The male pill is back in the news, now the Bill & Melinda Gates Foundation have awarded a seven figure grant to a team at Dundee University working on it.
Many have tried to get the ball over the line, as it were, and all have failed to bring out a commercially available product. I did two separate trials at Edinburgh University many years ago now, and so I’ve got a very personal interest in seeing the Dundee team pull it off.
More than 15 years ago I reassured my then partner that of course I would take a contraceptive pill if I could. I also understood her very apparent frustration with the side effects of the pill she was taking.
When next we went to the family planning clinic, the poster right next to the receptionist’s window was of Neil Armstrong on the moon, captioned: “Be the first man on the pill”. I couldn’t have said no even if I’d wanted to. And so I found myself on a year-long pill trial for the first time.
Can men be trusted to take the pill?
The experience was weirder than it would be for people using an approved version, with rather intrusive monthly photography and sample testing, but it was 100% effective for me, and – as far as I know – so it was for everyone else on the trial.
Four years later, I spent another year on a different version of the same concept, and that also worked well. The research team said not to use it as my primary contraception, as no doubt required by their ethics panel. That’s hard to stick to, though, when they’re also looking in a microscope each month and telling you your sperm count is zero.
And that’s the point. The problem has never been the science of stopping sperm: it’s been the economics of such a pill as a commercial product. That in turn rests on assumptions about the mindset of the people who might take it, or, more importantly, the mindset of people whose partners might take it.
Can men be trusted? It’s a very fair question.
This project could be genuinely transformative, but for decades now it has more closely resembled the story of cold fusion: full of potential, often discussed, but always 20 years away
If you’re having sex with someone who could get you pregnant, though, and you’re not using condoms, you already need to have had a conversation about your sexual health. Are you both tested? Are you sleeping with anyone else? If so, are you doing so safely? And so on.
If you can trust someone not to give you an STI, hopefully you could also trust them to keep taking the tablets and not get you pregnant. It is clear why that wouldn’t always apply to all relationships, of course – and no matter how successful these trials are, the product won’t be for everyone.
We’ve already got a pill: why do we need another one?
The term “male pill” is a misnomer in two ways. First, this contraceptive would be useful for some trans women as well as the many cis men who may end up using it.
Second, it doesn’t need to be a pill. This could help to answer the trust question
The first trial I did was a daily oestrogen pill to knock out sperm production, combined with a monthly injection of testosterone to prevent feminisation. But the second was quarterly implants of both. I can assure you that’s not something anyone is likely to forget or not notice.
There are many many people like that ex-partner of mine for whom the successors to the 1960s pill revolution just don’t work. Tackling it at the sperm side rather than the egg side wouldn’t be a replacement for that pill, just another option for couples alongside condoms, caps, IUDs, implants and the rest.
This project could be genuinely transformative, but for decades now it has more closely resembled the story of cold fusion: full of potential, often discussed, but always 20 years away.
In the case of the male pill, that delay is also the fruit of sexism in the medical world and amongst decision makers at the pharmaceutical companies. We’ve already got a pill: why do we need another one?
For a random comparative example, it took until Helen O’Connell’s work in the 1990s for the extent of the clitoris to be understood – at least by science.
Regrettably, the bulk of contraceptive responsibilities are still put onto women, just as the bulk of childcare and domestic work still are too.
There’s no pill that can sort out a fair division of labour around the home, but if the team at Dundee University can deliver the money shot and get a working product to market, they might just help redress the balance in bed.
James Mackenzie is a freelance media and public affairs consultant and former head of communications for the Scottish Greens
