
Why We Can’t Have the Male Contraceptive Pill - drtillberg
https://www.bloomberg.com/news/features/2017-08-03/why-we-can-t-have-the-male-pill
======
cgb223
I just want to share my two cents here:

I am a man in my 20's. At the moment, I am seeing people casually, because
that's the kind of relationships I currently want and have time for.

I have been wanting male birth control for a while now.

As a guy I feel like a lot of what we are told as teenagers by our parents,
and so on is that what ever you do, dont get someone pregnant. It will ruin
your life, and probably the life of the child.

I know many people who have had pregnancy scares with people who were keen on
keeping the child, without discussing whether the male counterpart felt
similarly.

If men had the ability to control whether they could get someone pregnant, it
allows them to live their lives, enjoy themselves, and explore without fear of
negative life changing repercussions.

I'd imagine the arguments for women's birth control back in the 60's (70's?)
were similar, with the added issue of carrying the child.

I'm not sure why male birth control is so controversial here on this forum,
and in general, it sounds like the arguments for both sexes are similar, and
having control of ones own body is never a bad thing.

~~~
ams6110
So use a condom. Especially if you are seeing people casually, as that helps
prevent STD infection.

~~~
user5994461
As said in the article. Condoms doesn't work 18% of the time. That's a pretty
high failure rate.

The contraception methods available to women are much more effective.

~~~
dennisgorelik
\---

[https://sexetc.org/info-center/post/do-condoms-work-whats-
th...](https://sexetc.org/info-center/post/do-condoms-work-whats-the-best-
brand-and-which-type-of-condom-is-most-effective/) Condoms—when used correctly
and consistently—prevent pregnancy about 98 percent of the time. The typical
effectiveness rate—where mistakes are made or condoms break—is about 82
percent.

\---

~~~
user5994461
It works all the time when ignoring the times it didn't.

~~~
tnzn
Now that's intellectual dishonesty. You start with using wrong numbers (or
manipulating numbers in a dishonest way to prove your point), then when
someone calls you out on that you give that sort of troll answer. 98% is on
par with the best female contraceptive methods, and it probably better than
what we could achieve with male pills.

~~~
mos_basik
What? He cited a failure rate of 18%, which the article supports and you quote
as the "typical" failure rate, taking into account that condoms do break and
are used incorrectly at times.

If a manufacturer says their manual transmission car gets 45 miles to the
gallon, and Fuelly says that same car gets 39 mpg (averaged over a million
user mileage submissions), is it intellectually dishonest to use 39 as the
working figure when budgeting for gas?

What you interpret as a troll answer, I interpret as a reasonably clear
explanation of why he chose the figure he did.

------
ahh
It's a hard problem. I think there's a simple observation that helps explain
why it's going to be so hard (the article hints at this without saying it): a
healthy adult man is, more or less, fertile. At all times. If a adult man is
infertile--if him having sex can't result in pregnancy--there's something at
least slightly wrong with him.

By comparison, an adult woman is often infertile--three weeks (ish) out of
every month, or whenever she's pregnant, she can't _get_ pregnant.

So it stands to reason that it's harder to produce male hormonal
contraceptives: we can (at least sort of) fake healthy-but-infertile states of
women, but there are no such states for men; we have to construct one from
whole cloth, so to speak, and that's much harder.

~~~
cgb223
> By comparison, an adult woman is often infertile--three weeks (ish) out of
> every month, or whenever she's pregnant, she can't get pregnant

So you're telling me that I could have unlimited unprotected sex with my
partner for three weeks out of every month (assuming we had perfect fertility
information about those three weeks) and there would be 0 chance that they
would get pregnant...?

~~~
chillacy
Yes, this is called the Rhythm Method / natural family planning:
[http://www.everydayhealth.com/sexual-health/rhythm-
method.as...](http://www.everydayhealth.com/sexual-health/rhythm-method.aspx)

Of course the tricky part is having perfect fertility information

~~~
dozzie
This method is also called "Vatican roulette".

~~~
true_religion
Vatican roulette has worked for me for over ten years... Or I'm infertile.
It's kind of a toss up, but anecdotally I wouldn't rely on it if you wanted
frequent sex. All contraception is a probability issue but there's a huge
difference between 99% and 80%.

------
peteretep

        > condoms, which have a real-
        > world failure rate of about 
        > 18 percent
    

That's odd, so I did some research and found:

    
    
        > With consistent and correct
        > use, condoms have a failure
        > rate of 2 percent. The 
        > typical use effectiveness
        > rate is about 18 percent
    

I ... don't understand. Are people putting them on their fingers? Can someone
explain?

~~~
dogma1138
Rolling it the wrong way, not rolling it all the way down, not rolling it
correctly which leads to more frequent tearing when air is caught at the end.

And one of the most common issues buying the largest size available even when
you don't have a 12" as thick as drink can tool.

While it's been 16-17 years since I had a sexed class i still remember the
girl who came and told us to buy regular or even ("small") since it was still
when I was 14-15 then she took a the smallest size Durex and rolled it over a
2 liter soda bottle and said unless you are bigger don't buy magnum super XL.

~~~
Scriptor
Just because they can stretch that much doesn't mean they're comfortable.

~~~
sli
Plus just rolling it over a 2 liter bottle doesn't account for the physical
side of what's going on. You can stretch a condom pretty far, but that does
not say anything about how it stands up to friction. If a condom is too tight,
it will break on you.

I hate talking about this because people just assume I'm lying, but... I've
had normal sized condoms break on me a couple times, it's frightening. Magnums
do not break on me, and fit much better, so that's what I use (the XLs are too
big). I just don't fit safely in a normal sized condom, it doesn't matter one
bit that I can fit them over a bottle.

~~~
dogma1138
It's fine to use a Magnum I you actually need it, Western condoms tend to be
51-54mm in width for non Magnum sizes and 56-59 for magnums if you actually
need it by all means use it but for most people the normal ones will be the
best fit.

In other places it might be different I know people think that Asian thing is
a trope but it's not Durex reduces the width from 54 to 49mm for the Asian
market which is a bitch.

------
rory096
Contraline, the polymer gel injection covered in the article, is a YC F3
(summer 2016) company. Kevin says he's on the road right now, but he'll be
around later to answer any questions.

[0] [http://contraline.com](http://contraline.com)

~~~
hjrnunes
I remember reading some time ago about an Indian guy who was developing
something like that. He said all he needed was investment but couldn't find
anyone interested.

Edit: here it is [https://www.bloomberg.com/news/features/2017-03-29/a-new-
kin...](https://www.bloomberg.com/news/features/2017-03-29/a-new-kind-of-male-
birth-control-is-coming)

------
drngdds
This article makes it sound like WIN 18,446 is a safe and effective male
contraceptive and it was abandoned completely just because it has bad
interactions with alcohol. Is this actually true? There are lots of drugs on
the market that have a bad interaction with alcohol. It's possible to just not
drink alcohol.

~~~
auggierose
Having a contraceptive pill not working together well with alcohol is probably
one of the worst user interfaces ever. At least judging from the behaviour I
observe amongst people in the UK :)

~~~
drngdds
Not for people who don't drink or would be willing to stop drinking. That has
to be a nontrivial market. Why not make it and just put a big warning label on
the bottle?

~~~
djsumdog
Even for people who don't drink, there's still small amounts of alcohol in
some medication, mouth wash, etc. If the severity of the reaction is high
enough, even small amounts could lead to a medical emergency.

~~~
GhotiFish
I hear what you're saying here, but just taking what the article was saying,
that shouldn't be much of an issue.

    
    
        Then one of the participants drank some contraband Scotch and became 
        unusually, violently ill. He confessed his transgression to the 
        researchers, and follow-up studies confirmed his account: WIN 18,446 
        didn’t mix well with booze.
    

I suspect this inmate was more than a little liquored up. Just a guess. But
more importantly this part:

    
    
        WIN’s side effects sounded familiar to Amory. In his clinical practice, 
        he’d occasionally prescribed Antabuse (disulfiram) to patients who 
        struggled with alcohol addiction. The drug blocks a form of the enzyme 
        acetaldehyde dehydrogenase (ALDH), which helps the body metabolize 
        alcohol;
    

which means it's effects are used in practice to combat alcoholism.

Can't be _that_ bad. Though, that still means that there could be other
interactions not described?

------
nxc18
While I get that you could argue that 'pregnancy is the worst std' with 18+
years-long untreatable consequences, I don't really see the appeal for
something that just targets pregnancy.

As a gay male, I would tend to favor condoms and other things that have a
chance of reducing std transmission. If anything, the AIDS epidemic taught us
that STDs are just as serious as pregnancies.

Ultimately it comes down to not fucking complete strangers and using
protection when you do. For long term relationships, there are so many
options: pills, IUDs, condoms, plan b, and even abortion.

I'm much more interested in research into how to make condoms more effective
and better treatments for unsolved problems, like herpes, HIV, Chlamydia,
gonorrhea, etc. (antibiotic resistance is still a thing btw).

~~~
andruby
I am intrigued, what is "plan b"?

~~~
stonemetal
It is a strong contraceptive made to be taken the morning after. Useful if a
condom broke or wasn't used.

------
JohnJamesRambo
A great male contraceptive is already here and it is testosterone injections.

"The two-and-a-half-year study of 399 couples in nine countries found that the
injections of the male sex hormone were an effective contraceptive for 98.6
percent of the participants."

[https://nytimes.com/1996/04/03/us/testosterone-injections-
wo...](https://nytimes.com/1996/04/03/us/testosterone-injections-work-as-
contraceptive.html)

~~~
walrus
Disclaimer: I have no idea what I'm talking about.

Here's roughly how it works, if I understand correctly. First, a normal male
endocrine system looks roughly like this:

    
    
      1. The hypothalamus produces GnRH.
      2. In response to stimulation by GnRH, the pituitary produces LH and
         FSH.
      3. In response to FSH and LH, the testes produce sperm and
         testosterone, respectively.
      4. Testosterone inhibits the production of GnRH by the hypothalamus (a
         negative feedback mechanism). This effectively keeps testosterone
         levels regulated.
    

When external testosterone is introduced, here's what happens:

    
    
      1. The increased testosterone inhibits the production of GnRH by the
         hypothalamus.
      2. In absence of GnRH, the pituitary produces less FSH and LH.
      3. In absence of FSH, the testes produce less sperm (this is the
         contraceptive effect). In absence of LH, the testes produce less
         testosterone.
    

The net effect is less sperm and the body produces less testosterone on its
own.

This makes me wonder: would this lead to testicular atrophy? That happens with
steroidal antiandrogens and GnRH agonists/antagonists, both of which have the
effect of decreasing LH and FSH. Also, I think there are cardiovascular risks
associated with high testosterone.

~~~
jgmmo
Its well known in the powerlifting/bodybuilding space that steroid use will
cause small balls. Yes to testicular atrophy. Supposedly they will come back
after you get off, assuming you did so properly.

------
ams6110
Female contraceptive pills have a lot of problems. They are linked to cancer,
liver disease, gallbladder disease, stroke, blood clots, high blood pressure,
and heart disease.

Taking pills to inferfere with your normal hormonal and bodily functions is
not a great idea, when there are other options with fewer or no side-effects.
As a man, I would not take pills for contraception.

~~~
evolve2017
First, I agree that non-hormonal contraception decreases a lot of the risk
associated with hormonal contraception (almost tautological, but worth
stating).

Second, there is no increase in mortality between women who use oral
contraceptive pills and women who do not (with the exception of women over 35
who smoke; OCPs are contra-indicated in this group).

For any OCP-users who might read this, there is _no_ overall increase in
cancer associated with OCPs, though some cancers are more likely with OCPs and
others are less likely with OCPs.

Many of the side effects you're mentioning are either rare (hypertension,
stroke/blood clots) benign (maybe you mean hepatic adenoma when you say liver
disease?) or things I have not heard of (would appreciate scholarly
references; gall bladder disease, heart disease[not sure what you mean here]).

 _> Taking pills to inferfere with your normal hormonal and bodily functions
is not a great idea, when there are other options with fewer or no side-
effects_

In general, all medications have risks and benefits. A blanket statement such
as this one ignores the risk-benefit calculation that each patient and her
physician must assess in picking a medication.

~~~
ams6110
> Many of the side effects you're mentioning are ... things I have not heard
> of

Admittedly hasty research, these are listed on WebMd as possible side effects
of contraceptive pills.

------
djsumdog
The article mentions the gel injections that destroy sperm as semen travels
from the testicles. Last I heard the Indian company that developed it was
still doing trials in Indian and the US (long running trials in India show it
effective and reversible for years).

It's more invasive than a pill, yes, but it seems like the most viable
reversible solution so far.

~~~
ams6110
I believe it was injecting/inserting a block (some kind of gel maybe?) into
the vas deferens, with the effect of a vasectomy but much more easily
reversible.

