majority of men will consider a method—if it is practical and safe.
A warm welcome to ARHP members who are new to the Male Contraception Update! Each month you’ll get news on how these methods are doing and how you can promote research—as well as the latest findings on welcoming men into family planning programs. Past newsletters are available in the archives, and you can read more about all the emerging methods at MaleContraceptives.org.
Last month we presented a status report on contraceptive research at startups. BIOQUAL, a research facility in Rockville, MD, doesn't quite fit under the "startup" category, since it primarily does contract research — but it is just as dependent on funding. Scientists there are pursuing two possible male contraceptive leads for the National Institutes of Health: a compound called L-CDB-4022, and the androgen DMAU. Both drugs could be taken by mouth —the elusive “male Pill.” What does the future hold?
L-CDB-4022
While doing safety-screening of potential new antihistamines many years ago, scientists at Sandoz discovered that a certain class of drugs (indenopyridines) had anti-fertility effects. BIOQUAL recently found that a derivative of one of these, L-CDB-4022, made monkeys infertile for 6 weeks after only 7 days of treatment. All monkeys regained baseline sperm production by week 16.
![Comparison of L-CDB-4022 effects on seminiferous epthelium [alpha]-tubulin levels](images/L-CDB-4022_tubulin.jpg) |
| Cross-section of testis from vehicle-treated or L-CDB-4022-treated monkeys stained for tubulin (brown color). Note the loss of mature germ cells in the testis from the l-CDB-4022-treated monkey and the compact nature of the Sertoli cells. |
The BIOQUAL team has focused on investigating the compound’s mechanism of action, and what conditions make it reversible or irreversible, and they’ve gotten some interesting results. But trouble looms: larger quantities of drug will be needed to do further monkey and safety studies, and it is hard to make. They need a higher-volume production process (“stereospecific synthetic method”). But BIOQUAL is not a chemical synthesis facility, so streamlining the production of the compound will have to be contracted out. Success is likely but not guaranteed, and the process will be expensive.
The Contraception and Reproductive Health Branch (CRHB) of NICHD has funded BIOQUAL's work so far. Will the CRHB have enough resources to fund this next step? Stay tuned.
Dimethandrolone undecanoate (DMAU)
The BIOQUAL team is also working on androgens that can be taken by mouth. One of them, DMAU, has dual hormonal activity, with both androgenic and progestational effects. It could be perfect for hormonal male contraception, rather than giving testosterone and a progestin separately. In rabbits, lower doses of DMAU, but not a high dose, suppressed spermatogenesis, resulting in reversible infertility.
In the past year, the team has moved several steps forward in animal tests on both DMAU and a second androgen. They are both in 28-day safety tests in monkeys right now, preliminary to phase I trials in men. And a collaboration with the University of Washington may bolster some of the potential non-contraceptive uses for DMAU; it will examine the compound’s effects on bone mineral density and muscle mass in rats.
Which androgen will progress faster, DMAU, or the one being developed by start-up GTx, Inc.? Will one of them make it through safety trials to become the first hormonal “male Pill?” Watch for updates on this work in future editions of this newsletter.
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We've been hearing from friends as far away as Berlin who saw "Sperm Warfare," an enthusiastic, lengthy piece on male contraception research in The Times (London). The article describes hormonal methods, the Vassonic device, the IVD, RISUG, ultrasound, and HIFU. The author missed out on a couple of depressing updates – that HIFU nonsurgical sterilization is stalled due to lack of funding, and the American IVD design is missing in action – but new funding could change that.
The comments offer an interesting glimpse of public opinion on these emerging male contraceptive methods:
“In my opinion, contraception and STD prevention are two separate things. Fidelity is all very well, but not all of us have met Mr/Ms Right yet. I had my tubes tied when I was 24, for contraception, but I still use condoms for STD prevention. There is no harm in doubling up - women do it all the time.” - L. Porter, London, UK
“Bring it on. Anything that can help couples avoid accidental pregnancies and men avoid 'accidental' pregnancies by both parties using a reliable form of birth control that doesn't have the lack of appeal of condoms has to be a good thing. The ultrasound sounds the most marketable.” - Chris Jackson, London, UK
Read more:
Sperm warfare
Times Online, 20 September
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This humorous article points out that 1 in 3 Australian men in their 40s and 50s has gotten a vasectomy, and gives the credit to "some fairly good education and some assertive Australian women!”
“Only one in six Americans over 35 has had the snip, but single 20-something American men are turning to the operation…, US publications including the Chicago Tribune and men.style.com have reported. Social analysts say this is because getting a chick pregnant would, like, totally not rock, dude… While men taking on responsibility for contraception is admirable, vasectomies are not always easy to reverse, and young men's scrotums being punctured left, right and centre like party balloons is not an ideal state of affairs.”
Check out this spirited Australian take on the alternatives under development.
Read more:
It's hip to get the snip
Sydney Morning Herald, 29 September
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Last month's article in Time (US) inspired bloggers at Feministing.org to ask: "Would the men in your lives (boyfriends, partners, brothers, friends) be open to new forms of birth control?" Fifty men and women weighed in with articulate comments, giving a sense of what's on the public's mind – from frustration with double standards for drug development, to thoughts on possible roles for male contraceptives in the family planning mix. A sample:
"It's not just the demand that drug manufacturers are looking at. It's whether or not they will be able to recoup cost of drug development and make huge profits… Success in the US market would mean that male birth control would need to be seen as a medical necessity. Otherwise insurers could refuse to pay (as they are trying to do for women's contraceptives) leaving men to foot the bill for a product that will most likely be more expensive than the female counterpart. Good luck with that. The obvious solution is for governments to subsidize part of the research like the US does for Orphan drugs (drugs for rare disorders that have a limited market yet serve an unmet medical need). Also, contraception needs to be considered a medical necessity so that insurers are obligated to a least cover part of the cost. But mind you there is probably another Viagra type product in the pipeline somewhere so all is not lost." - Sarah
"Most men, rightly or wrongly, are way too superstitious to trust a 'temporary' contraceptive… especially when there's a temporary one already available, and, oh bonus, it protects you against AIDS, too. They call it a condom." - Roxie
"The argument about hormonal male BC not preventing STDs is moot, a given, we already know that. If someone isn't in a relationship its just a good idea to double up (condom and BC). There are so many combinations and situations where male BC would be awesome. " - Spike
Read more:
Big pharma limits birth control options for men
Feministing.org, 6 August
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Chicago Tribune report of younger men turning to vasectomy, with discussion of pros and cons, including counseling issues. “Jeremy Youngman, a 32-year-old tattoo artist in Downers Grove, likes his birth control the way he likes his body art: permanent…”
Vasectomies: Word of caution on birth-control procedure
Chicago Tribune, 26 August
“There is an entire multimillion-dollar industry out there that won't put money on the odds that men are willing to take responsibility for the number of children they father… It would be different if Big Pharma got their 1962-tinged portrait of today's man right, but their own studies tell us otherwise.”
Why macho firms push Viagra instead of the pill for men
The New Zealand Herald, 10 September
“What is clear is the media, bloggers and researchers are talking about male contraception-the potential successes, failures and implications… Where is the larger, coordinated advocacy for the future of these technologies and where is the broader support for the rights of men to control their fertility and become more active family planners? As reproductive health and rights advocates… we can lend our knowledge, advocacy and lessons learned from the struggle to achieve women's reproductive rights to this new revolution.”
Male birth control: Seeds of revolution?
RH Reality Check, 16 September
A men’s rights take on the need for additional male contraceptive options. “As a man, there are traditionally two methods of birth control; condoms and relying on a woman’s word that she has reliable birth control. There are clear drawbacks to both methods.… [Additional] choice for men means better parenting for children because more men will be able to become fathers when they are married, willing, and stable- a huge benefit for children and society as a whole.”
Vasectomies: The only choice left for men?
Men’s News Daily, 19 September
More opinions on the idea of new options for men, inspired by press reports of Prof. Derek Abbott’s early-stage research. “I do think there are men that want alternative forms of birth control. I know many of my boyfriends would have preferred other methods to birth control than me using hormonal birth control that made me irritable and have a decreased sex drive…”
Remote control male birth control. Seriously.
Feministing.org, 23 September
Dr. Joseph Tash and Dr. Gunda Georg’s NIH-funded work on H2-gamendazole, and student reaction to the idea.
Balancing the burden of birth control
The University Daily Kansan, 25 September
A survey of South Korean women age 19-34 found 45% believe contraception should be a man’s responsibility, “seen as a carry-over from the country’s male-dominated Confucian culture, which exerts significant control over female sexuality.”
Korean Women Say Birth Control is ‘Men’s Responsibility’
EcoWorldly, 27 September
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Editors
Elaine Lissner, Director of the Male Contraception Information Project (MCIP)
Email: info@NewMaleContraception.org
MCIP is entirely nonprofit and works in three areas: raising public awareness of promising nonhormonal male contraceptives, advocating increased and expedited government research, and serving as a resource for journalists who wish to write about the subject.
Kirsten Thompson, Director of the Male Contraception Coalition (MCC)
Email: info@MaleContraceptives.org
The Coalition’s objectives are to speed the development of new male contraceptives through increased legislative and institutional support, to raise funds for applied male contraception research and development, and to educate the public about the work of the research community.
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