As technologically advanced as we supposedly are, sexually active men generally have only two crude methods of contraception available to them. The first is the "withdrawal" method, which requires the discipline and timing of a BASE jumper.

But, like a BASE jumper, all it takes is one second of hesitation and the early withdrawer can end up splattered against a wall – a vaginal wall, possibly causing an unwanted pregnancy.

Then there's the ridiculous, embarrassing act of putting on a condom. After calling a sexual timeout at the least convenient moment possible, you have to roll on something that's either too big, too small, too fluorescent, too glow-in-the-dark, too colorful, or just too cannoli.

You'd think that science would have come up with some better methods, but there's a hurdle to overcome that's just as much mathematical as it is biological.

Consider that female contraception is rather easy, in a sense. All you've got to do is thwart the one or two monthly eggs that travel through a woman's reproductive system – it's not exactly a biochemical battle of 300 Spartans at Thermopylae defending the passage against overwhelming odds.

But every time a man ejaculates, he's sending between 15 and 100 million spermatic troops into the fray, and wiping them out is going to take something on the order of a biochemical Death Star.

Doctors Stephanie Page from the University of Washington and Christina Wang from UCLA think they've found that Death Star and they're calling it the "male pill," but it's unlikely that most men are going to want to use it because no matter how you couch it, it's a type of chemical castration.

Besides, there's an older, almost forgotten contraceptive method available to men that should be reconsidered.

Look Like a Hairless, Pudgy Boy? Where Do I Sign Up?

Page and Wang made headlines recently when they concluded a 28-day study involving 83 test subjects and the drug dimethandrolone undecanoate, or DMAU. The drug works by lowering a man's testosterone levels to pretty much what they were in his boyhood.

With such low testosterone levels, the testicles take a holiday, a chaste and joyless holiday. But before male readers recoil in horror, the drug also acts as a male steroid hormone so that you'll supposedly maintain your male characteristics without triggering sperm production.

The test subjects who took the drug showed marked suppression of follicle stimulating hormone (FSH) and luteinizing hormone (LH), both of which are required to spur sperm production and testosterone production.

Very few of them reported any symptoms of testosterone deficiency, including sexual dysfunction or a souring mood. Most men did gain between 3 and 8 pounds of fat, though, in addition to a mild drop in HDL levels.

Testosterone Ain't a Light Switch

There are a couple of problems with Page and Wang's yet-to-be published study, though (other than the weight gain and compromised cholesterol). For one thing, the 28-day trial is way too short a time to gauge whether DMAU would lead to symptoms of low testosterone.

Testosterone, and more importantly, its psychological and libidinal influences, isn't like an on/off switch. If you cut off testosterone production today, it may well take a while for sexual dysfunction to occur, as well as for any signs of depression or loss of muscle mass and secondary sexual characteristics in general.

Furthermore, Page and Wang don't seem to understand the psychology of men very well. In my experience, the vast majority of men who would consider taking a drug that would chemically castrate them and cause them to gain body fat are probably running on testosterone vapors and are already infertile.

Injection

A Better Way?

There's a better method of male contraception currently available, but it isn't talked about at all because it involves men using more testosterone.

If you inject a sufficient amount of any one of the currently available testosterone esters – cypionate, propionate, or enanthate – you will effectively shut off the production of sperm for as long as the shots are administered.

It's a simple negative feedback loop. When there's "too much" testosterone in the bloodstream, FSH and LH production stop and can't bind to receptors in the testis and promote sperm production.

The World Health Organization (WHO) once considered this a viable option, even conducting a 10-nation trial of it back in the early 1990's. One hundred fifty-seven men (70% of the test group) who received a weekly injection of 200 mg. of testosterone enanthate reached azoospermia (absence of motile sperm) within 6 months.

The treatment was continued for a year and subjects refrained from using any other contraceptives. Only one pregnancy was reported, which is a pretty high success rate.

Another similar but larger study was conducted later, again with an impressively high success rate, but obviously the method was never adopted, probably because of the negative stigma associated with testosterone in general, along with some misconceptions about testosterone in general.

Still, it probably doesn't require any special insight into the preferences of men to realize that most guys would prefer that scientists further study the high-testosterone method rather than the chemical castration method.

Related:  American Men: As Fertile as Dead Hamsters

Related:  Testosterone, Body Composition, and Sex

Reference

  1. World Health Organization Task Force on Methods for the Regulation of Male Fertility (1990). "Contraceptive efficacy of testosterone-induced azoospermia in normal men," Lancet 336:955–9.