In the 1960s, the female contraceptive pill revolutionised family planning and empowered married women in the UK to take control of their own reproductive health (although it would take over ten years for this freedom to be extended to unmarried women). Today, women have a wide variety of contraceptive methods (NHS, 2021) at their disposal, yet the options available to men remain limited to condoms or vasectomies. However, increasing the variety of contraceptive methods available to men could allow both the responsibility for contraceptive use and its associated risks and side effects to be more equally shared between men and women in relationships.
Several novel contraceptive methods for men have been developed and trialled over recent years, including an ongoing global trial of a contraceptive gel involving the Universities of Edinburgh and Manchester (NHS, 2021), which have shown promising results (Anwalt et. al, 2019). However, overall progress towards the approval of such products has been slow, partially due to lack of pharmaceutical industry funding (Roberts, 2019).
While much is understood about the biological mechanisms of male fertility and contraception, there is surprisingly little literature investigating societal attitudes towards this issue which attracts so much media interest. As part of my undergraduate dissertation at De Montfort University, I examined various factors affecting men’s willingness to consider novel contraceptive methods. Would a ‘male pill’ be the next revolution in family planning, akin to the introduction of the female contraceptive pill over half a century prior? Or were these researchers on a road to nowhere, developing products for a market which didn’t exist?
In order to explore this, we conducted an online survey in which adult men used Likert scales (where they rated likelihood/acceptability on a scale of 1-5) to describe their willingness to consider using various contraceptive methods and the acceptability of potential side effects. A random sample of men were recruited from Twitter and Facebook posts advertising the survey. Perhaps due to the nature of the recruitment method, or the nature of the topic being researched, the sample was younger (the median age of participants was 22) and more educated (a majority had studied at degree level) than the population at large. Despite this, the sample contained an almost even mixture of single men (23) and men in long-term relationships (24).
This research found a high degree of acceptance towards the idea of a male contraceptive pill, with the majority of men in the study saying they were likely to consider using such a method. This figure was significantly higher amongst younger men than their older counterparts. These findings supported past research conducted in this area (Heinemann et. al, 2005) and suggests that the development of a male contraceptive pill should be a continued area of focus for the pharmaceutical industry. This is because, as this research found, by contrast much fewer men were willing to consider methods which involved any kind of injection.
Whilst the method of using a contraceptive gel applied to the skin daily had been viewed positively by men involved in clinical trials, few men in this research were willing to consider such a method of contraception. One of the potential factors which was attributed to this reluctance was lack of awareness of this as a method compared to the contraceptive pill. Future research may therefore want to explore whether better awareness and understanding of the diversity of contraceptive methods may help increase the acceptability of these alternatives.
Our data showed that men’s stated tolerance for almost all potential side effects was low, particularly those which may negatively affect their health such as increased blood pressure or slightly increased risk of cancer. Interestingly, the side effect which the most men said was not acceptable, an increased cancer risk, has been observed in relation to female oral contraceptives currently in widespread use. Tolerance of various side effects was found to be significantly lower amongst those men in long term relationships than amongst single men. A few ideas were considered to explain this difference, one of which being that those in long-term relationships were more likely to be older and therefore be more concerned about side effects. However, this was not borne out as data showed no significant difference in attitudes towards most side effects based on age alone. Another possibility is that men in long-term relationships are less concerned about the potential of unplanned pregnancy, and so the incentive to tolerate side effects in order to prevent pregnancy is reduced compared to single men. Further research is needed into this question before any firm conclusions can be drawn.
As well as examining men’s attitudes towards various methods of contraception and their potential side effects, this research also sought to examine how men’s perception of their own ‘masculinity’ affected their perceptions and opinions on such contraceptive methods. To achieve this, we compared how willing men were to consider methods which increased or decreased testosterone levels versus those which affected progesterone levels, as there is an association between testosterone levels and attributes which are perceived to be masculine. As had been hypothesised, men were significantly less likely to consider using methods of contraception which decreased their body’s testosterone levels, which might indicate that men’s perception of masculinity was an important consideration when it came to making decisions about contraception.
In summary, this small study supported previous research which found a high degree of willingness amongst men to consider the use of a ‘male pill’, in particular amongst the younger generation of men (Heinemann et. al, 2005). On the other hand, barriers to the widespread use of novel contraceptive methods amongst men persist including a lack of awareness of novel methods, low acceptability of side effects and notions of what altering testosterone levels means for their masculinity.
Can these barriers be overcome by increased awareness of novel contraceptive methods? Or by more education into the role of sex hormones? A great deal of further research is required if the goal of increasing choice for men, and sharing responsibility for contraception more fairly, is to be achieved anytime soon.
By Oliver Mannix
References:
Anawalt, B.D., Roth, M.Y., Ceponis, J., Surampudi, V., Amory, J.K., Swerdloff, R.S., Liu, P.Y., Dart, C., Bremner, W.J., Sitruk-Ware, R., Kumar, N., Blithe, D.L., Page, S.T. and Wang, C. (2019) ‘Combined nestorone-testosterone gel suppresses serum gonadotropins to concentrations associated with effective hormonal contraception in men’, Andrology, 7(6), pp. 878-887. doi: 10.1111/andr.12603.
Heinemann, K., Saad, F., Wiesemes, M., White, S. and Heinemann, L. (2005) ‘Attitudes toward male fertility control: results of a multinational survey on four continents’, Human Reproduction, 20(2), pp. 549-556. doi: 10.1093/humrep/deh574.
NHS (2021) Your contraception guide. Available at: https://www.nhs.uk/conditions/contraception/
(Accessed: 18th January 2022).
NHS (2021) Couples wanted to be part of pioneering male contraceptive research study – ‘NES/T’. Available at: https://mft.nhs.uk/2021/09/07/couples-wanted-to-be-part-of-pioneering-male-contraceptive-research-study-nes-t/ (Accessed: 18th January 2022).
Roberts, M. (2019) ‘Male pill- why are we still waiting?’, BBC News, 26th March. Available at: https://www.bbc.co.uk/news/health-47691567 (Accessed: 18th January 2022).
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