Is male birth control finally here?

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1:03For as long as I can remember, I've heard this vague promise that someday there will be a birth control pill for men. And meanwhile, I've heard endless stories about the struggles that people with uteruses 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.

1:46But I learned recently, it seems like things might finally be changing. Birth control options for people with sperm are here.

1:58Annalisa Merelli:I've found out that there's actually quite a few options that are being studied, tested, in various stages 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 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 trials. But for the first time in history, some of the options are looking really viable.

2:41And 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.

3:13Do you think this is something that will happen in our lifetime?

3:16Annalisa Merelli:Oh, I mean, for sure is never, you should 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 is 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.

4:04And 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.

4:50Annalisa Merelli: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, vasectomies 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.

5:35Annalisa Merelli: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 run into 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.

6:17Annalisa Merelli:This all makes vasectomy like a bigger decision for someone who is, let's say, done or never wants to have children or is sure and never 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.

7:18Annalisa Merelli:And so some of the products that 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 NES-T, which stands for inestrone 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 their 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.

8:06Annalisa Merelli: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 of sort of lifestyle issues with this gel, though. The other downside is that testosterone transfer to other people when you have a gel put 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 when they went to trial, who, by the way, was 100 % on board.

8:52Annalisa Merelli:This man was saying, if I had to choose between no birth control and putting 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 he 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 he knew he could be away from skin contact with people for a little while, which is a bit of a downside.

9:32Annalisa Merelli:I suppose. He said it was manageable. In fact, he said that when he was in the phase two study, when the study ended, he wished he could continue and immediately looked for another trial that you could, you know, participate in.

9:51Were there any side effects with that trial?

9:54Annalisa Merelli:You know, not really. Not really. One of the men spoke with said initially he was a little bit fatigue, 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 birth control 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.

10:33Annalisa Merelli:And we know this exists in 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 in 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. This has had a lot of success in the trial, so far as we can tell.

11:17Annalisa Merelli: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 are pretty happy with it. They wish to continue when the trial, and it still needs to go to 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.

12:04Annalisa Merelli: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 inject the date. 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 it 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.

12:44Annalisa Merelli: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 hydrogel. So hydrogels are like gels that are injected in the body. They can be done for a lot of things. They are not rejected by the body as an external tissue. So there's no issue of having reactions to them or anything like that. And what a hydrogel 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.

13:35Annalisa Merelli:The other thing that I think about is like, oh, it's like a male IUD, but I'm told far less painful than an IUD insertion 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 hormonal 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.

14:30And 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.

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17:30Oh, yes, you're going. Could you two please dump some hormones? 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?

17:45Annalisa Merelli:So I believe that the number one reason why we don't have middle birth control is today, you know, in 2026, is 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 man 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 birth control?

18:31Annalisa Merelli: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 ethical trials, recruiting people is not necessarily so easy to recruit someone. and be like, do you want to try and see if maybe you get pregnant, maybe you don't.

19:11Annalisa Merelli: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 sort of 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.

20:11Annalisa Merelli: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 of agency 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 get the funding they're still not being like flashed with tons of funding and investment and still not getting to that desirable level.

21:20Annalisa Merelli: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 Roe v. Wade. 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 or company who's developing birth control told me that the interest they got in clinical trials since job 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.

22:10Annalisa Merelli: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 over 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 on the man. And there's a cultural movement, which is of much bigger awareness of the challenges that women face through their entire life dealing with fertility.

23:00And, you know, the side effects that birth control, hormonal birth control can have.

23:06Annalisa Merelli:Her skin is breaking. She's gaining 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 hormonal birth control for a decade. She's tired of it. I think it's my turn. There is that really encouraging willingness to share the burden and to understand that, you know, avoiding a pregnancy and unwanted pregnancy is not just a woman's responsibility. It's a responsibility of both partners. And I think that's an important cultural shift. another thing that i've heard mentioned more than once is that sometimes couples typically american couples in connection with the dobs 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 another data point that can support the impact of the dobs decision There was a survey that was done asking men if they'd be up for taking male birth control.

24:09Annalisa Merelli: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, it 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 money, you know, sufficient funding would make sure that there are the next step of trials are done or paid for.

24:55Annalisa Merelli:And then all the research can be done. Assuming those are successful, then the products can go into the market. And we're relatively close. I believe, you know, the on-demand pill and an atom, it might be a matter of a couple of years. 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 rolling back of reproductive health funding and money and options. It seems to me like this is a small but important 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 studied in 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 interests which unfortunately are always at the base of, you know, spreading, having more option, having more research, more availability.