Short Wave - Beyond Condoms!

Episode Date: October 19, 2022

Contraceptive research has historically prioritized women because they bear the burden of pregnancy and most contraceptive options available today are for women. But there are efforts to widen the contraceptive responsibility. Today, Scientist-in-Residence Regina G. Barber talks to host Emily Kwong about the state of research into male contraceptives and which method researchers expect to hit the market first.We're always excited to hear what's on our listeners' minds. You can reach the show by emailing [e-mail] or tweeting us @NPRShortWave. See pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. Hey, shortwavers. Emily Kwong here with scientists in residence, Regina Barber, one of my favorite people. Hello, Regina. Oh, thank you. Hey, M. I actually want to share with you a story of sperm-stopping science in Seattle. And why we don't have more male contraception on the market. I want to know the answer to this question very badly. So let's talk about it. And let's talk about sex. Let's talk about sex, but let's talk about Philip Shaw's sex life back in 2019. He was part of clinical trials at the University of Washington to test a new male contraceptive. It was underground at the UW Medical Campus that they have there. I had to go like literally underground.

So he would visit the campus roughly once a month for his sperm levels to be checked. But this study was for couples. So his girlfriend, now wife, was also part of the study. Cool. What did they have to do? Well, Philip had to keep a record of his moods. I had to basically review my day, like how I felt, was I sad, was I angry, did I feel ill? So I had to be very introspective.

But I did not have to write some racy sex journal like my wife had to. What? So the researchers divvied up the labor of chronicling their life during the study. and his girlfriend at the time, wife now, had to log when they had sex. Interesting. Okay. And what kind of contraception was part of this study? The kind of male contraception used in this study is a gel, like that you apply, like a lotion. It's clear and it has the consistency of hand sanitizer. So it was this gel that I would rub on my shoulders, both shoulders, once a day.

And the gel is designed to reduce phil sperm count. Oh, interesting. We'll get into the science of how that works later. But the bottle of gel had this pump, so researchers would make sure everyone was getting the right amount daily. And then I would have to wash my hands because apparently if it were to get on anybody else that could be detrimental to them. Why is that? It's because the gel contains testosterone. Oh, okay.

Right. And any prolonged exposure for a woman or child to testosterone could mess up their hormonal balance. Sure. Now, this study is still going on. It's not over. But researchers at UW have already found that there's little risk of hormonal transferring. And short-term exposure is safe. But to be extra careful, the researchers asked participants like Philip to...

Make sure that my shoulders are always covered. Make sure that I did it every single day. And he wore that T-shirt until the gel was fully absorbed. Regina, I have never, ever heard of contraception that worked like this. Of a gel that a man would apply to ultimately prevent pregnancy? Yeah, no, I hadn't either. This was, like, really fascinating. And all of this work, you know, applying this gel,

it seemed like a small inconvenience to Philip because he was actually really eager to join the study. He got a little cash and he got to share some of the burden of birth control with his partner. I was happy to participate because I think this is a really important sort of scientific advancement. And also, I guess, social advancement too, because generally women are faced with the brunt of contraceptive choices. And he says he didn't have any side effects. I never once felt moody. I didn't feel any quicker to anger. I didn't feel any annoyance.

I didn't feel anything like food cravings or anything else that's unusual for me. I mean, I love food, so I'm always craving food. But I never felt anything unusual that I would ever attribute to the gel that I was using. So we don't know how effective the gel is yet. That's what the study is for. And the hope is that the person producing sperm can take partial to full responsibility for preventing pregnancy, too. Today on the show, we ask some questions of male contraception. Why haven't we seen birth control for men?

And when will there be contraception on the shelves? That includes more options for those who produce sperm. I'm Emily Kwong. I'm Regina Barber. And this is Shortwave, the Daily Science podcast from NPR. Before we get into this story, I just want to acknowledge that all the language in these studies and in this episode is gendered. Researchers are working on making it more inclusive, but these studies are typically done on cis males between 18 and 50. All right, good to know. Okay, pop quiz for you. I'm ready. What was the last

male contraceptive to hit the market? I think it has to be condoms. I can't think of anything really honestly targeted to men beyond condoms. Ding, ding, ding, ding, you are totally right. And that was like 200 years ago. Two hundred years ago. Yeah, that's the last thing that a man can just buy specifically for a male contraceptive. All right. And you're here because it sounds like there are other male contraception options in progress. And we could really use them. So what are researchers working on right now? Well, I spoke with professor and medical researcher, Dr. Stephanie Page, at the University of Washington.

Her team is trying to get the next male contraceptive to the public. So they've got a few projects going on at once, including the gel that Philip described earlier. We would like to create a menu of options for men, similar to what women have available to them. and that would include, and things we are actually working on, a transdermal gel that men would apply every day, an oral birth control pill for men, and long-acting injections. And in all cases, those, at least the methods that we're developing, would be reversible. So interesting. Wow. Okay. So Stephanie works exclusively with hormonal methods. And what's the difference between hormonal and non-hormonal? How do they work?

Hormonal contraception works by interrupting the signals from the brain to in men, the testes, that they cause them to create new sperm. That's Logan Nichols, the research director at male contraceptive initiative. He says that when the hormonal gel or pills are taken regularly, they lower testosterone levels, reducing the ability to produce sperm. The male contraceptive initiative focuses on helping researchers working on potential non-hormonal methods. Some of those methods are drugs that target. proteins in the body that when absent will slow down the speed of sperm, reducing their ability to reach the egg. Other options are more physical, for instance, a way to block the vasdeferens, the tube that

carries the sperm from the testes to the urethra. Oh, okay. And what do those physical methods look like? So Logan says it would be something that can be implanted. Implanted. What do you mean? Think of like a small object that can be implanted into the sperm-carrying tube we were just talking about.

It acts as an alternative to vasectomy. You know, vasectomy, very effective, very cheap, very easy, not always reversible. These new methods are a hydrogel, kind of a gel-like substance that gets injected into the vast deference, that blocks the transport of sperm over time. And men don't ejaculate sperm, but they still produce sperm. And then eventually that gel either degrades or is reversed via a second injection, and men restore fertility. So which method hormonal or non-hormonal will make it to the market first?

you think? Yeah, this was my top question for everyone. I asked all my sources, Stephanie, Logan, and even another researcher, Dr. Brian Nguyen. He's an OBGYN and a professor at the University of Southern California. Like Stephanie, he conducts clinical research on hormonal contraception for men, including the gel philip used. I'll tell you what I'm most excited about first, which is the method that we are closest to getting the market, which is a hormonal method of male contraception, hormonal consciousness of gel, that essentially sends a signal up to the brain to shut down the signals for producing sperm. And that way we decrease men's sperm count, and then at some point when they want to stop using the drug, and the signals restart all over again.

This is so fascinating, Regina. I'm wondering, do we know how effective these birth control methods are? I know the research is still happening, but ultimately, do we know if these methods can be used to prevent pregnancy entirely all on their own? I mean, the idea is yes, right? Okay. That's what they're doing now in the study is to measure how effective this method is to reduce the sperm count to levels that will not produce a pregnancy. And when will this gel be available to those who want it?

Most researchers I talk to seem to think will have something within the decade. An optimistic but still realistic timeline is in the order of seven to ten years. The seven to ten years is due to how long clinical trials take. But Logan says the non-hormonal method of physically blocking sperm with an implant could be released sooner. They've just started their first in human studies in Australia. But because it's regulated as a device, it has a theoretically much shorter approval pathway than a drug does. Okay. So that's the status of these contraception methods. But I got to say, Regina, why has it taken so long to develop contraception for men?

Yeah. Stephanie says the first priority. was for those who can have children. Initial contraceptive efforts were really focused on women appropriately as women bear the life-threatening burden of pregnancy. And so the initial energy went into ensuring that women had control of their own reproduction. Anne, she says developing male contraception is more complicated. The fact that women ovulate once a month, two or three eggs, and that they have a finite reproductive time period is very different than men.

So men are making literally millions and millions of sperm per day. And in the ejaculate, there's more than 200 million sperm. There's a lot to parse through. Like researchers had to figure out the threshold on how much sperm needs to be blocked. And then she says there's a lot of regulatory controls that have to be worked through, too. For one, the criteria for the FDA to approve a new male contraceptive is vague. And two, all the risk calculations are different across people. of different biological sexes?

You know, male contraception is a funny thing because when we think about risks, what are we protecting the man from? And in the case of female contraception, the woman is being protected from the risk of pregnancy and of potentially unsafe abortion. So, but with men, they're really using a contraceptive to protect their partner. And so if we just think about the man as a single unit, the risk equation is not very good, right? There should be absolutely no side effects and no risk. But I think we really need to move to thinking about couples as a dyad and this is shared risk.

And Stephanie says there are financial barriers in drug development. The way that drug development happens in the United States ultimately is funded by the pharmaceutical industry. And that's really because the final phase three trials are exceedingly expensive. Logan agrees. Drug companies want to know they have something that sells. Drug companies invest millions and millions and millions of dollars into a drug before they ever see a dime of profit. And if a drug has really high barriers of safety and efficacy, once that they maybe aren't sure they're going to be able to hit, they might not even take the effort at all. Overall, after talking to everyone, I noticed that they were all optimistic that a male contraceptive would be out on the market in the next decade.

They also all agreed that we in the media and society need to start thinking about contraception as something that everyone should be involved with. Absolutely. Yeah, be it to give a man a chance to take more responsibility or to recognize that an unwanted pregnancy would affect a couple, not just the person carrying the baby. Regina Barber, thank you so much for bringing us this reporting. I have learned a lot from it. Yeah, you're welcome. And I've learned a lot from this one, definitely. This episode was produced by Rebecca Ramirez.

It was edited by supervising senior editor, Giselle Grayson, and fact-checked by Britt Hansen. The audio engineer was Trey Watson. Brendan Crump is our podcast coordinator. Beth Donovan is our senior director, and Anya Grunman is our senior vice president of programming. I'm Emily Kwong. I'm Regina Barber. And thank you for listening to Shortwave, the Daily Science Podcast from NPR. See you tomorrow.