Male Contraceptives - The Good, The Bad, and The Ugly
This week, my news feeds have been flooded with stories about the recent research on an injectable male contraceptive. The headlines I saw focused on the fact that promising research was halted because a few men experienced troubling side effects such as acne, mood disorders, and decreased libido. Most of the women I know (including myself, to be honest), had little sympathy for this. Any of us who have taken the pill have experienced at least some of the side effects and have had little support or cooperation from our physicians when we reported them.
Today I saw an article from Snopes (snopes, no less!) claiming to debunk all of this. It was not true, they said, that the research was halted because of the complaints of a few men. The research is ongoing, they claim, but this particular study has been stopped, not by the men, but by an outside research control group who felt there needed to be further exploration of the side effects and safety issues.
Pardon me Snopes, but same difference. Of course the subjects didn't stop the study. They are not in control of that. What happened was: research subjects were asked about side effects, they reported the side effects, researchers determined the side effects were of concern and they stopped the study. (I must also mention here that it wasn't just the side effects issue that was of concern, there were a few pregnancies and a few participants who did not demonstrate a return to fertility up to a year after stopping the drug - more on that below). This means that the subjects were asked meaningful questions, they answered them, they were believed, and action was taken on it. This is exactly what should happen. It shouldn't be remarkable, and yet, it is.
Women have been complaining of side effects from the birth control ever since it was invented. It was only when women started actually dying from blood clots that that issue was investigated and lower dose pills were developed. I have suffered from low libido and depression from taking the BCP and could not even begin to count the number of women I know who have also. It is only very recently that it has been acknowledged that these can be side effects. 2016 was the release of the first study showing a strong correlation between depression and the use of hormonal contraceptives. That study was met with a resounding "I told you so!" by the countless women who have experienced this.
The Snopes article claims that, even though it certainly looks like this is evidence of gender bias, it's really not because the BCP was approved in 1960. The research and approval process was very different than and we just didn't study these things the way we do now. Had the BCP been up for approval today, they say, it likely wouldn't pass, given the much more stringent requirements.
I call bullshit on that, Snopes. All you have to do to throw that theory into question is look at the approval of Flibanseran. This is a drug that's supposed to increase libido in women. After initially being denied approval, it was approved by the FDA last year. This, in spite of the fact that studies of Flibaneran show very minimal positive effect and some serious side effects including nausea, insomnia and dizziness due to low blood pressure. Flibanseran is also contraindicated for use with just about any drug you can imagine, including alcohol, and presents serious health issues if combined with them. All this, and yet Flibanseran - a drug meant just for women - received approval in 2015. 'splain that one to me Snopes.
There's also the fact that Yaz a birth control pill which was approved and came onto the market in 2006 has demonstrated a 74% higher risk of creating blood clots than other BCP's. Yaz has been implicated in the deaths of at least 23 women in Canada alone and there are currently more than 11,000 lawsuits against Bayer over Yaz and Yasmin. All of this, and Yaz is still on the market. 'splain that one to me too Snopes.
Yes, there was a lot of snarky commentary about the male contraceptive story suggesting men are wimps and can't handle the side effects that women have been dealing with forever. To me, that's not the point of the story at all, The story is that as soon as any ill effects were noted in this study of a male contraceptive, the researchers stopped the study in order to look into it. This is what should happen. Men shouldn't have to endure these side effects because the positives are thought to outweigh them. And yet that's exactly what women have been told - in regards to all forms of hormonal contraception, Flibanseran, and other drugs.
One of the things that most of the coverage hasn't mentioned is that the failure rate (4 in 266 of the subjects' partners conceived) was of concern and about 5% of them did not have a return of motile sperm up to one years after stopping the drug. Those are of major issues, of course, and I can understand why researchers would stop the trial to investigate this. However, while one person conceiving when they don't want to is too many, this is still a relatively low failure rate for a contraceptive. Failure and interference with fertility are very common. So yet again, I have to wonder, why is that being taken seriously during the investigation of this drug and not with the ongoing use of BCP's? Again, it is only recently that the medical community is even taking seriously the possibility that women who have taken hormonal contraceptives for years will have trouble conceiving once they stop taking them. With the male contraceptive, it's reason to stop a study altogether. With female ones, we have to wait decades until someone even notices.
I hope this research continues because this injectable contraception sounds promising. An option for men that would allow them to take more control over their own fertility, and to contribute more to decisions around contraception in their relationships would be amazing. I hope they find a way to mitigate the more serious side effects. This will, if and when it becomes available, make it more likely that men will use it and, who knows, perhaps it will even open doors to reducing side effects for female contraception.