Study explores reversible birth control for men

David Bell, MD, MPH, medical director of the Young Men's Clinic at Columbia University in New York, is frustrated with the limited contraceptive choices available to his male patients. Some express a desire to share in the family planning responsibilities. Others don't trust their partners to use their own contraception reliably. He'd like to be able to offer them more than condoms or a vasectomy.

"Something that has few side effects will be a good thing for a lot of guys," he said.

According to a study published in the April 29 Lancet, at least one potential option -- hormonal contraception for men -- is one step closer to reality.

The paper re-analyzed the data from 30 studies involving various doses of androgens or androgens combined with progestagens. It found that the fertility of most men was restored within three to four months of ending treatment. Nearly all recovered within a year.

"We do not want to make the men forever infertile," said Christina Wang, MD, one of the authors and a professor of medicine at the Los Angeles Biomedical Research Institute at the Harbor-UCLA Medical Center.

Experts praised the research for proving reversibility -- a characteristic considered crucial to making a hormonal form of birth control available for men.

"This is a step closer to having a drug or product that men or couples could use," said Peter Schlegel, MD, chair of urology at Weill Cornell-New York Presbyterian Hospital. "Men are half of a couple, but we don't have great contraception for men."

Still a long way to go

Those who work in this area warn, however, that such options are still a ways off and that there are numerous barriers blocking the path.

"This field is a bit of a heartbreaker," said John Amory, MD, MPH, associate professor at the University of Washington in Seattle, who conducts related research. "It's not hopeless, but it's not easy."

For starters, commercial interest has never been great -- primarily because of doubts that men would use it. The Food and Drug Administration does not have any male hormonal contraceptives currently under consideration, although a joint venture of Organon and Schering AG is running a phase IIb study of a progestogen implant combined with injections of a long-acting testosterone. This product is viewed as having the most potential to reach the market first. The results are expected later this year, although widespread availability is still believed to be years away.

"I think there's a market," said Diana Blithe, PhD, program director of male contraceptive development at the National Institute of Child Health and Human Development. "We're doing as much as we can do, but the NIH cannot commercialize a product. We need a pharmaceutical company to take over and move forward."

Scientific challenges also are in play because the risks of any male contraceptive have to be particularly low. For women, the concerns about the risks of hormonal birth control are often not as troubling as the fear of an unwanted pregnancy. The same cannot be said for men.

"The biggest factor is trying to make sure that what ever regimen we use is very safe," Dr. Blithe said.

Those pursuing male hormonal contraception say the need and the desire for something like this is great. Researchers maintain that they have no problem finding willing subjects, and several studies have suggested that many men are interested. Many also hope that hormonal contraception could have a similar beneficial effect on men's health as it has had for women by closely linking more people to health care services. Additionally, some experts anticipate that male birth control might protect against some cancers in a way similar to how women's hormonal contraception lowers the risk for ovarian and endometrial cancer.

"Men will use it. Women will trust men to use it, and the potential benefit for mankind is so great," Dr. Amory.