Male Contraception

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Male Contraception

by Rita Arditti

‘Science for the People’ Vol. 8, No. 4, Month 1976, p. 12-15 & 35

Rita Arditti is interested in the question of women and the scientific establishment because of her own personal experiences as a woman in science. She is one of the coowners of New Words, a feminist bookstore (419 Washington St., Somerville, MA 02143) and she works as a faculty member at the Union Graduate School, a nontraditional doctoral program. 

How will men feel about receiving a capsule? Will they give up this one stronghold of male ego, even if temporarily? Will the voluntarily agree to sterilize themselves, as nine million women Pill users in this country are doing every day? Or will they balk? 

From Now to Zero: Fertility, Contraception and Abortion in America, by Leslie and Charles Westoff, 1971. 

In the last few years discussions about contraception and health issues have established without a doubt the dreadful menace that many contraceptive practices are for the health of women. Oral contraceptives and the IUDs, in particular, are highly suspicious and have proven dangerous in many specific cases.1 Nobody knows what their effects over long periods of time will be and their harmful effects in the short range are usually dismissed with the argument that “pregnancy carries higher risk.” Thromboembolism, the major proven “side effect” deriving from oral contraceptives makes women using the pill nine times as likely to have blood clotting problems as women not taking the pill. In numbers, this means that among the 9 million women who are taking the pill, 300 will die from blood clotting problems while the number of deaths that would occur from abortion, deliveries and complications of pregnancy and childbirth is about 1200. IUDs are not even considered “drugs” and the FDA does not require safety tests on them. One of them, the Dalkon Shield, has been implicated in 14 deaths and 223 pregnancy-related injuries. This warped reasoning forces many women to rely on these agents, presenting them essentially with a no-choice situation since other techniques (foam, diaphram) are considered to be less effective and old-fashioned. Furthermore, subtle and not-so-subtle pressures exist to make women feel that they are responsible for the esthetic aspect of sexual intercourse, and as a result, many women feel intimidated and do not discuss openly contraceptive practices. 

One of the fallacies that has permeated our minds on the topic of reproduction is the belief, conscious and unconscious, that women are the reproductive units of the species. The fertility of the male is rarely taken into consideration, as if women reproduced by themselves. We forget that we are fertile only during a limited period of our lives, between adolescence and menopause, while males are fertile all through their lives. Moreover, women are fertile only during a certain portion of the menstrual cycle. If we think in terms of male fertility and focus on the male as the target for birth control, we begin to get a feeling of the exploitative framework on which birth control ideology has been based. The language used in the contraceptive literature gives us a clue to the frame of mind of the scientists involved: “executive hormones” is a common term used to refer to male hormones; an important gland like the pituitary is called the “master” gland. The concern for females regards their appearance and not their health: “. . . females, in the absence of their sex hormones, lose their soft smoothness and become wrinkled.”2

 As pointed out in another article,3 “scientific” rationalizations are offered for the fact that many more contraceptive agents are being developed for the use by females than for males. Contraceptive Technology lists 29 potential methods to regulate fertility in the female, 9 for the male and 6 for use by either male or female. The argument is put forward that females have many more steps in their reproductive system which are amenable to manipulation: the maturation of the egg, ovulation itself, the transport of the egg, fertilization, transport of the fertilized egg, etc. According to the established viewpoint, the male reproductive system offers much less with which to work. Only four steps can be interfered with: the production of sperm cells, the storing of sperm, its transport and the chemical constitution of the seminal fluid. However, this argument does not tell the whole story, and it is easy to construct a case for males being the ideal target for contraception if one cared to do so . . . . The fact is that their reproductive system is less complex and a concentrated research effort aimed at understanding one or two areas could conceivably bring more results. Males do not have a cycle, and complications arising from changing levels of hormones would be avoided. Their sex glands, placed outside the body, are more accessible and easier to work on than women’s organs.4 In statistical terms, male birth control is an ideal method because males can produce as many children as the number of women they have intercourse with, while women are restricted to about 1.4 pregnancies per year. (And so on.) 

The condom, the only method of reversible contraception available for males, is definitely underplayed in the U.S. It is the number 1 method of contraception in England, Japan and Sweden. In Japan, the condom industry has taken care in presenting the condom as a device that will enhance sexual pleasure: condoms are made in a variety of shapes and colors: light blue, violet, pink, forms ranging from plain to “reservoir tipped,” “two stage pagoda nipple end,” “sponge pattern with narrow neck,” etc. Research is done on ways of perfuming it, adding hormones for the female in the exterior and perfecting the packaging to make it practically noiseless.5 Some of these extras may be harmful for women (adding hormones), others are plainly absurd. In this country it is hardly promoted by physicians, compared to the pill and the IUDs, and in fact, its use dropped considerably in the sixties with the advent of the pill.6 It has an image associated with prostitution and secretive sexual relations and 22 states have laws which restrict its sale, distribution, advertising and display.7 The condom is a highly efficient method (used in combination with a foam it is as effective as the pill) and it offers the best available protection against venereal disease. It is unique in that it is totally free of side effects, its use is easy to understand and it offers visible proof of effectiveness immediately after use. It is still one of the better available methods.

“Loss of libido” is one of the main concerns expressed by researchers in the area of male contraception. Very few meaningful studies have been done on this issue, and it is hard to understand what the concern is exactly about. Observations on rats, hamsters and rabbits are difficult to extrapolate to human males and the issue is approached in a vague and inconclusive fashion. “Loss of libido” is almost never taken into consideration when dealing with female contraception, the obvious bias being that women do not have anything to lose since the “active” force in sexual intercourse stems from the male. “Loss of libido” might very well express psychological resistance and depression arising from the fact of being the target of birth control, a role that most men are not socialized into. A recent study suggests that this might indeed be the case: in an experiment where males were taking a contraceptive pill, two of the males reported “loss of libido” during a period in which they were taking a placebo pill containing a sugar (they thought they were receiving a birth control agent). After an initial period of 8 weeks (3 weeks taking the placebo and 5 weeks taking the contraceptive pill), their libido returned to normalcy. In the same experiment, other males reported increased libido, which may have been connected to general relief and less anxiety in the area of sexual intercourse, because of the diminished probability of pregnancy for their partners.8

Vasectomies and Sperm Banks

Regarding “loss of libido”, vasectomies, a surgical procedure in which the two vas deferens are cut and tied off, are invariably presented with the accompanying theme that “masculinity” will not be affected and sexual relations will actually improve. “The atmosphere in our house has become a relaxed and happy one. Our own children, our pupils and our careers have benefited too. As for our sex life, we both can only say – WOW,” writes a couple to the surgeon who performed a vasectomy on the husband.9 Although vasectomies have increased from a few thousand in the fifties to a peak of 850,000 in 1971,10 this is not a method that is going to appeal to the majority of males, and the term “vasectomy revolution” flamboyantly used by the “experts” in the field is hardly justified. The men most likely to seek a vasectomy are married (“vasectomy couples” is a common term in the literature), have 2 or 3 children and are in their middle thirties. It is certainly not a method that is appropriate for single people who are not interested in having children during a certain phase of their lives.11

Even though a particular vasectomy may be successfully reversed, vasectomies should be considered a permanent sterilization procedure. Research on clips, valves and plugs that will allow for a “turn-on, turn-off” situation is being carried on,12 but there is no way to know in advance how effective they will be for each individual case. For one thing, vasectomies may have a permanent sterilization effect even if the vas deferens is recanalized and anatomical integrity has been achieved. This is because antibodies against the sperm may have been produced as a result of the occlusion of the ducts, and the immune system of the male will now continue producing these antibodies which will render the male sterile. There are also speculations that the anti-sperm antibodies might not be absolutely specific to the sperm. If that were the case “side effects” could arise in vasectomized males.13

Feeding on the males’s fear of loss of fertility, commerical sperm banks have sprung up in the last few years in different parts of the country. Sperm banks were forcefully proposed in the sixties by Herman Muller, an American scientist who won the Nobel Prize in 1947 for his work on radiation and genetic material. Muller envisioned the banks to be a solution to the problems of humanity; he truly believed that out of conscious selection of germinal material, a society will arise where only the highest human qualities would exist. He spoke of “worthy genetic material,” “superior lot of children,” and very appropriately “germinal capital.” His hope was that “normal” people would be happy to raise children of “truly outstanding and eminently worthy personalities” so that those distinguished citizens (i.e., men) would be free of the dilemma of having to raise their families or devoting their energies to other causes: ” … their germinal material would tend to be sought by others, if not in their own generation, then later, and to a degree more or less in proportion to their achievements. Thus they would be free to give their best services in whatever directions they elected.”14

For $80 to open an account and an annual fee of $18, a customer is directed to a small room with a comfortable armchair and pornographic magazines. His ejaculate is examined, diluted with a glycerol preservative and stored at -196’C in liquid nitrogen. He is now a depositor at the bank which is also interested in buying sperm at $20 per ejaculate to sell to couples in which the male is sterile. Idant Company first opened a branch in suburban Baltimore, followed by a New York one in December 1971. It envisions banks in 20 major cities and plans to expand internationally (Japan, England). Genetic Laboratories, Inc. of Minnesota, opened in 1970 and has banks in 5 major cities. Although not enough data exist to indicate that frozen sperm can retain its fertilizing power after 16 months, the banks anticipate indefinite preservation of the sperm. No regulations in any state govern their operations.15

Who is going to use the banks? Obviously men who regard their semen as truly special. For example: a member from a prominent family from Minnesota deposited sperm in the bank to make sure that his family line will be continued in case that his only son turns out to be sterile. The bank advocates are, not surprisingly, concerned to show that high quality offspring will result for their depositors and are explicit about the results: “I shall show you a photograph of one of our older children born of frozen semen. He is a 16-year-old boy, 6 feet tall, in excellent health and an A student.”16 

The mere idea of a sperm bank tells clearly what, in our culture, seems worth preserving. But not all sperms are equally precious. It is very unlikely that the banks will open accounts in Kerala or Gujarat, where “festivals” and “vasectomy camps” have been held and tens of thousands of poor Indian males have been sterilized in a few months attracted by small amounts of money, some food or clothes for them or their families.17 In my view, sperm banks have eugenic connotations and reinforce individualistic and competitive attitudes connected with parenting and family issues. 

Research for Male Contraceptives

In 1970, when the Ford Foundation awarded Alan Jones at the University of Manchester, England a grant for research on male anti-fertility chemicals, Jones commented that this type of research had to be done at universities because the drug companies have a “repugnance” toward the idea of tampering with male fertility.18 Although a variety of compounds have been tried on male animals, very few chemicals have been tested on human males. 

A fact that is easily overlooked is that the testes (like the ovaries) depend upon the pituitary in order to produce sperm cells and sex hormones. The pituitary produces FSH* and LH* both in men and women. In men, FSH stimulates sperm production and LH stimulates the production of testosterone (sex hormone). It follows that sperm production can be stopped by stopping the production of FSH. Hormonal contraceptives could be as effective in males as they are in females. Testosterone has been tried as a male contraceptive and it does suppress sperm production. But there are indications that increasing the level of testosterone might stimulate cell growth in the prostate and increase the chance of blood clotting.19 In fact, the use of hormones in males will probably give rise to side effects similar to those suffered daily by women who are taking the pill. In 1973, a brief report in an English medical journal presented a case of pulmonary embolism in a man who had been taking an oral contraceptive. The patient, a 47-year-old transvestite had been taking on his own initiative one tablet of “Gynovlar 21” daily for 25 days before being admitted to the hospital.20

A combination of hormones, an estrogen to inhibit sperm production supplemented with an androgen that will deal with the eventual “loss of libido,” is the current approach to male hormonal contraception. Also, instead of trying hormones that are relatively unknown and for which human testing will have to be delayed until toxicological testing is carried on animals, it makes sense to try hormonal compounds that have already been approved for sale to treat a variety of conditions. For instance, a group of compounds containing a combination of an androgen with an estrogen is currently used in the treatment of osteoporosis in men (a condition in which the bone tissue decreases in density and there is great susceptivity to fractures). Initial studies on men with osteoporosis receiving the hormones had shown that these men had stopped producing sperm. The hormones 

*FSH = follicle stimulating hormone. 

LH = luteinizing hormone.

were then tried on healthy male volunteers who took a capsule twice a day with their meals. By the 63rd day of hormone treatment, the number of sperms produced was significantly decreased and so was the motility of the sperm (100 million sperms or more per ejaculate is considered normal). After the treatment was stopped the sperm number became normal and as motile as before the treatment. It was during the course of this experiment that two of the men reported “loss of libido” while they were taking a placebo pill, before the hormones were administered!21 The idea of testing for contraceptive effects compounds that have already been on the market for a long time, and for which no extensive animal testing would be necessary, is a good one and it might give Impetus to hormonal research.

Of the non-hormonal compounds tried, the most promising were the diamines, a series of compounds that totally inhibited sperm production without interfering with the sex hormones. Work with these compounds was abandoned after the discovery that when the subjects ingested alcohol, side effects appeared. There was also concern about a higher occurence of hepatitis. It now seems that these experiments will be re-evaluated and that further work to establish an effective dose that will minimize toxicity will be undertaken.22 

A new chemical has attracted attention in the last couple of years: 5-thio-D-glucose, which interferes successfully with tumors and spermatogenesis in mice. It is not clear why interference with the utilization of sugar would inhibit spermatogenesis, but diabetic men have been reported to have a decreased sperm count and their sperm is less motile. This compound is not scheduled for clinical trials in the near future since the scientist working with it, (Roy L. Whistler at Purdue University, Indiana) is currently reported to be “out of funds.”23 But this compound does look interesting and it might provide some hope.* 

Reports have appeared linking high temperature to intrascrotal infertility. In some cases a two-week regime of 30°cold baths has caused an increase in sperm count and motility of the sperm, but clinical trials have not yet been carried out and the state of this research is quite preliminary.24 

Other chemicals have been tried in the last few years, but though they are effective in stopping sperm production, they all seem to have toxic effects and may cause genetic damage. It is important to keep in mind that many substances effective as anti-fertility agents have proved to be mutagens. This can cause genetic damage to the cells that survive the treatment, and the damage could be transmitted to the progeny when fertility is restored. In other words, damaged sperms could still fertilize an egg and as a result an abnormal embryo could develop. This might lead to a miscarriage or to the birth of an infant with a genetic defect. 

*Being an analog of sugar, it could be less toxic than other chemicals. Also, this is the first time that a chemical other than a hormone or an alkylating agent has been shown to interfere reversibly with spermatogenesis. 

Other Considerations 

The issues involved in male contraception go well beyond biological problems and technological matters. On the one hand, there is the reluctance of the pharmaceutical companies to invest in areas that might turn out to be unprofitable. In 1962, the introduction of the Kefauver-Harris Amendment to the Food and Drug Act (under which the FDA derives its authority) caused the number of new drugs to drop dramatically. Research expenditures in the area of contraception have been greatly reduced and it is likely that there will not be many new birth control agents in the next decade. The government regulatory requirements have been singled out as the chief reason why so many drug companies have completely ceased all research toward new contraceptives. It costs about $10 million to develop an agent with a new mechanism of action over a span of 10 to 14 years. If the results from the tests in animals are controversial, a complete loss of the investment can result. This is the reason why drug companies are stopping this type of research and for the next few years we will get only new formulations or different delivery systems for already existing contraceptives.25 

On the other hand, the mere mention of male contraception is anxiety-producing for many people since it reminds them of the fact that males and females are biologically equally responsible for reproduction. Sexual programming in our culture demands from the male suppression of feelings and extreme emphasis on “achievement.” Male contraception raises fears of “loss of libido” and castration. Emphasis on “manliness” and performance do not allow for rational and caring communication to take place around the issues of sexual intercourse and birth control. It is obvious that the re-education of men around this topic is crucial, both for the development and acceptance of new agents and for the better use of existing ones. For instance, most sex education and health courses dealing with birth control are directed towards the female. Teenage birth control means birth control methods for young girls. Among those teenage boys who receive no education about their bodies and contraception are the future doctors and researchers who will continue to ignore men’s responsibility in contraceptive affairs. Also, it is easier to experiment on women than on men, since Planned Parenthood clinics and individual obstetricians can reach vast numbers of females, who, in need of contraception, will be “appropriate material” for clinical trials. Thus the cycle continues. 

The attitudes of women toward male contraception are themselves varied and give an indication of the tensions to which most women’s sexual lives are subject. Many females feel that even if male birth control methods were available, they would not welcome their partners using them since errors or lapses of responsibility would result in their becoming pregnant. They do not feel relaxed or  comfortable with the idea of being dependent on somebody else for their contraceptive needs. It is clear that lack of trust between the sexes can render the best contraceptive totally ineffective. 

Effective contraception can exist in a very oppressive context. As pointed out before, a typical male-dominated society like Japan relies on the condom as the number 1 method of birth control and that does not guarantee any improvement in the position of women. Dehumanized sexual intercourse can coexist with any technical breakthrough ap.d the most violent rape can be performed with the ideal contraceptive. Consciousness raising around the issues of sexuality, birth control and male participation have to go hand in hand with the scientific and technological work to develop contraceptive methods for the male. Men must share the responsibilities and risks that up to now have been born by women alone. 

For the next few years, though, the sexual politics of the research establishment plus the profit motive of the drug industry makes it very unlikely that we will be presented with a safe, simple and effective contraceptive for either sex. 

>> Back to Vol. 8, No. 4 <<

Notes

  1. The Doctor’s Case Against the Pill, Barbara Seaman. Avon, 1969. Health Research Group report, January 28, 1976. Letter to Commissioner Schmidt, FDA. Public Citizen. “Oral contraception and increased risk of cerebral ischemia or thrombosis,” by the Collaborative Group for the Study of Stroke in Young Women, The New England Journal of Medicine, 288:17, 871-877 (April 26, 1973). “Copper 7 IUD recalled,” by Belita H. Cowan, Her-Self 3:4 (August 1974). “Dalkon Shield IUD called dangerous,” by B. Cowan, Her-Self, 3:4 (August 1974). “The mini-pill hits the market,” Her-Self 3:4 (April 1974).
  2. Interview with A.F. Parlow, in “Major male sex hormone unraveled,” Science News, August 10, 1974.
  3. “Women as objects: Science and sexual politics,” by R. Rita Arditti, Science for the People, September 1974.
  4. B. Seaman, quoted in “Contraceptive research: a male chauvinist plot?” Sheldon Segal, Family Planning Perspectives, 4:3, 21-25 (July 1972).
  5. “Condom use in Japan,” Y. Scott Matsumoto, Akira Koizumi and Tadahiro Nohara, Studies in Family Planning, 3:10 (October 1972).
  6. From now to zero: Fertility, contraception and abortion in America. L.A. Westoff and Ch. F. Westoff. Little, Brown and Company, 1971.
  7. “Condoms. A new look,” Philip D. Harvey, Family Planning Perspectives 4.
  8. “Oral contraceptive for men,” by Michael Briggs and Maxine Briggs, Nature Vol. 252, (584) 585-6, 13 Dec. 1974.
  9. The Complete Reference Book on Vasectomy, by Michael Greenfield and William M. Burrus, page 15, Avon 1973.
  10. “Sterilization: a switch from men to women,” by Nancy L. Ross. Data from Association for Voluntary Sterilization, Boston Globe, July 10, 1973.
  11. “Vasectomy: who gets one and why?” by Joel W. Ager, Harriet H. Werley, Doris V. Allen, Fredericka P. Shea, Harvey Y. Lewis, ALPH, Vol. 64, no. 7, July 1974.
  12. “The man’s turn,” by Joann S. Lubin. The Wall Street Journal, September 29, 1975.
  13. “Sperm Immunology, infertility and fertility control,” Tien Shun Li, MD. Obstetrics and Gynecology, October 1974.
  14. “Human Evolution by Voluntary Choice of Germ Plasm,” by H.J. Muller, pp. 643-49, Volume 34, Science, 1961.
  15. “Sperm banks multiply as vasectomies gain popularity,” by C. Holden, pp. 4030-32 Science, 1976, April 7, 1972.
  16. “The use of frozen semen banks to preserve the fertility of vasectomized men,” by Matthew Freund, Ph.D., in Foolproof Birth Control – Male and Female Sterilization, by Lawrence Lader, Beacon, 1972.
  17. “Festivals with a Purpose,” War on Hunger. 6(1):6, 8-9, January 1972. “The Gujarat state massive vasectomy campaign,” by J. Palmer Studies in Family Planning 3(8): 186-192, 1972. “Indian vasectomy campus,” in R.M. Richart and D.J. Prager. Human Sterilization, Springfield, Illinois, by D.N. Pai, pp. 5-11, 1972.
  18. Liberation News Service, “Off our Backs,” September 30, 1970.
  19. “Reversible contraceptive action of testosterone in males,” by P.R.K. Reddy. Proc. of the Indian Society for the Study of Reproduction and Endocrinology. J. Reprod. Fert. 38, 227, 249. (1974).
  20. “Pulmonary embolism in a man taking an oral contraceptive,” by N.G. Rothnie and A.J.M. Brodribb, The Lancet, October 6, 1973, page 799.
  21. See Reference Number 8.
  22. Reports on Population/Family Planning, July 1971. A publication of the Population Council, 245 Park Avenue, New York, NY 10017.
  23. “5-Thio-D-Glucose, a unique male contraceptive,” by Thomas H. Maugh II, Science, Volume 186, page 431, November 1974.
  24. “Sperm don’t like it hot,” by Joan Arehart-Treichel. Science News, May 11, 1974.
  25. “Factors limiting the development of new contraceptives,” by J.P. Bennett. J. Reprod. Fert. 37, 487-498. (1974)