Gregory S. Kopf, Director of Research & Development, FHI 360
Happy Father’s Day! What better day to focus on the state of male contraceptive research. Despite huge medical advancements on multiple health fronts over the past century, contraceptive options for men still only consist of the several-thousand-year-old technique (withdrawal), a 400-year-old device (condom), and a 100-year-old surgical procedure (vasectomy). And while we read in the popular press about new male methods being developed, they always seen to be “at least a decade” away from reaching the market. Why is this? The answer is complex – there are major challenges in developing new male contraceptives. In a series of blogs over the next several weeks, we will explore these challenges and the overall state of male contraceptive research.
The slow pace of developing new male contraceptives is not due to lack of need or demand. While we often hear that men won’t use contraception or that their partners won’t trust them with the responsibility, current contraceptive use patterns and the results of surveys measuring the acceptability of male methods tell a different story. Globally, male-controlled methods (vasectomy, condoms, and withdrawal) make up one-fifth of all contraceptive use. Moreover, 50% of men report a willingness to try a new male method if it were made available (and their partners say they would trust them to do so). This issue of acceptability of male methods and integrating men into family planning decision-making will be discussed in the second blog of this series, written by Drs. Rebecca Callahan (FHI 360) and Dominick Shattuck (Georgetown University’s Institute for Reproductive Health).
In our third and fourth blogs, we will explore some of the scientific and clinical challenges of developing new generations of male contraceptives. Drs. John Amory and William Bremner from the University of Washington will provide insights into ongoing studies of both hormonal and non-hormonal methods. While hormonal methods have been under study for more than 40 years, challenges remain. For example, individual differences in time to efficacy and return to fertility have been observed, side effects such as acne and mood changes have been documented, and frequency of administration and injection-site pain remain important issues. Non-hormonal methods (both devices and drugs) have theoretical advantages over hormonal approaches but have not yet been fully tested in clinical trials.
I believe the opportunity to develop novel non-hormonal drug-based therapies with minimal to no side effects will soon become a reality given our rapid advances in “omics” technologies, genetics, and pharmaceutical sciences. In this regard, Dr. Martin Matzuk of the Baylor College of Medicine will address the future of male contraceptive research, highlighting the newest scientific tools that can be brought to bear on identifying and validating new male contraceptive targets. These include large scale gene knock out and knock down screens, bioinformatics and computational biology.
The future of male contraceptive development is strong with a viable market and some promising leads. However, it will take serious and steadfast commitment and coordination from the federal, academic and private sectors to turn new male methods into reality. Research and development (R&D) is not cheap. While several government funding agencies, foundations and start-up companies continue to support male contraceptive development, the pharmaceutical industry is notably absent. Due to liability concerns surrounding contraceptive development, prohibitive R&D costs, and extraordinary safety and effectiveness regulatory hurdles, investment by Big Pharma has all but ceased. In the final blog of this series, I will build the business case for their return to the field, for increased funding for this research, and the need for strong and consistent advocacy from a public who knows we can do better!
While Father’s Day is traditionally a time for children to bestow good wishes on their fathers, it is my sincere wish for my young son that he will have new male contraceptive options to choose from during his reproductive life.