That Male Contraception Story Was Bad Science Reporting At Its Worst | Vol. 4 / No. 1.5

Just what we’re trying to prevent | Photo: Zappy’s Technology Solutions, CC BY 2.0

If you’ve been reading the news about the latest male contraception study, you could be forgiven for thinking that it was canceled because men are a bunch of wimps who can’t handle the side-effects women have been putting up with for years. That’s the story as reported by headlines like “Male birth control study nixed after men can’t handle side effects women face daily,” and “Yes, contraceptives have side effects – and it’s time for men to put up with them too.” The only problem? Everyone got so caught up in the “lol men” that they didn’t even bother to read the study.

The reporting has, to put it mildly, been pretty reductive. The reasons are pretty obvious: we on the internet like to read things that reaffirm our preconceived notions, and the story played into a narrative we’re all familiar with (and pretty invested in). Not only do doctors in general treat women’s pain (and other symptoms) as less serious, but birth control does (at least anecdotally) have fairly common side-effects, and it’s been an unjustly one-sided thing for far too long. Thankfully there are clever people working on developing safe and reversible birth control for men to use — and this study was a good step in the right direction. It may not have been 100% perfect, but nor was it (a) an abject failure nor (b) ruined by weak men who didn’t want to put up with the side-effects.

So let’s take a look at what happened.

The study was split into two parts. First, 320 men got at least one injection in the first half of the study to see if it would reduce sperm counts after 24 weeks. It did work in 274 of the men (if by “work” we mean dropped sperm levels to or below a million sperm per mL, which has been criticized as still too high by others in the field).

Next, those men in the original study who it worked for were asked whether they’d like to volunteer to participate in another phase of the trial to see whether it prevented pregnancy (which is a different, if related thing). This would, of course, entail having a partner you’re willing to have a baby with by accident if it fails. A surprising 266 of those stayed in the study to test a generally-unproven birth control method and risk having a kid. Twenty men dropped out of the study due to side effects.

The researchers ended the study early for two reasons: First, they already had what they needed (pregnancy rates were 1.57 births per 100 — there were four pregnancies, which is pretty good, being about on-par with already-available methods for women), and second, because an outside safety review had concerns about the side effects, particularly the mood issues:

“The safety committee felt that the number of side effects, particularly the mood changes, were too many,” said one doctor associated with the study.

So just to be really clear: the study did not end because men “couldn’t take the side-effects,” or because it’s more acceptable for side-effects in women than men. It ended because once they had their results, the risk-benefit ratio shifted such that an outside body suggested they shouldn’t continue.

Looking at the study, the adverse effect numbers do look on the high side (these numbers are for the whole population of 320, not just the 266): 16.9% reported mood disorders, with 3.8 and 1.9 (of that 16.9) being hostility and aggression, and 2.8 being depression (they were sorted into “mood altered/moodswings,” “hostility,” “depressed mood/depression,” aggression,” and “affective disorder” (no I don’t know what that last one means). Honestly, the outside observers may have been more concerned with the hostility and aggression as much as with the depression, because hostile and aggressive men are potentially dangerous, but it doesn’t go into detail there.

After all that — that is to say after it was ended — when asked whether they’d use it, 75% said they still would (and actually the numbers who said they wouldn’t were way lower than 25%, because the majority of the rest were in the “meh, not sure” category). So three out of four would still volunteer to take something that they’d been told to stop taking early for safety concerns. I’m frankly surprised it’s that high, and so were the researchers, who wrote:

“Despite the various AEs [adverse effects] and clinically intensive study regimen, male participants and their partners found this combination to be highly acceptable at the end of the trial, even after being made aware of the early termination of the study intervention. More than 75% reported being at least satisfied with the method and willing to use this method if available, which supports further development of this approach.”

So actually, they’re still viewing it as a success. I’ve heard interviews on the radio saying that what’ll probably change before the next round is the balance of the hormones in the shots, as a way of preventing the men taking it from, I don’t know, getting the birth control equivalent of “roid rage.”

And just as a side note: every person who scoffed at the “increased libido” side-effect? Stop being a jerk. Yes, increased libido can be a good thing if your libido isn’t as high as your partner wants, but it’s a massive problem if you already want to have sex than your partner, so just back off a little. We’re talking about real people in real relationships.

So anyway, as I say, “lol men” probably isn’t the takeaway we should be getting from this at all. Rather, it should be that scientists are getting a lot closer to leveling out yet another lopsided field of responsibility between the sexes, and that’s an unabashedly good thing.

The study is published in the “Early Release” section of October’s Journal of Clinical Endocrinology & Metabolism under the title “Efficacy and safety of an injectable combination hormonal contraceptive for men.”

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