The World Health Organization (WHO) announced last week that reversible male contraceptives are expected to be available on the market within five to 10 years. This landmark statement comes after decades of slow progress in male contraception, which has seen few advances since the first vasectomy in the 1890s and the mass-market arrival of rubber condoms in the 1850s.
Decades of Scientific Foundations
The fundamentals of male hormonal contraceptives have been known for decades, but no major medical breakthrough has just been announced. Richard Anderson, professor of clinical reproductive science at Edinburgh University, says the development has been "agonisingly slow" over nearly 50 years since the first hormonal contraceptives were tested on men. "While there have been refinements focused on optimal drug formulations, the fundamentals have remained the same," Anderson said.
Male hormonal contraception targets sperm production, which requires continuous suppression. "This requires continuous, steady suppression, suppression all day, every day," Anderson explained, "but it is proven to work."
How It Works and Trial Results
A testosterone-based treatment can trick the brain into switching sperm creation off while maintaining healthy hormone levels. In the late 1980s, WHO proof-of-concept trials used weekly testosterone injections. "In the first trial, over 60% of men achieved a zero sperm count and successfully used it as their sole contraceptive for a year," Anderson said. A subsequent trial of 450 couples confirmed hormonal suppression is "highly effective" in reducing sperm count.
By the 1990s, the addition of progestin made these contraceptives more effective, with a success rate equivalent to female hormonal methods and a reduced quantity of testosterone required. More recently, the US National Institutes of Health funded a major international study of a testosterone/progestogen gel, with participants rubbing it into their shoulders daily. Trials across North and South America, Africa and Europe have shown "surprisingly effective" early results and an "extremely low" pregnancy rate. Anderson oversaw Edinburgh's 40-couple cohort, where patients recorded zero pregnancies.
Side Effects and Reversibility
Side effects such as mood shifts can occur with any hormonal interventions, but in the worldwide study, "participant dropouts due to side effects were extremely low at only a few per cent," Anderson said. In Edinburgh, "participants tolerated it exceptionally well, with female partners often thrilled to take a break from birth control."
Crucially, the suppression proved reversible. "Across all trial follow-ups (typically after up to 18 months of use), sperm counts returned to normal, and many couples have subsequently conceived healthy children," Anderson said.
Barriers to Development
Billie J D Porter, film-maker of the documentary It's Different For Girls, attributes the slow evolution to "corporate greed and systemic misogyny." She points to German pharma giant Bayer, which cut all funding to male contraceptive research in the early 2000s despite a trial proving "efficient, with a tolerable side-effect profile," because bosses felt taking the medication would be "inconvenient" for men.
The female hormonal contraceptive market is worth billions globally and forecast to hit nearly $30bn by 2034. Male birth control represents disruption and risk, so major clinical trials have historically been run by public health bodies on tight budgets.
Changing Attitudes and Future Prospects
A recent WHO study found nearly 75% (72.3% male, 76.2% female) of respondents across diverse countries reported willingness to use new male contraceptives, with more than 85% of women saying they would trust their male partners to take responsibility. Dr James Kiarie, who heads up contraception and fertility care at the WHO, says, "Men today are increasingly open to gender equality and sharing contraceptive responsibility. Concerns about side effects are the leading reason women discontinue birth control. Soon, if one partner experiences side effects, the other will be able to try."
The biggest obstacle remains "limited research financing," says Kiarie. "We urgently call on funders to invest in this area… it is a gamechanger for public health and human relationships."
Globally, 40% of women live in countries with restrictive abortion laws. In the US, interest in male contraceptives increased from 39% to 49% after the supreme court's decision to overturn Roe v. Wade in 2022. Porter notes concerns about "hyper-masculine 'red pill' subcultures obsessed with testosterone and sperm retention" in the sector.
Porter spent time with couples on recent trials, saying, "The male contraceptive option transformed their relationships. It fostered deep mutual respect, relief, and shared responsibility. It offers men a meaningful way to share a burden that women have historically carried alone under immense social judgment."
