Duke Medical Ethics Journal
It Takes Two
The discovery of a potential new male contraceptive reveals much about how reproductive responsibility is unequally distributed between genders — and what can be done to bridge that gap.
by Sophia Roud
“More contraception options for people of all genders will guide our society to be more equitable, and allow both women and men to work together and choose how they wish to share the responsibility of navigating shared decisions about reproduction.”
At birth, a baby girl has only one million of her eggs left. By age 20, she has about 150,000-300,000 eggs remaining and will continue to lose them throughout the rest of her life .
In comparison, at age 20, a man can produce 1,500 sperm in a single second. That’s over one hundred million sperm every day .
Despite how sperm counts outnumber eggs by the trillions, women (or people born with a uterus) have significantly more contraception options to choose from than men (or, people who produce sperm). If a woman does not want to get pregnant, a quick Google search and a visit to the CDC’s website can offer her a plethora of options: implants, injections, intrauterine devices, patches, pills, and more. If a man wants to help prevent a pregnancy, however, he has two choices: wear a condom or get a vasectomy.
The hunt for new options for male contraceptives has been in motion for years. This February, researchers at Weill Cornell Medicine published their results on a compound called TDI-11861 . In mice trials, TDI-11861 appears to be extremely successful as a contraceptive because it literally stops sperm from moving — and it only takes 15 minutes to take effect, and is 100 percent effective at preventing pregnancies for 2 ½ hours .
This is not the first male contraceptive that has shown promise in laboratory testing. Many male birth control treatments are currently being evaluated in clinical trials, including a hormonal gel that lowers sperm count, birth control pills, and implants  Male contraceptives have been in clinical trials as early as 1970 , twenty years after “The Pill” created a scientific breakthrough as the first oral contraceptive .
The invention of The Pill, and all subsequent contraceptive methods, gave women more autonomy over their reproductive choices and, by extension, their lives [8, 9] But despite much ongoing research into a male contraceptive — and the growing 13.8 billion dollar contraception market  — no male birth control option has ever made it to a Phase III clinical trial .
The Pill is the Only Pill: Reproductive Responsibility Between Genders
The persistent lack of contraceptive options for men perpetuates the unequal distribution of reproductive responsibility between heterosexual couples. The longer we go without a reliable male birth control option, the longer women will be expected to take on the primary responsibility for all matters related to conception, pregnancy, and raising children .
The effects of a society that deems women to be solely responsible for shouldering this reproductive responsibility have been analyzed in numerous studies. This pressure begins with institutionalized narratives in how children are taught sex education in school, extends to harmful associations around teenage pregnancy , , and even to the way clinicians react to women requesting contraceptive support . Above all, there’s an expectation that women should be managing the contraceptive choices between heterosexual partners  even regarding a decision on whether or not to terminate a pregnancy . Out of fear of conversations about STIs, heterosexual couples tend not to hold the man accountable for wearing a condom if the woman is taking birth control, even if both partners know they should use both methods .
While women are the ones with more options to choose from, many of the most effective female contraceptives are hormonal and induce a wide range of side effects. For birth control pills, the most common choice for women, side effects range from mood changes to breakthrough bleeding, to rarer but severe illnesses including blood clots, high blood pressure, and risk of developing cancer . But while such side effects are the norm rather than the exception for women using contraction, it’s an open secret that male contraception would be held to a much different standard.
In fact, the reason why TDI-11861 has gathered much attention is that not only is it a non-hormonal treatment, but it’s also temporary, can be taken as needed, and appears to have no lasting side effects . In 2016, the side effects of male birth control became a sensitive subject: research into a male hormonal contraceptive was canceled because participants were dropping out due to severe mood swings. One participant developed severe depression and another committed suicide during testing, even if not explicitly because of the medication . Following this, there was a significant response from women online and ethicists alike about this double standard, considering that emotional swings are a signature symptom of many female hormonal birth control methods .
The reality is that a male contraceptive will not be successful if it has similar side effects to female contraceptives that have been on the market for years — and it all comes down to balancing risks. For many women, the risk of pregnancy outweighs the side effects that come with birth control. But men experience no tangible physical risk if they get their partner pregnant. So the pharmaceutical industry is assuming that men will be less tolerant of side effects, even milder ones. And when a company is investing millions of dollars into a drug, they need to know that its target demographic will buy it .
These setbacks in developing male birth control only continue to reinforce the way women are expected to manage the reproductive burden for both themselves and their partner, whether that manifests as sacrifices to personal health, career goals, or mental well-being. And these effects are especially amplified in college students, especially since young adults have the highest rates of unintentional pregnancy and tend to be uninformed about contraceptives and safe sexual practices [24, 25, 26]. Even young men’s limited contraceptive options are further diminished as doctors frequently deny vasectomy requests on account of age (though it’s important to note young women are even more likely to be denied tubal ligation requests) . As a result, most college students stick to male condoms, birth control, and the withdrawal method as their preferred contraception methods .
On the Verge of a Breakthrough
With so much active research into a male contraceptives, a male birth control option that’s available at any local pharmacy is not a matter of if, but when. But the longer it takes to arrive, the more work it will take to reverse society’s expectations over who should be responsible for birth control.
Most importantly, consumers — especially young adults — need to show the pharmaceutical industry that a male contraceptive is in demand, and that it’s in demand now. Both men and women want men to play a larger role in contraceptive choices . Even among the men in the controversial 2016 birth control study, those who did not drop out due to side effects said that they would use the birth control product if it became available in the market . Young adults also need to change the way these companies think about their target demographic to change the narrative about the “risk” of male birth control. In reality, heterosexual couples who are in stable, long-term relationships are already more likely to use birth control as it stands . These are the same couples who are most likely to invest in male contraceptives when they do arrive and have concerns that go beyond just worrying about physical side effects. It’s likely that these partners will be more forgiving of a male birth control option with side effects than pharmaceutical companies think.
The more time, energy, and money that is devoted to creating a male contraceptive, the sooner it will become available for public use. In the meantime, it is unethical to be complacent about the progress towards more male contraceptives and better communication between sexual partners about equitable reproductive responsibilities. The female oral contraceptive was available for purchase within ten years: a male contraceptive has been researched for forty years. Just because some contraceptive options exist for one gender does not mean we can drag our feet in providing equitable options for the other — especially when it means women have experienced the complications of years and years of ongoing hormonal treatments alone.
Overall, the male contraceptive is so important because it represents the freedom of choice. Just as female birth control liberated a generation from sexual conservatism and allowed an entire gender access to a new form of personal autonomy, more contraception options for people of all genders will guide our society to be more equitable, and allow both women and men to work together and choose how they wish to share the responsibility of navigating shared decisions about reproduction. After all, if it takes two to conceive, then it should take two to contribute to contraception.
Review Editor: Mahi Patel
Design Editor: Heiley Tai
 T. Jewell, “How Long Does It Take for Sperm to Regenerate? Tips for Production,” Healthline, Sep. 19, 2018. https://www.healthline.com/health/mens-health/how-long-does-it-take-for-sperm-to-regenerate (accessed Apr. 11, 2023).
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