Editor’s note: In this article, we use the term “male” to describe people who produce sperm, which could include cisgender men, trans women, and nonbinary people. Similarly, the term “female” is used to describe cisgender women and people assigned female at birth.
The pill. The ring. The IUD. The implant. The list of female contraceptives goes on. Yet when it comes to male contraceptives, there are only condoms and vasectomies, which, contrary to what some people believe, aren’t easily reversible.
Now, a new generation of contraceptives is on its way to open up options for people who produce sperm. A variety of hormonal and nonhormonal methods are in development, with the frontrunner as close as five years away.
“It’s important that we’re building a true offering of full-range means to prevent pregnancy,” says Heather Vahdat, executive director of the Male Contraceptive Initiative. “It’s not male versus female contraception—it’s just contraception. The best-case scenario is for two individuals to be able to protect themselves.”
Below, we provide an overview of these upcoming contraceptive options and how you can advocate for more progress in this underfunded field.
The frontrunner: Hormonal shoulder gel
Scientists first began experimenting with a male hormonal contraceptive in the 1970s. Half a century later, it’s finally close to entering the market.
The hormonal topical gel NES/T, short for the two hormones (nestorone and testosterone) it contains, is currently in phase two clinical trials. If all goes well, it’s expected to be available in about five to 10 years.
The gel can be compared to our existing birth control pills. It’s applied daily and absorbed through the skin of the user’s shoulders and upper arms. The two hormones work together to suppress sperm production so that the user is made temporarily infertile while minimizing side effects like lower libido.
“When we started the trials, we weren’t sure if the men or the couples would accept the gel,” says Dr. Christina Wang, who has worked for decades on male contraceptives and now leads the NES/T gel trials at the Lundquist Institute at Harbor-UCLA. “But after we showed them how to use it and they developed a routine, they liked it. Many of us were surprised that the couples responded so positively to something that has to be applied every day.”
So far, the NES/T gel is proving to be a safe, effective, and reversible contraceptive. Wang is also developing similar hormonal male contraceptives in the form of a daily pill and as an injection, though they are not as far along in development as the gel.
Reversible vasectomies: Nonhormonal hydrogels
In the days after the Supreme Court overturned Roe v. Wade, Google searches for vasectomies spiked, and doctors reported receiving an overwhelming number of requests for the procedure. But vasectomies—which consist of cutting the vas deferens (the tubes that carry the sperm)— aren’t meant for people who may want to regain their fertility in the future.
The good news is there are some promising nonhormonal contraceptives in the works that aim to offer a less permanent alternative to vasectomies. A company called Contraline is developing ADAM, a hydrogel that gets injected into the vas deferens to block the sperm’s pathway. NEXT Life Sciences is developing Plan A, another hydrogel that works the same way.
Designed to act as long-lasting contraceptives that are easily reversible and minimally invasive, these hydrogels are comparable to copper IUDs. Both ADAM and Plan A will be dissolvable, allowing sperm to flow through the vas deferens again and the user to regain their fertility.
Vahdat says ADAM will likely be the first nonhormonal male contraceptive to reach the market. The company is currently conducting its first human trials in Australia.
On-demand options: Pre-sex pills
Another exciting development in the nonhormonal space is pre-sex pills, which have the potential to be an on-demand contraceptive. The idea is that people who produce sperm would be able to take the pill about 30 minutes before intercourse and its effects would wear off after a few hours or a day.
A Weill Cornell Medicine study published in February on one of these pre-sex pills showed that it worked in mice. The drug works by targeting the enzyme that basically tells sperm to start swimming. When the enzyme is suppressed, sperm lose their ability to travel through the female reproductive tract and fertilize an egg.
“If things go well, we could be in the market in eight years,” says Lonny Levin, one of the study’s authors.
“It’s optimistic, but not unrealistic,” adds Jochen Buck, another of the study’s authors.
Another on-demand contraceptive pill being developed by a team at the University of Minnesota has also been shown to work in mice.
Vahdat notes that these on-demand options could end up getting to the market faster than others, even though they’re not in human clinical trials yet.
“If you have a product that you anticipate lasting for months or longer, you have to follow people for a long time,” she explains. “Whereas if you have a product that you are expecting to work for a couple of hours, that clinical trial process by nature is going to be faster.”
Will people use them?
A survey published in February of 19,000 people who identify as men across eight countries found that there is significant interest in new male contraceptives: 78 percent of U.S. respondents said they would be interested in trying a new male contraceptive, and about 40 percent of U.S. respondents said they would try a new male contraceptive within a year of it being available. (Demand is even higher internationally: 70 percent or more of people who identify as men in Bangladesh, Nigeria, and Vietnam said they would try a new male contraceptive within a year of it being available.)
The rise in interest around vasectomies after Roe fell indicates that cisgender men want to play a larger part in preventing pregnancies, notes Dr. Brian Nguyen, who leads the EMERGE Lab, a research group committed to the protection of women’s health and gender equity.
“The myth that we’re seeing overcome here is that men are unwilling to step up to the plate,” Nguyen says. “It actually turns out that men are—we’re just not giving them the tools or the opportunity to. This ends up putting the entire burden on female patients, and that further siloes [them] and increases our gender disparity.”
The other big question is, if a new male contraceptive became available, would people trust their partners to use it? Vahdat believes that trust is not as big an issue as we may think, especially when it comes to long-term partners who are seeking contraceptive methods together. But Wang says it’s crucial to continue studying and finding ways to improve couples’ trust.
Using at-home sperm test kits could be an easy way to build that trust, Wang says. The SpermCheck Fertility test, which works like the at-home COVID-19 test kits that we’ve become so familiar with, can confirm that a person’s sperm count is low enough to be infertile.
“In theory, a couple will be able to check the man’s sperm count whenever they want to,” Wang says. “The more involved the couple is, the better. They need to be engaged in the contraceptive matter—both of them.”
What can we do to push new contraceptives forward?
The biggest limitation to progress around new contraceptives is funding. So far, the majority of funding for this next generation of contraceptives comes from the Gates Foundation and the National Institutes of Health. Pharmaceutical companies have shied away from the research and development in this space, probably because they see more risk than benefit when considering investing, Vahdat says.
Pharmaceutical companies “feel like there’s enough on the [contraceptives] market,” she says. “But if you look at it with more of a global health mindset, or if you just look at the maternal mortality rate in the U.S.—which is only going to get worse with the reversal of Roe—you see contraception actually has a huge benefit and very much impacts people’s lives.”
If you want to take action to push new contraceptives forward, Wang recommends writing to your politicians, which can help pressure the pharmaceutical industry and the government to invest more money in the space. Besides making your voice heard, you can consider signing up for a clinical trial for one of the contraceptives being developed. (The NES/T gel is expected to launch its phase three trials by the end of 2024, so if you’re interested, you can sign up to be on the outreach list.)
Nguyen says learning more and having conversations about male contraception is another good place to start. The goal is to normalize thinking about cisgender men as part of the reproductive and contraceptive process.
“There’s a need for more funding and more publicity around male contraception,” Nguyen says. “The benefit is not just the prevention of unplanned pregnancies, but for men to understand the experience of being a female in today’s society—the difficulty of trying to access prescriptions, getting them on time, having to pay for them. It’s not so much about men protecting themselves, but very much about gender equity. It’s been far too long that we have not addressed men’s responsibility.”