From rubbers to rub-ons: will women trust men with a new contraceptive gel? 

(By Olive Bradshaw on 30th September 2024)

The introduction of a new male contraceptive gel, now showing promise in phase two clinical trials, represents a significant departure from the limited male birth control options available today.  

Dr. Jeffrey Kroopnick, medical officer from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), who is overseeing the clinical trial for the gel, explains that it works by “lowering the testicular testosterone values to very, very low levels, so that sperm production is essentially stopped”. 

Despite this innovation, reactions have been mixed. The gel emerged after the 2022 Supreme Court decision to overturn the constitutional right to an abortion in the US, (commonly referred to as “Roe v. Wade”) which had triggered a period of heightened fragility for female reproductive rights. Could this gel shift the burden of contraceptive responsibility that women have borne for centuries? The answer depends on several critical factors: Will men use it? Will women trust it? And why has it taken so long to get here? 

Where they are accessible, women’s contraceptives range from permanent solutions like tubal ligation, to temporary measures such as barrier methods, hormonal pills, implants, injectables and intrauterine devices (IUDs). Historical records date the use of vaginal poultices made from cotton or wool soaked in oil, fruit juices, herbs, and other substances to make tampon-like plugs as far back as 2000 BCE. 

In stark contrast, the male contraceptive catalogue is barren, stocked with only two real options, vasectomies or condoms. These, too, have a history; as far back as ancient Egyptian and Roman civilizations records show early versions of the male condom made from animal bladders, intestines, or treated linen. By the 20^th century, condoms were widely used and the invention of synthetic latex in the 1920s brought about the thinner, more flexible condoms we know today. 

Still, approximately half of global pregnancies are unintended each year, with 250 million women who wish to delay or avoid pregnancy lacking effective means to do so. According to the WHO, 6 out of every 10 unintended pregnancies end in abortion worldwide, 45% of which are unsafe. 

On the contraceptive front, any news is good news. 

Why has it taken so long? 

Male contraception actually has seen innovation since the 20s. Gregory Pincus, co-inventor of the female contraceptive pill, first tested similar methods on men in 1957. And in 2000, a BBC news article claimed 100% effectiveness for a male contraceptive pill, using methods not dissimilar to the current gel. 

However, time and time again, clinical trials for male contraceptives are halted due to concerns over worrying (yet not unfamiliar) side effects or the attitudes of men towards contraception. These concerns are valid but never fail to induce a synchronised eye roll amongst women, who need only check the NHS website to be reminded of the array of side effects they are likely to endure from their contraceptives: from headaches, nausea, and increased risk of depression to more severe risks like blood clots and pelvic infections.  

Dr. Arianne Shahvisi is a philosopher and Senior Lecturer of Medical Ethics at the University of Sussex. She says that during a surge in female contraceptive development in the 1960s and 70s, “side effects were downplayed, and approval was granted even where the risks to women’s health were severe”. 

“Either doctors will literally tell you that you aren’t having the side effects, or tell you that you should just deal with them, and ignore just how difficult and damaging those side effects can be”, says Leila Malik, who has had both the implant and the copper coil twice. 

Despite these risks, 43% of women worldwide use either long or short-acting reversible methods and an additional 27% of women opt for sterilization. This reflects just how necessary contraception is for women, for whom the repercussions of an unwanted pregnancy are far greater. 

Unsurprisingly, news of the male gel sparked lively debate on social media. 

The Gel 

The hormonal gel, which is under development at the Contraceptive Development Program in the U.S., is rubbed between the shoulders daily and works by suppressing sperm production sufficiently to prevent pregnancy.  

Dr. Kroopnick explained: “The first component is called segesterone acetate, that’s a progestin. It halts the signals that come from the pituitary gland that tell the testicle to make sperm”. 

“The second component of the gel is testosterone. So that, when they apply the gel, the blood values of testosterone are normal and they don’t experience side effects.” 

Dr. Kroopnick says that one of the reasons it is so difficult to get a product like this to market is because it hasn’t been done before, “The regulatory pathway for approval has not been defined because it’s a first-in-class product”. 

This alternative could be a step towards a more equal standard for contraceptive responsibility. But will men even use this gel, and just how ‘equal’ can contraceptive responsibility ever be? 

Will men use it?

In the aftermath of the 2022 Supreme Court ruling, which took away the right to an abortion for millions of American women, reproductive rights in the US have fallen apart. Over 14 states issued out-right bans on the practice, and there has been a notable increase in men seeking vasectomies; a report from telehealth research company, Innerbody Research, showed that in the weeks following the decision, searches for “where can I get a vasectomy” increased by 850%.  

Overturning such landmark legislation had repercussions globally and set a precedent for the vulnerability of women’s reproductive rights. This was seen in the UK, where vasectomies increased by 25% from 2021/22 to 2023/24, suggesting a growing willingness among men to take responsibility for contraception. 

But this isn’t a new phenomenon; a German study as early as 2005 which surveyed over 9,000 men across nine countries, found that more than half were willing to use a male contraceptive method “capable of preventing sperm production”. 

Still, for the male contraceptive gel to gain widespread acceptance, societal attitudes towards male contraceptive responsibility must evolve. As Dr. Shahvisi points out, “[even] in jurisdictions in which abortion is available, men generally have less control than women over whether an unwanted pregnancy results in childbirth. In some cases, men can end up making long-term child support contributions for unwanted children.” 

Changing the expectations regarding responsibility for contraception would render penis-in-vagina sex more equitable, she adds, and could lead to a shift in the discourse around abortion access. 

Will women trust it? 

It looks like this gel has potential: the trials (so far) have shown it is effective; there seems to be demand from men; and the side effects don’t appear to be dramatic. Still, for this to work, both baby-not-making parties must be comfortable with the method of contraception they choose.  

Picture the scene…Your date has gone particularly well, and you end up at your place with the hunky guy from Hinge. But, oh no, you’ve run out of condoms. “Don’t worry, I’m using the gel” he says…. 

I think you get the point. Trusting someone you don’t know well, without proof that he has really taken anything, could be a significant barrier to the uptake of this contraception. “I would still double-Dutch it and go extra safe”, says Alex, a woman who has been on the mini-pill for over 3 years, “it’s not the gel that I don’t trust, it’s the man. I wouldn’t want him to use it as an excuse”.  

A promising approach that might help to alleviate these trust issues may come in the form of a non-hormonal male contraceptive pill currently under development. 

The ‘instant-pill’ has been successful in animal trials and works by ‘stunning’ the sperm, preventing them from swimming towards an egg. It takes effect within 3-4 hours and wears off after a day, which would allow women to directly watch their partner take it before intercourse. Is that what it would take for single women to be able to trust men with contraceptive responsibility? 

“Sex is often unpredictable and not really something that you plan three hours in advance”, says Alex, again, “I still wouldn’t take his word for it”. 

Sam, a single straight man, says, “it’s tricky because if it’s agreed upon, the spice of ‘will we/won’t we?’ dissipates. A lot of the fun comes from the spontaneity of it”  

For established couples who have more of a foundation, however, this gel could be a game-changer, offering a new layer of shared responsibility and peace of mind. Especially for women who have had a bad experience with existing methods of contraception.  

Despite promising clinical trial results and growing demand among men for more birth-control options, levelling the playing field of contraceptive responsibility is not straightforward, and remains a distant reality. As Dr. Kroopnick says, “it’s large, it’s complex, it just takes a while, so I can’t give an exact estimate, but it’s not going to be months, it’s going to be years”. 

Feature photo: Photo by Reproductive Health Supplies Coalition on Unsplash