6 ms·

Why We Can’t Have the Male Contraceptive Pill

46 points by drtillberg 9y ago

drngdds 9y ago
This article makes it sound like WIN 18,446 is a safe and effective male contraceptive and it was abandoned completely just because it has bad interactions with alcohol. Is this actually true? There are lots of drugs on the market that have a bad interaction with alcohol. It's possible to just not drink alcohol.
- auggierose 9y ago
  Having a contraceptive pill not working together well with alcohol is probably one of the worst user interfaces ever. At least judging from the behaviour I observe amongst people in the UK :)
  - drngdds 9y ago
    Not for people who don't drink or would be willing to stop drinking. That has to be a nontrivial market. Why not make it and just put a big warning label on the bottle?
    - djsumdog 9y ago
      Even for people who don't drink, there's still small amounts of alcohol in some medication, mouth wash, etc. If the severity of the reaction is high enough, even small amounts could lead to a medical emergency.
      - GhotiFish 9y ago
        I hear what you're saying here, but just taking what the article was saying, that shouldn't be much of an issue. Then one of the participants drank some contraband Scotch and became unusually, violently ill. He confessed his transgression to the researchers, and follow-up studies confirmed his account: WIN 18,446 didn’t mix well with booze. I suspect this inmate was more than a little liquored up. Just a guess. But more importantly this part: WIN’s side effects sounded familiar to Amory. In his clinical practice, he’d occasionally prescribed Antabuse (disulfiram) to patients who struggled with alcohol addiction. The drug blocks a form of the enzyme acetaldehyde dehydrogenase (ALDH), which helps the body metabolize alcohol; which means it's effects are used in practice to combat alcoholism. Can't be that bad. Though, that still means that there could be other interactions not described?
    - woodandsteel 9y ago
      >That has to be a nontrivial market. Yes, but it might be so much smaller a market than a male contraceptive without that problem that the company decided it wouldn't be able to recoup its development costs.
      - chillacy 9y ago
        I was looking up numbers in the US and came across this: > 30% of american adults don't drink at all > the top 10% of drinkers consume 74 drinks per week (over 10 drinks per day) https://www.washingtonpost.com/news/wonk/wp/2014/09/25/think-you-drink-a-lot-this-chart-will-tell-you/ https://www.washingtonpost.com/news/wonk/wp/2014/09/25/think... Wow, that's horrifying.
  - deleted 9y ago
    [deleted]
- mabub24 9y ago
  I'm saying this fully aware I am not a doctor but... I think it depends on the severity of the response, and the context of use. For severity, it's not clear in the article but it seems like the adverse response was quick and quite severe. Another problem with reactions to alcohol: let's face it, many sexual encounters are surrounded by alcohol. For many people, for better or for worse, alcohol and sex go together. You want people to take your contraception, but if you get immediately ill whenever you drink are you going to be taking that pill like clockwork? Sex is important, and, frankly, people take a lot of risk for the sake of having sex. Often that means choosing to drink alcohol, not always, but often. It's complicated, and I know I sound like someone trying to rationalize doing the least amount of work, but the truth is you want male contraception to be easy because men could potentially be using it their entire lives. Female oral contraception works, but it likely would not pass medical trials today precisely because of many of the side effects that occur when one takes it.
- bdamm 9y ago
  For many candidates I suspect the requirement of not drinking alcohol would be 98% effective.
- SolarNet 9y ago
  I think it is how dangerous the reaction with alcohol is. Most drugs with alcohol make you extra drunk. This one gives you a heart attack.
- cbr 9y ago
  I was also curious about this. A male contraceptive that is incompatible with drinking would be a good fit for many people who don't ever drink, including me. There would definitely be people it was a poor fit for, but it still seems like there's a teetotalers market. The main question to me is whether it's compatible with the small amounts of alcohol that are in many foods.
JohnJamesRambo 9y ago
A great male contraceptive is already here and it is testosterone injections. "The two-and-a-half-year study of 399 couples in nine countries found that the injections of the male sex hormone were an effective contraceptive for 98.6 percent of the participants." https://nytimes.com/1996/04/03/us/testosterone-injections-work-as-contraceptive.html https://nytimes.com/1996/04/03/us/testosterone-injections-wo...
- true_religion 9y ago
  "It is a painful injection in the buttock,".... most likely the reason why it is not more popular.
  - JohnJamesRambo 9y ago
    It isn't that painful at all, that is the equivalent of FUD in this article. It is about as painful as any other shot.
- walrus 9y ago
  Disclaimer: I have no idea what I'm talking about. Here's roughly how it works, if I understand correctly. First, a normal male endocrine system looks roughly like this: 1. The hypothalamus produces GnRH. 2. In response to stimulation by GnRH, the pituitary produces LH and FSH. 3. In response to FSH and LH, the testes produce sperm and testosterone, respectively. 4. Testosterone inhibits the production of GnRH by the hypothalamus (a negative feedback mechanism). This effectively keeps testosterone levels regulated. When external testosterone is introduced, here's what happens: 1. The increased testosterone inhibits the production of GnRH by the hypothalamus. 2. In absence of GnRH, the pituitary produces less FSH and LH. 3. In absence of FSH, the testes produce less sperm (this is the contraceptive effect). In absence of LH, the testes produce less testosterone. The net effect is less sperm and the body produces less testosterone on its own. This makes me wonder: would this lead to testicular atrophy? That happens with steroidal antiandrogens and GnRH agonists/antagonists, both of which have the effect of decreasing LH and FSH. Also, I think there are cardiovascular risks associated with high testosterone.
ams6110 9y ago
Female contraceptive pills have a lot of problems. They are linked to cancer, liver disease, gallbladder disease, stroke, blood clots, high blood pressure, and heart disease. Taking pills to inferfere with your normal hormonal and bodily functions is not a great idea, when there are other options with fewer or no side-effects. As a man, I would not take pills for contraception.
- evolve2017 9y ago
  First, I agree that non-hormonal contraception decreases a lot of the risk associated with hormonal contraception (almost tautological, but worth stating). Second, there is no increase in mortality between women who use oral contraceptive pills and women who do not (with the exception of women over 35 who smoke; OCPs are contra-indicated in this group). For any OCP-users who might read this, there is no overall increase in cancer associated with OCPs, though some cancers are more likely with OCPs and others are less likely with OCPs. Many of the side effects you're mentioning are either rare (hypertension, stroke/blood clots) benign (maybe you mean hepatic adenoma when you say liver disease?) or things I have not heard of (would appreciate scholarly references; gall bladder disease, heart disease[not sure what you mean here]). > Taking pills to inferfere with your normal hormonal and bodily functions is not a great idea, when there are other options with fewer or no side-effects In general, all medications have risks and benefits. A blanket statement such as this one ignores the risk-benefit calculation that each patient and her physician must assess in picking a medication.
  - ams6110 9y ago
    > Many of the side effects you're mentioning are ... things I have not heard of Admittedly hasty research, these are listed on WebMd as possible side effects of contraceptive pills.
djsumdog 9y ago
The article mentions the gel injections that destroy sperm as semen travels from the testicles. Last I heard the Indian company that developed it was still doing trials in Indian and the US (long running trials in India show it effective and reversible for years). It's more invasive than a pill, yes, but it seems like the most viable reversible solution so far.
- ams6110 9y ago
  I believe it was injecting/inserting a block (some kind of gel maybe?) into the vas deferens, with the effect of a vasectomy but much more easily reversible.
nxc18 9y ago
While I get that you could argue that 'pregnancy is the worst std' with 18+ years-long untreatable consequences, I don't really see the appeal for something that just targets pregnancy. As a gay male, I would tend to favor condoms and other things that have a chance of reducing std transmission. If anything, the AIDS epidemic taught us that STDs are just as serious as pregnancies. Ultimately it comes down to not fucking complete strangers and using protection when you do. For long term relationships, there are so many options: pills, IUDs, condoms, plan b, and even abortion. I'm much more interested in research into how to make condoms more effective and better treatments for unsolved problems, like herpes, HIV, Chlamydia, gonorrhea, etc. (antibiotic resistance is still a thing btw).
- nxc18 9y ago
  Also it should be mentioned that female contraceptive is also advertised for beneficial side effects, like reducing the symptoms of PMS. While there are surely hormonal cycles that men experience, there really is no regular, painful, recurring symptom to be relieved.
- Rjevski 9y ago
  If you're in a relationship and are both clean, STDs are not an issue. However when only the female takes the pill its efficiency isn't 100%, so there is still a tiny risk of pregnancy. Having the male take a pill or similar contraception will pretty much nullify that risk (both the female and male pill would have to fail in this case)
  - ams6110 9y ago
    The chances of both partners in a relationship staying monogamous are undoubtedly smaller than the chances of getting pregnant while on the pill.
- Mikeb85 9y ago
  The real benefit for male contraceptive is to prevent pregnancy in couples. Not all women react well to the pill, IUDs require a doctor to install/remove, plan B isn't reliable and abortion is morally troublesome for many (even if people are pro-choice, they may not want to get an abortion for themselves). But yes, it's not a replacement for condoms as the article suggests.
rory096 9y ago
Contraline, the polymer gel injection covered in the article, is a YC F3 (summer 2016) company. Kevin says he's on the road right now, but he'll be around later to answer any questions. [0] http://contraline.com http://contraline.com
- heurist 9y ago
  Question for Kevin: Is there any way we as private citizens can help push the FDA forward on this? I've been looking forward to this since I first heard of the successful trials in India 10 (ish?) years go. Women deal with some awful side effects to existing birth control methods. Effective male contraceptives, even with side effects, could alleviate a lot of suffering.
- hjrnunes 9y ago
  I remember reading some time ago about an Indian guy who was developing something like that. He said all he needed was investment but couldn't find anyone interested. Edit: here it is https://www.bloomberg.com/news/features/2017-03-29/a-new-kind-of-male-birth-control-is-coming https://www.bloomberg.com/news/features/2017-03-29/a-new-kin...
peteretep 9y ago
> condoms, which have a real- > world failure rate of about > 18 percent That's odd, so I did some research and found: > With consistent and correct > use, condoms have a failure > rate of 2 percent. The > typical use effectiveness > rate is about 18 percent I ... don't understand. Are people putting them on their fingers? Can someone explain?
- chimeracoder 9y ago
  > I ... don't understand. Are people putting them on their fingers? Can someone explain? Abstinence has a "consistent and correct" usage rate of 100% (within rounding error). Of course, in the real world, abstinence has a pretty poor rate of preventing unintentional pregnancies, when not combined with other methods. Real-world use encompasses everything from people keeping condoms in their wallet (exposing them to heat + friction) to people deciding not to use a condom (whether because they forget, because they believe the other person is on birth control, because they decide to just "take a risk this once", or anything else).
  - userbinator 9y ago
    to people deciding not to use a condom I don't think that counts as part of the "use effectiveness rate", which AFAIK are only those who (claimed to?) have used one but failed.
    - chimeracoder 9y ago
      > I don't think that counts as part of the "use effectiveness rate", which AFAIK are only those who (claimed to?) have used one but failed. It actually (usually) is, because that's a really important part of the effectiveness of a method. That's why I added the part about abstinence - it might work if you're consistent and committed about it, but people still decide not to use it as a method. If someone invented a condom that had a 100% perfect-use effectiveness rate, but it also made sex uncomfortable to the point that people decide not to use it most of the time even when it's available, it's real-world effectiveness would be low. And that's the important number to measure.
ahh 9y ago
It's a hard problem. I think there's a simple observation that helps explain why it's going to be so hard (the article hints at this without saying it): a healthy adult man is, more or less, fertile. At all times. If a adult man is infertile--if him having sex can't result in pregnancy--there's something at least slightly wrong with him. By comparison, an adult woman is often infertile--three weeks (ish) out of every month, or whenever she's pregnant, she can't get pregnant. So it stands to reason that it's harder to produce male hormonal contraceptives: we can (at least sort of) fake healthy-but-infertile states of women, but there are no such states for men; we have to construct one from whole cloth, so to speak, and that's much harder.
- cgb223 9y ago
  > By comparison, an adult woman is often infertile--three weeks (ish) out of every month, or whenever she's pregnant, she can't get pregnant So you're telling me that I could have unlimited unprotected sex with my partner for three weeks out of every month (assuming we had perfect fertility information about those three weeks) and there would be 0 chance that they would get pregnant...?
  - kbsletten 9y ago
    Yes. The problem is nobody has "perfect fertility information". Little flukes in exact timing could change the "safe" days significantly. There's actually a whole bunch of info for couples wanting to do this with multiple ways to track fertility with more or less invasive options.
  - chillacy 9y ago
    Yes, this is called the Rhythm Method / natural family planning: http://www.everydayhealth.com/sexual-health/rhythm-method.aspx http://www.everydayhealth.com/sexual-health/rhythm-method.as... Of course the tricky part is having perfect fertility information
    - dozzie 9y ago
      This method is also called "Vatican roulette".
cgb223 9y ago
I just want to share my two cents here: I am a man in my 20's. At the moment, I am seeing people casually, because that's the kind of relationships I currently want and have time for. I have been wanting male birth control for a while now. As a guy I feel like a lot of what we are told as teenagers by our parents, and so on is that what ever you do, dont get someone pregnant. It will ruin your life, and probably the life of the child. I know many people who have had pregnancy scares with people who were keen on keeping the child, without discussing whether the male counterpart felt similarly. If men had the ability to control whether they could get someone pregnant, it allows them to live their lives, enjoy themselves, and explore without fear of negative life changing repercussions. I'd imagine the arguments for women's birth control back in the 60's (70's?) were similar, with the added issue of carrying the child. I'm not sure why male birth control is so controversial here on this forum, and in general, it sounds like the arguments for both sexes are similar, and having control of ones own body is never a bad thing.
- ams6110 9y ago
  So use a condom. Especially if you are seeing people casually, as that helps prevent STD infection.
  - user5994461 9y ago
    As said in the article. Condoms doesn't work 18% of the time. That's a pretty high failure rate. The contraception methods available to women are much more effective.
    - dennisgorelik 9y ago
      --- https://sexetc.org/info-center/post/do-condoms-work-whats-the-best-brand-and-which-type-of-condom-is-most-effective/ https://sexetc.org/info-center/post/do-condoms-work-whats-th... Condoms—when used correctly and consistently—prevent pregnancy about 98 percent of the time. The typical effectiveness rate—where mistakes are made or condoms break—is about 82 percent. ---

46 points by drtillberg 9y ago

This article makes it sound like WIN 18,446 is a safe and effective male contraceptive and it was abandoned completely just because it has bad interactions with alcohol. Is this actually true? There are lots of drugs on the market that have a bad interaction with alcohol. It's possible to just not drink alcohol.

auggierose 9y ago
Having a contraceptive pill not working together well with alcohol is probably one of the worst user interfaces ever. At least judging from the behaviour I observe amongst people in the UK :)
- drngdds 9y ago
  Not for people who don't drink or would be willing to stop drinking. That has to be a nontrivial market. Why not make it and just put a big warning label on the bottle?
  - djsumdog 9y ago
    Even for people who don't drink, there's still small amounts of alcohol in some medication, mouth wash, etc. If the severity of the reaction is high enough, even small amounts could lead to a medical emergency.
    - GhotiFish 9y ago
      I hear what you're saying here, but just taking what the article was saying, that shouldn't be much of an issue. Then one of the participants drank some contraband Scotch and became unusually, violently ill. He confessed his transgression to the researchers, and follow-up studies confirmed his account: WIN 18,446 didn’t mix well with booze. I suspect this inmate was more than a little liquored up. Just a guess. But more importantly this part: WIN’s side effects sounded familiar to Amory. In his clinical practice, he’d occasionally prescribed Antabuse (disulfiram) to patients who struggled with alcohol addiction. The drug blocks a form of the enzyme acetaldehyde dehydrogenase (ALDH), which helps the body metabolize alcohol; which means it's effects are used in practice to combat alcoholism. Can't be that bad. Though, that still means that there could be other interactions not described?
  - woodandsteel 9y ago
    >That has to be a nontrivial market. Yes, but it might be so much smaller a market than a male contraceptive without that problem that the company decided it wouldn't be able to recoup its development costs.
    - chillacy 9y ago
      I was looking up numbers in the US and came across this: > 30% of american adults don't drink at all > the top 10% of drinkers consume 74 drinks per week (over 10 drinks per day) https://www.washingtonpost.com/news/wonk/wp/2014/09/25/think-you-drink-a-lot-this-chart-will-tell-you/ https://www.washingtonpost.com/news/wonk/wp/2014/09/25/think... Wow, that's horrifying.
- deleted 9y ago
  [deleted]
mabub24 9y ago
I'm saying this fully aware I am not a doctor but... I think it depends on the severity of the response, and the context of use. For severity, it's not clear in the article but it seems like the adverse response was quick and quite severe. Another problem with reactions to alcohol: let's face it, many sexual encounters are surrounded by alcohol. For many people, for better or for worse, alcohol and sex go together. You want people to take your contraception, but if you get immediately ill whenever you drink are you going to be taking that pill like clockwork? Sex is important, and, frankly, people take a lot of risk for the sake of having sex. Often that means choosing to drink alcohol, not always, but often. It's complicated, and I know I sound like someone trying to rationalize doing the least amount of work, but the truth is you want male contraception to be easy because men could potentially be using it their entire lives. Female oral contraception works, but it likely would not pass medical trials today precisely because of many of the side effects that occur when one takes it.
bdamm 9y ago
For many candidates I suspect the requirement of not drinking alcohol would be 98% effective.
SolarNet 9y ago
I think it is how dangerous the reaction with alcohol is. Most drugs with alcohol make you extra drunk. This one gives you a heart attack.
cbr 9y ago
I was also curious about this. A male contraceptive that is incompatible with drinking would be a good fit for many people who don't ever drink, including me. There would definitely be people it was a poor fit for, but it still seems like there's a teetotalers market. The main question to me is whether it's compatible with the small amounts of alcohol that are in many foods.

JohnJamesRambo 9y ago

A great male contraceptive is already here and it is testosterone injections. "The two-and-a-half-year study of 399 couples in nine countries found that the injections of the male sex hormone were an effective contraceptive for 98.6 percent of the participants." https://nytimes.com/1996/04/03/us/testosterone-injections-work-as-contraceptive.html https://nytimes.com/1996/04/03/us/testosterone-injections-wo...

true_religion 9y ago
"It is a painful injection in the buttock,".... most likely the reason why it is not more popular.
- JohnJamesRambo 9y ago
  It isn't that painful at all, that is the equivalent of FUD in this article. It is about as painful as any other shot.
walrus 9y ago
Disclaimer: I have no idea what I'm talking about. Here's roughly how it works, if I understand correctly. First, a normal male endocrine system looks roughly like this: 1. The hypothalamus produces GnRH. 2. In response to stimulation by GnRH, the pituitary produces LH and FSH. 3. In response to FSH and LH, the testes produce sperm and testosterone, respectively. 4. Testosterone inhibits the production of GnRH by the hypothalamus (a negative feedback mechanism). This effectively keeps testosterone levels regulated. When external testosterone is introduced, here's what happens: 1. The increased testosterone inhibits the production of GnRH by the hypothalamus. 2. In absence of GnRH, the pituitary produces less FSH and LH. 3. In absence of FSH, the testes produce less sperm (this is the contraceptive effect). In absence of LH, the testes produce less testosterone. The net effect is less sperm and the body produces less testosterone on its own. This makes me wonder: would this lead to testicular atrophy? That happens with steroidal antiandrogens and GnRH agonists/antagonists, both of which have the effect of decreasing LH and FSH. Also, I think there are cardiovascular risks associated with high testosterone.

ams6110 9y ago

Female contraceptive pills have a lot of problems. They are linked to cancer, liver disease, gallbladder disease, stroke, blood clots, high blood pressure, and heart disease. Taking pills to inferfere with your normal hormonal and bodily functions is not a great idea, when there are other options with fewer or no side-effects. As a man, I would not take pills for contraception.

evolve2017 9y ago
First, I agree that non-hormonal contraception decreases a lot of the risk associated with hormonal contraception (almost tautological, but worth stating). Second, there is no increase in mortality between women who use oral contraceptive pills and women who do not (with the exception of women over 35 who smoke; OCPs are contra-indicated in this group). For any OCP-users who might read this, there is no overall increase in cancer associated with OCPs, though some cancers are more likely with OCPs and others are less likely with OCPs. Many of the side effects you're mentioning are either rare (hypertension, stroke/blood clots) benign (maybe you mean hepatic adenoma when you say liver disease?) or things I have not heard of (would appreciate scholarly references; gall bladder disease, heart disease[not sure what you mean here]). > Taking pills to inferfere with your normal hormonal and bodily functions is not a great idea, when there are other options with fewer or no side-effects In general, all medications have risks and benefits. A blanket statement such as this one ignores the risk-benefit calculation that each patient and her physician must assess in picking a medication.
- ams6110 9y ago
  > Many of the side effects you're mentioning are ... things I have not heard of Admittedly hasty research, these are listed on WebMd as possible side effects of contraceptive pills.

djsumdog 9y ago

The article mentions the gel injections that destroy sperm as semen travels from the testicles. Last I heard the Indian company that developed it was still doing trials in Indian and the US (long running trials in India show it effective and reversible for years). It's more invasive than a pill, yes, but it seems like the most viable reversible solution so far.

ams6110 9y ago
I believe it was injecting/inserting a block (some kind of gel maybe?) into the vas deferens, with the effect of a vasectomy but much more easily reversible.

nxc18 9y ago

While I get that you could argue that 'pregnancy is the worst std' with 18+ years-long untreatable consequences, I don't really see the appeal for something that just targets pregnancy. As a gay male, I would tend to favor condoms and other things that have a chance of reducing std transmission. If anything, the AIDS epidemic taught us that STDs are just as serious as pregnancies. Ultimately it comes down to not fucking complete strangers and using protection when you do. For long term relationships, there are so many options: pills, IUDs, condoms, plan b, and even abortion. I'm much more interested in research into how to make condoms more effective and better treatments for unsolved problems, like herpes, HIV, Chlamydia, gonorrhea, etc. (antibiotic resistance is still a thing btw).

nxc18 9y ago
Also it should be mentioned that female contraceptive is also advertised for beneficial side effects, like reducing the symptoms of PMS. While there are surely hormonal cycles that men experience, there really is no regular, painful, recurring symptom to be relieved.
Rjevski 9y ago
If you're in a relationship and are both clean, STDs are not an issue. However when only the female takes the pill its efficiency isn't 100%, so there is still a tiny risk of pregnancy. Having the male take a pill or similar contraception will pretty much nullify that risk (both the female and male pill would have to fail in this case)
- ams6110 9y ago
  The chances of both partners in a relationship staying monogamous are undoubtedly smaller than the chances of getting pregnant while on the pill.
Mikeb85 9y ago
The real benefit for male contraceptive is to prevent pregnancy in couples. Not all women react well to the pill, IUDs require a doctor to install/remove, plan B isn't reliable and abortion is morally troublesome for many (even if people are pro-choice, they may not want to get an abortion for themselves). But yes, it's not a replacement for condoms as the article suggests.

rory096 9y ago

Contraline, the polymer gel injection covered in the article, is a YC F3 (summer 2016) company. Kevin says he's on the road right now, but he'll be around later to answer any questions. [0] http://contraline.com http://contraline.com

heurist 9y ago
Question for Kevin: Is there any way we as private citizens can help push the FDA forward on this? I've been looking forward to this since I first heard of the successful trials in India 10 (ish?) years go. Women deal with some awful side effects to existing birth control methods. Effective male contraceptives, even with side effects, could alleviate a lot of suffering.
hjrnunes 9y ago
I remember reading some time ago about an Indian guy who was developing something like that. He said all he needed was investment but couldn't find anyone interested. Edit: here it is https://www.bloomberg.com/news/features/2017-03-29/a-new-kind-of-male-birth-control-is-coming https://www.bloomberg.com/news/features/2017-03-29/a-new-kin...

peteretep 9y ago

> condoms, which have a real- > world failure rate of about > 18 percent That's odd, so I did some research and found: > With consistent and correct > use, condoms have a failure > rate of 2 percent. The > typical use effectiveness > rate is about 18 percent I ... don't understand. Are people putting them on their fingers? Can someone explain?

chimeracoder 9y ago
> I ... don't understand. Are people putting them on their fingers? Can someone explain? Abstinence has a "consistent and correct" usage rate of 100% (within rounding error). Of course, in the real world, abstinence has a pretty poor rate of preventing unintentional pregnancies, when not combined with other methods. Real-world use encompasses everything from people keeping condoms in their wallet (exposing them to heat + friction) to people deciding not to use a condom (whether because they forget, because they believe the other person is on birth control, because they decide to just "take a risk this once", or anything else).
- userbinator 9y ago
  to people deciding not to use a condom I don't think that counts as part of the "use effectiveness rate", which AFAIK are only those who (claimed to?) have used one but failed.
  - chimeracoder 9y ago
    > I don't think that counts as part of the "use effectiveness rate", which AFAIK are only those who (claimed to?) have used one but failed. It actually (usually) is, because that's a really important part of the effectiveness of a method. That's why I added the part about abstinence - it might work if you're consistent and committed about it, but people still decide not to use it as a method. If someone invented a condom that had a 100% perfect-use effectiveness rate, but it also made sex uncomfortable to the point that people decide not to use it most of the time even when it's available, it's real-world effectiveness would be low. And that's the important number to measure.

ahh 9y ago

It's a hard problem. I think there's a simple observation that helps explain why it's going to be so hard (the article hints at this without saying it): a healthy adult man is, more or less, fertile. At all times. If a adult man is infertile--if him having sex can't result in pregnancy--there's something at least slightly wrong with him. By comparison, an adult woman is often infertile--three weeks (ish) out of every month, or whenever she's pregnant, she can't get pregnant. So it stands to reason that it's harder to produce male hormonal contraceptives: we can (at least sort of) fake healthy-but-infertile states of women, but there are no such states for men; we have to construct one from whole cloth, so to speak, and that's much harder.

cgb223 9y ago
> By comparison, an adult woman is often infertile--three weeks (ish) out of every month, or whenever she's pregnant, she can't get pregnant So you're telling me that I could have unlimited unprotected sex with my partner for three weeks out of every month (assuming we had perfect fertility information about those three weeks) and there would be 0 chance that they would get pregnant...?
- kbsletten 9y ago
  Yes. The problem is nobody has "perfect fertility information". Little flukes in exact timing could change the "safe" days significantly. There's actually a whole bunch of info for couples wanting to do this with multiple ways to track fertility with more or less invasive options.
- chillacy 9y ago
  Yes, this is called the Rhythm Method / natural family planning: http://www.everydayhealth.com/sexual-health/rhythm-method.aspx http://www.everydayhealth.com/sexual-health/rhythm-method.as... Of course the tricky part is having perfect fertility information
  - dozzie 9y ago
    This method is also called "Vatican roulette".

cgb223 9y ago

I just want to share my two cents here: I am a man in my 20's. At the moment, I am seeing people casually, because that's the kind of relationships I currently want and have time for. I have been wanting male birth control for a while now. As a guy I feel like a lot of what we are told as teenagers by our parents, and so on is that what ever you do, dont get someone pregnant. It will ruin your life, and probably the life of the child. I know many people who have had pregnancy scares with people who were keen on keeping the child, without discussing whether the male counterpart felt similarly. If men had the ability to control whether they could get someone pregnant, it allows them to live their lives, enjoy themselves, and explore without fear of negative life changing repercussions. I'd imagine the arguments for women's birth control back in the 60's (70's?) were similar, with the added issue of carrying the child. I'm not sure why male birth control is so controversial here on this forum, and in general, it sounds like the arguments for both sexes are similar, and having control of ones own body is never a bad thing.

ams6110 9y ago
So use a condom. Especially if you are seeing people casually, as that helps prevent STD infection.
- user5994461 9y ago
  As said in the article. Condoms doesn't work 18% of the time. That's a pretty high failure rate. The contraception methods available to women are much more effective.
  - dennisgorelik 9y ago
    --- https://sexetc.org/info-center/post/do-condoms-work-whats-the-best-brand-and-which-type-of-condom-is-most-effective/ https://sexetc.org/info-center/post/do-condoms-work-whats-th... Condoms—when used correctly and consistently—prevent pregnancy about 98 percent of the time. The typical effectiveness rate—where mistakes are made or condoms break—is about 82 percent. ---