Being diligent at taking a pill at the same time every day can be stressful (and tough). Having an IUD inserted is also not the most pleasant experience. And buying the morning-after pill can be heavy on your wallet. With a super-limited number of male contraceptive methods available, the burden of pregnancy prevention has historically fallen primarily on women.
So when we heard that there could be a male topical gel to actually prevent pregnancy, we got a little excited. Most improvements have been female-focused (think: oral contraceptives like the pill and the morning-after pill, the patch, the IUD, etc.), so a new contraceptive option in which men have more responsibility over pregnancy prevention is a welcome relief.
The up-and-coming gel for men isn’t yet available. Rather, it’s set to be studied in a new clinical trial funded by the National Institutes of Health (NIH). Here’s what you need to know in the meantime.
How does the gel work?
Developed by the Population Council and the NIH’s National Institute of Child Health and Human Development (NICHD), the gel, called NES/T, contains a combination of testosterone and a progestin compound called Nestorone. The progestin blocks a guy’s natural testosterone production, which reduces sperm production to extremely low or practically “nonexistent” levels, according to an NIH statement. Then, the testosterone in the gel makes sure he still has his normal sex drive–and that other bodily functions that depend on testosterone continue as normal, too.
While it might sound like the kind of thing he’d smooth over his penis like lube, it’s actually applied to the back and shoulders and absorbed through the skin. And in theory that’s easy-peasy–except how many men have the ability and flexibility to fully reach their backs to apply this gel properly by themselves? We’re imagining a super-awkward Cirque Du Soleil-esque performance by a half-dressed man trying to lather a sticky gel on his back. Not sexy. (But definitely hilarious.)
However, if a woman lends a helping hand and applies the gel for the man, there’s some concern the exposure to those hormones in the gel could have an effect on her. Since it’s still unclear if that can happen, the best thing to do would be to vigorously wash your hands following the application to avoid having these hormones absorbed into your own skin, says Sherry Ross, MD, an ob-gyn in Santa Monica, California, and author of She-ology: The Definitive Guide to Women’s Intimate Health.
What will happen in the clinical trial?
Researchers are going to enroll 420 couples. In the first phase of the study, the men will apply the gel daily for four to 12 weeks to first evaluate for any negative side effects. If, after 12 weeks, their sperm levels haven’t decreased enough to prevent pregnancy, they’ll keep using the gel for up to 16 weeks.
Once sperm levels have declined enough to consider the gel safe to use as contraception, the couples will have a 52-week trial period to see if it actually works to prevent pregnancy. After that, men will be monitored for another 24 weeks once they have stopped using the gel to see if there are any lingering side effects.
Male birth control available now is limited
Men are currently limited to condoms, the pull-out method, and sterilization by vasectomy as means of birth control. Experts discourage using the pull-out or withdrawal method, since it’s not a fool-proof or reliable means of preventing pregnancy or STIs.
When used correctly, condoms can prevent pregnancy and STIs. However, many couples skip condoms when things start to heat up because they don’t have one on-hand, are living in the moment, or believe the barrier decreases pleasure. Even when used correctly, condoms can still slip down or break, which then leaves both people vulnerable to risk.
On the other hand, vasectomies are more permanent solutions. They require surgery, in which the man’s vas deferens duct, a tube that transports sperm to the urethra, is cut or tied off. Less than 1% of men who’ve had vasectomies experience unplanned pregnancies with their partners. While they can sometimes be reversed, it’s not always possible, so this is not a great solution for couples who do want to get pregnant in the foreseeable future.
Could this gel replace condoms?
Since many women can’t or don’t want to use hormonal contraception and male contraceptive methods are so limited, this gel is certainly a step in the right direction. “A safe, highly effective, and reversible method of male contraception would fill an important public health need,” investigator Diana Blithe, PhD, chief of NICHD’s Contraceptive Development Program, said in a press release.
However, experts aren’t thrilled with the idea of condoms being totally replaced by this gel, since condoms help prevent sexually transmitted infections, points out Dr. Ross. You might also want to take into account that not every partner will apply it properly or when they should, making it less reliable (similar to you missing a birth control pill). “I would not have women stop using their form of contraception even if a man is doing his part in preventing pregnancy,” Dr. Ross says.
Having men make contraception a personal priority as women have done for decades is definitely an improvement. This promising gel may not be the answer–at least, not yet–but experts are on the right track by bringing men more fully into the picture. “We are ‘seconds’ away from having men join women in the contraceptive responsibility,” says Dr. Ross. “Even though more studies are needed, researchers are getting closer to having men join in on the responsibility of birth control.”