Health Science Reviews

by Husnaa Bux

Despite medical advances, uneven access to healthcare still contributes to gender inequality. The female combined oral contraceptive pill has been on the market for sixty years and has empowered women, giving us autonomy over our bodies. As reviewed by Dr. Stephanie Page and colleagues in Frontiers in Endocrinology, the variety in female contraception contrasts with male contraception which consists of condoms, withdrawal, and a vasectomy. Only 16% of global contraceptive use is male-driven, with the ‘latest’ commercially available male contraceptive being the condom, which was established two hundred years ago. Inadequate male contraception emphasises how society places the responsibility of safe sex on women.

Though the proof of concept of androgen use to suppress spermatogenesis was established by the WHO almost fifty years ago, male hormonal contraception is unavailable and pharmaceutical companies have abandoned male contraceptive development. Predictive models suggest novel reversible male contraception could decrease unplanned pregnancies by 30 to 40%, improving the mental, physical, and economic well-being of women and their families, and decreasing population growth. The perceived lack of market for male contraception highlights the commercially driven pharmaceutical industry.

Surveys show that 50-85% of men are willing to use male hormonal contraception. To date, however, only eight male hormonal contraception efficacy studies have been conducted, some of which were terminated prematurely due to mood-altering side effects. An unequal standard of healthcare between genders is seen by the side effects of the female ‘pill’ which include headaches, nausea, weight gain, mood changes, and more. Dimethandrolone undecanoate (DMAU) is an oral and injectable male hormonal contraceptive that acts on both progesterone and androgen receptors. Studies show it is safe, well-tolerated, and markedly suppresses gonadotropins and sex hormones, with few or no symptoms of hypogonadism. Yet male hormonal contraception commercial availability remains unseen.

While men bear no risks of childbirth or abortion, women are forced to use contraception as the benefits outweigh the risks. The benefits may only outweigh the risks for men if there were additional health benefits, for example, reducing long-term disease risk. Prolonging development, for an expectation yet to be explored for women, augments the burden of responsibility of pregnancy that society has already placed on women, diminishing the reality of the “shared risk”.

Through education, increased awareness, and engagement of pharmaceutical companies, male hormonal contraception can be materialised. This will improve the health and wellbeing of women, and decrease global burdens.

References
• Page, S. T., Blithe, D. & Wang, C. 2022. Hormonal Male Contraception: Getting to Market. Front Endorcrinol (Lausanne). DOI: 10.3389/fendo.2022.891589
• Roberts, M. 2019. Male pill – why are we still waiting?. BBC News (online). Available: https://www.bbc.com/news/health-47691567.