Sure, we all know about condoms. For most of us, the condom was the first birth control method we ever heard about. Maybe you bought your first condom with your friend in a corner store. Maybe you nabbed your first condom from an older sibling, carrying it around in your wallet for months (years, if we’re being honest). Maybe you got it from the free bowl in your college dorm. In any case: getting your first condom was a BFD. An announcement that you were here, and you were a man – because you were not just ready for sex but you were ready for safe sex.
But then we got older. And we realized that condoms...had their limits. Decreased sensitivity, latex allergies, expiration dates, needing to carry one at all times, that loaded pause when you need to take a break from the action to open one up and roll it down.
And maybe you started talking to women about their birth control. About all of their options – the pill, the shot, the patch, the ring, the IUD. And, if you’re anything like us, maybe you started thinking “I’m a 21st century man – I want to practice safe sex, not get women pregnant, and feel all my feelings during sex. I want it all!” This goes out to everyone who’s ever asked“Where my birth control options at? Is it really *just* the condom?” Fellows, get ready to dive deep into the top 5 things to know about male birth control.
The condom was one of the earliest-used contraceptives. Condoms – made of animal intestines – first became widespread way back in the late 1400s, after an outbreak of syphilis in Europe (spread by the French army). For many men, we assume this was an improvement over previous forms of male contraceptives. Writing during the Middle Ages recommends soaking your penis in onion juice or covering it in tar to prevent pregnancy. Yikes!1
And the facts don’t lie – the condom is also consistently the most used contraceptive reported by both male and female adolescents. According to the Guttmacher Institute, “In 2015–2017, 63% of females and 82% of males aged 15–19 reported having used a condom the first time they had sexual intercourse.”2
As we age, however, condom use changes. According to the CDC, 23.8% of women and 33.7% of men used a condom during their last sexual encounter (that’s a big drop from those teen rates!) and while many things can influence this, the CDC also reports “studies have shown a decline in condom use among women after the initiation of hormonal contraceptives.”3
As we get older and access to contraceptives gets easier, more women opt for hormonal methods of pregnancy prevention. However, for men, there’s no analogous product currently out on the market. Why not? Let’s explore.
Every so often we see headlines and updates on Twitter that the male birth control pill is ready. Then we start seeing retractions – that it’s still a distant dream. Starting to feel like Groundhog Day? Here’s a (very) quick history of what’s been going down.
In the 1950s, injections to prevent pregnancy were tested at insane asylums on both men and women – and yes, the ethics of that are dubious, at best. While the side effects on men and women were similar, renowned birth control advocate Margaret Sanger shut this down – she wanted birth control to be a tool that women could use to control their own bodies. Research focus shifted to a birth control pill exclusively for women. (For an excellent overview of all of this, check out The Cut).
1960: the female birth control pill (officially named the combined oral contraceptive pill) is approved by the FDA! The pill is currently the most used contraceptive by women in the United States (15% of all US women aged 15-44 are on the pill, and 25% of all women who use contraceptives use the pill).4
Since the launch of the female pill, researchers have been interested in launching a male hormonal contraceptive. An extensive 2018 study was ended by an independent review board because of the rate of side effects, despite a 96% success rate at preventing pregnancy.5 This version used testosterone and a hormone called progestin to shut down sperm production in the testes.
Side effects included things like acne, emotional and mood changes, increased sex drives, night sweats and testicular pain. While these side effects are similar to what women may experience on the pill, the rate at which men experienced them was significantly higher. Researchers were particularly concerned about the mood effects men in the study experienced – there were significant reports of negative mood, depression, and one suicide.6
Today, research continues on male birth control pills. Due to the biological differences between men and women, though, it remains a tough problem to solve. Women release 1-2 eggs a month, so any hormonal birth control has to prevent that one release. Men, on the other hand, produce millions and millions of sperm every day – and ejaculate can have a concentration of up to 250 million sperm per milliliter of ejaculate. A male birth control pill has to drop that number to less than 1 million sperm per milliliter in order to be effective – while maintaining the normal levels of testosterone needed by a healthy body. It’s a complicated riddle but one researchers are working on – although asNewsweek reports, it may be 10 years or more until a viable pill hits the market.
So, if a hormonal pill you ingest via the mouth isn’t an option for male birth control (yet), what about other ways of delivering hormones? Wellllll…they have similar challenges. Whether you are delivering hormones orally, transdermally – a fancy way of saying “rubbing some gel on your upper arms” – or intravenously, when you decrease testosterone, which decreases sperm, you encounter other health issues like low libido, hair loss, and fatigue. While researchers are still working on both of these options (a multi-country study is currently underway for the upper arm gel and a Berkeley-based startup is exploring a non-hormonal contraceptive that blocks proteins in sperm) don’t hold your breath – we’re looking at a many-years process.
So we know about condoms and we know that a pill for men would be great but isn’t going to be around for a decade-and-change. What else is there? Well, these next two – the withdrawal method and the rhythm method – are both very simple and a little complicated. They’re simple because they are some of the oldest tricks in the book (literally. The Greek physician Soranus of Ephesus was writing about the rhythm method around the first century AD). They’re complicated because they depend on really excellent timing to actually work.
Let’s start with the withdrawal method. Sounds easy – you pull out right before ejaculation, to avoid ejaculating into your female partner and risking pregnancy. But, if you’ve ever had sex before, you know that timing during this sensitive moment can be...hard. And even pulling out in time doesn’t factor in pre-ejaculate. A recent study in the journal Human Fertility concluded that “a major proportion of men leak motile sperm in their pre-ejaculatory fluid.” This means that even if you successfully pull out before ejaculating, there’s a chance that your pre-cum contains sperm – which can find their way into a woman’s reproductive system and, potentially, to a pregnancy.7
That said, the withdrawal method is greatly increasing in popularity – according to the CDC, use of withdrawal as the primary form of birth control doubled between 2011 and 2015.8 This increase can be chalked up to more than just an “everything old is new again” vibe. As more and more women decide that synthetic hormones may not be something they want in their bodies, they’re stopping birth control and experimenting with withdrawal (often, it should be noted, against the advice of their OBGYNs).
The rhythm method involves tracking a woman’s cycle to understand when she’s fertile – and having unprotected sex (no pulling out here!) during her “safe” days. Let’s back up: to get pregnant, an egg must meet a sperm and become fertilized. After an egg is ovulated (released from the ovary into the uterus) it has 24 hours to meet a sperm. If it doesn’t, the egg disintegrates and a woman’s period begins. Women generally ovulate roughly halfway through their monthly menstrual cycle, but sperm can live in a woman’s body for up to 5 days (that’s crazy!). So if you’ve had unprotected sex around the day of ovulation, there’s a chance your sperm can meet up with her egg and boom, pregnancy.
By tracking a woman’s cycle, you can start to have unprotected sex after ovulation, in theory without risking pregnancy (assuming you’re tracking correctly -- it can be hard to pinpoint the exact day of ovulation). While the rhythm method was used extensively before the advent of birth control, the technology has gotten much better. For example, women can track their Basal Body Temperature to help hone in on when they’re ovulating.9 The verdict? Finding your rhythm can be hard, but can pay off – the effective rate of preventing pregnancy is 75% - 87%, if the rhythm method is done correctly.10
Bonus: we hear Clue is a good app for period tracking, if a lady in your life is looking.
What do Dr. Phil, Ozzy Osbourne, and Slim Thug have in common? They’ve all gotten vasectomies – along with 500,000 men in the United States every year! The vasectomy is a common, quick (10-30 minutes), and typically painless surgery. In a vasectomy a doctor will cut and cauterize the vas deferens (tubes that carry semen in between the testicles and the penis). After a vasectomy you will still ejaculate, but your semen won’t carry any sperm. Because sperm only make up approximately 5% of semen, the amount you ejaculate will remain largely unchanged.11 As you might expect, this is a highly effective type of birth control – only 1 or 2 women out of 1,000 will get pregnant from a partner who has had a vasectomy.12
A vasectomy is, however, close to permanent. While you can reverse a vasectomy (and approximately 5% of men do),13 it doesn’t guarantee a successful pregnancy – the longer it’s been since your vasectomy, the harder it may be to get pregnant after a reversal, and you often need IVF.14 Vasectomy reversals can also be expensive – while vasectomies are covered under most insurance plans, reversals can cost approx. $7,000 to $9,000, or even more.15 The bottom line? If you’re sure you don’t want (more) biological children, a vasectomy can be a highly effective way of preventing pregnancy. If you’re not sure? Do some deep thinking before going under the knife. By the way, we nerded out about vasectomies and wrote a more in-depth article about them here.
There you have it – an overview of the birth control options available for men today. Is there more research to be done on different ways to prevent pregnancy? You bet. Is it good to know about all your options? 100%. As with anything related to sex, open communication is key – discuss birth control with your sexual partners frequently (feel free to send ‘em this blog post!) and you’re well on your way to making your old sex ed teacher proud.
The information we provide does not constitute medical advice. You should make all reproductive health decisions with a medical professional.
It would be nigh impossible to find a bunch more passionate about fertility than the Fellow Team. We are a group of colleagues who loves to author articles in our free time (that is, when we aren't challenging each other to games of Code Names). You can reach us at firstname.lastname@example.org.