Unexplainable - Is male birth control finally here?

Episode Date: April 1, 2026

Typically, the burden of birth control falls on whoever has a uterus, but it seems like that might change — and soon! Guest: Annalisa Merelli, contributing writer at STAT. For more, go to ⁠⁠http://vox.com/unexplainable⁠⁠ It’s a great place to sign up for our newsletter, view show transcripts, and read more about the topics on our show. Also, email us! [e-mail] We read every email. Support Unexplainable by making a financial contribution to Vox! ⁠⁠bit.ly/givepodcasts⁠⁠ Learn more about your ad choices. Visit ⁠⁠podcastchoices.com/adchoices Learn more about your ad choices. Visit podcastchoices.com/adchoices

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have to navigate. The pill, the shot, the ring, hormonal IUD, copper IUD. Trust me, it was the most pain I've ever experienced in my entire life. And the inevitable side effects. Even with all of these options, almost every person who takes birth control I know has faced some kind of pitfall at some point while figuring out what's best for them. And that responsibility is normally up to whoever has the uterus.

But I learned recently. It seems like things might finally be changing. Birth control options for people with sperm are here. I've found out that there's actually quite a few options that are being studied, tested, and in various stage of testing, But we might be getting commercial availability. If all goes well, which is a very, very big and heavy if,

we may get that commercial availability, you know, in a matter of a few years. Like, it's not really in the remote future. I called up a health reporter, Annalisa Morelli, who wrote about the drugs and devices in development right now for stat. For a while, the drugs in development always halted. Some were met with side effects. Others never made it to human trial. But for the first time in history, some of the options are looking really viable.

And there's a lot of confidence that they'll go to market. And I wondered, like, is this for real? Today, will male birth control work? And do people really want to take it? I'm Amy Padula. This is unexplainable. Do you think this is something that will happen in our lifetime? Oh, I mean, for sure is never.

Never say that with science, but I think it's very likely. I was just talking to one of the developers of two of the methods. They're thinking three years, two, three years. There's a couple others that are going to enter phase three trials. So again, we're talking a handful of years and potentially several options might be available. Before we keep going, I want to break down what these trials mean. It's kind of like drafts of a story. Phase one trials, draft one, let's say, look at safety and dosage within a small group of participants. Phase two looks at how the drugs work in a larger group. And then phase three confirms how effective the drugs are, watches for side effects,

and then compares the new treatment to other proven forms in larger studies. And by that point, we really have a solid sense of what the drug does and how it performs. Final draft, essentially. The male birth control methods in development right now are in phase two, which is much further than they've been in a long time. The last time, one of the options made it to phase two, was back in 2011. But the options being tested right now, so far, are working. And they're showing a lot of promise.

Which is good, because the options on the table for male birth control today are really limited. They can use condoms. or they can get a vasectomy. Condoms, I think many of us are familiar with. There's an issue of reliability, right? Even in the best case scenario, they're fallible, they can break. But, you know, add to that human error

and you're talking about, depending on the study, but like 13% to 18% rate of failure, very high. And then when it comes to vasectomies, desectomies can be very effective. They do fail upon occasion. but very, very rarely.

They are also, which not many men or people know, reversible, especially if you do that within the first five years. However, there are a number of downsides. Number one, you may not want to undergo a procedure of that type. Two, it is not guaranteed that it can be reversible. So if you're a younger man, you may not just want to run the risk. Number three, it can be expensive. And unlike contraception for women, contraception for men in America,

is not free and not covered by the Affordable Care Act. So some of the men that I spoke with when I wrote about male birth control would have been happy to get a vasectomy and then found out it was going to be, depending on their insurance status, could be running the thousands of dollars. And the reversal is expensive, can be expensive even more so than the vasectomy, and it might be hard to find someone to do it. This all makes vasectomy like a bigger decision for someone who is, let's say, done or never. ever wants to have children or is sure and ever want to have children. There's not anything remotely comparable to all the range of options that women have. And I am aware as anyone that I want to say none of the options that women have is ideal, but most of them do the job and work and are reliable, which is something. So Annalisa says there's a couple interesting

options in these clinical trials. And we're going to break them down into two groups. There are medications and there are devices. And the reason why I'm breaking them down this way is that because of the way the FDA approval process works, devices are faster to get approval and to get cleared than medications. And so some of the products that have been seem to be a little bit behind in the testing phase, because they aim to be cleared as devices, will have the likelihood to come in on the market sooner than medications. The first one is a hormonal gel. It's called NEST, which stands for Nestrone and testosterone, and these are the two components of this gel. It's a gel that men have to apply,

I believe it's either on the arm or on their shoulder daily. Raising testosterone, this sort of leads to infertility. They have completed their phase two studies a while ago. I've spoken to one of the people who took part in the studies. They liked it very much. It was very effective. It has some downsides. One is that you need to apply it every day.

So it requires very high compliance. There's a couple sort of life. style of issues with this gel, though. The other downside is that testosterone gel, testosterone transferred to other people when you have a gel foot on yourself. And so say, like, you can't touch a child if you've just applied testosterone. You have to wait a few hours. You can't cuddle with a partner if you've just put on your testosterone gel because she will

have effects from the exposure to those levels of testosterone. This essentially means when I was talking to the person who went to trial, who was, by the way, was 100% on board. This man was saying, if I had to choose between no birth control and put in this gel on my arm every day, I'll put my gel on my arm every day. Like, he was sold on it.

So the person that I spoke with was saying that because of the fact that he couldn't really have skin contact with someone else after he put on the gel, this made him essentially plan his day out, right? So he would put it on in the morning if you knew that he was seeing his girlfriend later in the day, or if he was staying at home that morning,

then he would put it on at a time where you knew he could be away from skin contact with people for a little while, which is a bit of a downside, I suppose. He said it was manageable. In fact, he said that when the study, when the study ended, he wished he could continue and he immediately looked for another trial

that you could participate in. Were there any side effects with that trial? You know, not really. Not really. One of the men spoke with said initially he was a little bit fatigued, but he couldn't really put it down to the gel itself. He said it might be something else going on in his life. One of the reasons why the hormonal birth control trial was halted

is that the mental health side effects were really felt by men. And when I was talking to men and asking them, well, would you take a problem? birth control a pill. And what would make you not want to take it? Depression, anxiety, like the increasing the mental health side effects were really the one thing that men were aware of. And we know this existing women's for women who take birth control pills as well, but I thought it was remarkable how really that specific seemed to be the one where they drew the line. I didn't hear men talking, for instance, like weight gain or other things that you may think about mental health really was a top concern.

Another option is something called YCT-529, a non-hormonal birth control pill for men. Basically, it stops the receptors of vitamin A and the testes, which are essential for making sperm. So while you're on it, you don't make any. You're sort of temporarily infertile. These has had a lot of success in the trial, so far as we can tell. the science behind it was just published in several papers. It's sort of like an innovative way of thinking about suppressing fertility. From what I hear men who are participating in the trials, I'm pretty happy with it.

They wish to continue when the trial, and it still needs to go to like a larger size trial, but the expectation of the company that's developing this are pretty good and high. And there's a different pill in development. It's sort of like the on-demand option. It's called NLS 133. And you take it 90 minutes to three hours before intercourse. The way that it works essentially stops men from ejaculating. You have intercourse as you were going to, but you don't ejaculate, essentially.

You don't produce. This doesn't mean that you don't have orgasms. It just means that you don't ejaculate. And that way, nobody gets pregnant. The medication is a combination of two existing drugs that do different things. The drug works by stopping a receptor that plays a role in sperm production. The idea is that you would be similar to Viagra. You'd go to the doctor, you'd have a prescription, you have a few pills on you, and then you take them when you need them.

Essentially, the way that I think about it is it's a more reliable alternative to a condom. This is not going to alter your fertility permanently. It's something that you have to do every time. Upon occasion, it's on demand. And then there's a fourth option, an injectable, implanted gel. It's called Adam, a set it and forget it option. These are the other group that I was mentioning, which are devices. So one is Adam, which is a hydrogill.

So hydrogels are like gels that are injected in the body. They can be done for a lot. of things, they're not rejected by the body as an external tissue or in a, so there's no, there's no issue of having reactions to them or anything like that. And what a hydrogeal does, in this case, it sort of creates a seal that is small enough that the head of the sperm literally will not go through. The other thing that I think about is like, oh, it's like a mild IUD, but I'm told far less painful than an IUD insert. for many reasons, including the male anatomy, they would have it easier.

But essentially, it creates this barrier. There is another product, which is called Plan A that another company is doing, which doesn't need to be dissolved. So it's longer active. It will last for a few years. It's basically like a hormone of birth control that releases a steady amount of hormone in your bloodstream and it lasts up to five years. So an abundance of methods, it seems.

One thing I learned that surprised me was that there was a male birth control pill in the works. At the same time, the female birth control pill was in development, like back in the 1950s. And that made me think, why has it taken this long to develop these new drugs? We'll dig into it all after a short break. It's all about you. And when you fly with Virgin Atlantic and their upper-class case, cabin, they take the VIP treatment to the next level. With a private wing to check in, and your own security channel at London Heathrow, you can glide from your car to their clubhouse,

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Ontario only. Please play responsibly. If you have questions or concerns about your gambling or someone close to you, please contact Connects Ontario at 1-866-531-2600 to speak to an advisor, free of charge. BetMGEM operates pursuant to an operating agreement with Eye Gaming Ontario. So these drugs are in various stages right now. It seems like we're further ahead, though, in these trials than we have been in the past.

Why is that? So I believe that the number one reason why we don't have middleware control is today, you know, in 26, it's cultural. We belong to a society that believes pregnancy is a woman's responsibility. maybe because men are not used to being compliant with medications, they're not used to having to account for pregnancies. But there's just been a skepticism that men would be reliable. And so that if a men were taking birth control, the question was always, would a woman trust it?

Would a woman trust that they're taking it for real when they're supposed to? If it has any side effects, would women really not want to take birth control themselves or would they want to take breath control? Birth control was a woman's game. You know, there are products that exist. Are they great? No, do women still use them? Yes.

You know, so even then there's not even a great incentive to make a better product because, you know, what we have is fine, you know, nobody is going to invest large sums of money to go through the complicated process of making sure that something works for birth control, which is a pretty, you know, pretty high bar when it comes of, you know, even when it comes to, like, health trials, recruiting

people is not necessarily so easy to recruit someone. Be like, do you want to try and see if maybe you get pregnant, maybe you don't? There's a second reason, which is business. You know, all of the innovations in birth control and reproductive health that has been made in recent years are all typically funded by nonprofits, grants, even the ones that I've mentioned are receiving grants because big pharmaceutical companies stepped away, you know, they had some of the products, they had the pill, you know, talk about a real, like a money maker, right?

And then, you know, those were developed and then the patents expire. And it just doesn't make that much money. And so it's sort of like not really been an area of great business appeal. Now, what has changed? are a number of things. So number one, men, some of the sort of research and development and even thinking about male birth control was getting momentum right as the AIDS epidemic. And so there was such a push, understandably, towards using condoms, that that kind of became the default. I just wonder, what has kept a lot of these methods in testing and not made it to market?

Well, I think right now the push is stronger. The attention is greater. There's dedicated research. There's been a change. There's been a shift in how we think about contraception and male responsibility in contraception. And this is social and it's personal. Many more men than ever before want to be responsible and want to be in charge and evagency over their fertility. I believe this is a result of a change in legal landscape in many ways, while also noting that we're still, it's still, you know, some of the products that I spoke with will still tell me that, you know, we'll get into, you know, phase three trial when we got the funding. They're still not being, like, flashed with tons of funding and investment. It's still not getting to that desirable level.

But I think the things that changed are several. As I said, they're the cultural, but they're also in America legislative. So one is the reversal of where we wait. The Dobbs decision was a massive catalyst and in the interest that men have in birth control. And I know this because every organization that I spoke with who's developed, our company who's developing birth control told me that the interest they got in clinical trials

since Dobb just skyrocketed. If you no longer have choices to terminate pregnancies, you now live in a society in which two people are responsible for it. And it's easier to hold men accountable in a way that wasn't until too long ago. And so you suddenly have men who have shifted. I don't want to necessarily frame it only this way because obviously there's always been men who have been aware and allies and willing to participate in being responsible in their. sexual life. But that said, you know, you suddenly have men who see not having birth control, not so much as like, this is not my job and I'm free of a burden, but as I don't have agency. I don't have agency of my own body and my own fertility because pregnancy is so much more invasive

and, you know, so much more of a burden on the woman than it is in the man. There's a cultural movement, which is of much bigger awareness of the challenges that we're. women face through their entire life dealing with fertility. And, you know, the side effects that hormonal birth control can have her skin is breaking. She's getting weight. She feels depressed. And so I've spoken with men who told me, you know, my partner, my girlfriend, my wife, has been taking hormone of birth control for a decade. She's tired of it. I think it's my turn. Like, there's, there is that really encouraging willingness to share the birth. and to understand that, you know, avoiding a pregnancy and unwanted pregnancy, it's not just a woman's

responsibility, it's the responsibility of both partners. And I think that's an important cultural shift. Another thing that I've heard mention more than once is that sometimes couples, typically American couples, in connection with Addobs decision, both partners want to take birth control at the same time. both partners, they want to be that sure that there are no accidental pregnancies. And, you know, to an added data point that can support the impact of the dog's decision, there was a service that was done asking men if they'd be up for taking male birth control. And in some countries, I believe Nigeria, I might be wrong, but I believe it's Nigeria. It was up to like more than 70% men were like, sure, sign me up.

in the United States was relatively low, it was 39%. And then they redid the same survey after the Dobbs decision. And in a matter of a year, I believe it was 49%. I think the men who are open for it are also likely in a position to be trusted to do it. So what would it really take for these drugs to go from the lab and to the market? Like, are we close? Money. And obviously, there's a number of other things.

But the money, you know, sufficient funding would make sure that there are the next step of trials that are done and are paid for. And then all the research can be done assuming those is successful, then the products can go into the market. And we're relatively close. I believe, you know, the on-demand pill and an item, it might be a matter of a couple of years. It's like really close. Do you think we're really at a moment in reproductive health care history that's the beginning of a new era? I hope so. My most hopeful self thinks of this as a cultural counterweight to the political sort of rolling back of reproductive health funding and money and options. It seems to me like

this is like a small but important sort of cultural change. You know, large pharmaceutical companies aren't so interested in investing in reproductive care. And that remains true. It's also true that if the interest and if the market matches what has been studies and surveys, like this is a huge, huge market. We're talking like billions of people. So there is a hope that that too will perhaps then move financial interest, which unfortunately are always at the base of, you know, spreading.

having more option, having more research, more availability. Birth control for people with sperm is just about, almost, but not quite here. I was struck by some pretty wild data. Since Roe v. Wade was overturned back in 2022, vasectomies increased by one-fifth in the country, according to a study done in 2023. I want to stress how heartening the conversations that I've had with men who participated in the trials have been. Nature is designed the way that it is. There's some things we cannot avoid.

People who have a uterus get pregnant. The burden will always be on the body that carries the pregnancy. But the level of awareness and willingness to do as much as possible to share the responsibility really struck me. And I found it, again, very hopeful. This promise 80 years in the making. Finally, seems within reach. This episode was produced by me, Amy Padula. It was edited by Joanna Solitarev, mixing and sound design from Christian Ayella and music from Noam Hassanfeld.

Melissa Hirsch checked the facts. Jorge Just is our editorial director. The team includes Sally Helm, Meredith Hodnott, Christian Ayella, Noam Hassanfeld, and Bird Pinkerton got out of the train at 190th Street Station and started walking down the long pedestrian tunnel looking for any kind of cue. Sun never shines, shadows run from themselves. And then she heard the beep.

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