A study investigating contraceptive injections, titled Efficacy and Safety of an Injectable Combination Hormonal Contraceptive for Men, was released this Friday. The birth control in question is intended for people with testes and penises (please forgive any cisnormative language, but unfortunately much of the science and reporting on this form of birth control has been written with the assumption that “all men have penises” and that “all women have vaginas.” We will do our best to write in as gender-neutral of a mode as is possible without obfuscating the content of the piece). The study, which, with a success rate of 96 percent, found that male hormonal birth control has the potential to be just as effective as the pill is for people with uteruses, was recently discontinued due to the side effects that its participants were suffering from.
The clinical trial constituted 320 men between the ages of 18 and 45 who were given regular injections of progestogen (a hormone which lowers sperm count) and synthetic testosterone (which tricks the body out of making its own testosterone, and therefore producing sperm). This is a preliminary scientific study that could lead to a successful hormonal birth control for those with testes and penises, allowing those people to take contraception into their own hands, as well as decreasing the burden of responsibility for those with uteruses. The health and social implication of “male” birth control are remarkably significant, and pioneering studies such as these have both symbolic value and a very real impact on bodily health and autonomy.
The study, though largely successful, was discontinued early because twenty men reported side effects. According to the study, "Of these 20, 6 men discontinued only for changes in mood and 6 men discontinued for the following single reasons: acne, pain or panic at first injections, palpitations, hypertension, and erectile dysfunction." The other eight men cited mood changes as their reason for dropping out of the study, including “4.7 percent of men [who] experienced mood swings, and 2.8 percent [who] experienced depression.” These side-effects are nothing to take lightly. They are all dangerous, and even potentially life-threatening — including the mood changes, which can lead to major mental health problems and suicidality. We do not blame these men at all for prioritizing their personal health over their participation in the study, they were simply doing what was best for them.
What is at issue, however, is the fact that the study was discontinued due to these reports. Women have to face all of these side effects and more. Oral contraception for women includes a risk of blood clot, heart disease, stroke, severe mood changes, cramping, acne, and decreased sex drive. As you may have read, depression correlates highly with taking oral contraception. A recent study reported that among women, "both with and without a psychiatric history who were using hormonal contraceptives, about 10 percent to 15 percent got a prescription for an antidepressant during a five-year period." The risks for adolescent women, in particular, is quite high: “Two or three out of every 100 women between 15 and 19 years old who take hormonal contraceptives will become depressed over the course of a year” and “Adolescents seemed more vulnerable to this risk than women 20 to 34 years old." I know that I, as a teenager who took birth control, suffered from severe depression. Hormone changes at all ages can have huge impacts on health and quality of life, particularly at the beginning of sexual maturation. This is an under-researched aspect of female contraception and speaks to the lack of investment in women’s health and well-being.
What’s more is that the history of hormonal birth control for people with vaginas is rooted in racism, elitism, and even eugenics. The first hormonal birth control studies were conducted on Puerto Rican women in the 1950s, many of whom had no idea that they were being dosed with contraceptives, and some of whom were made to undergo sterilization procedures known ominously as La Operacion. During these studies, the side effects of hormonal birth control were so severe, with seventeen percent of study participants reporting nausea, dizziness, headaches, stomach pain, and vomiting, that “the doctor in charge of the trial recommended against its use.” Yet, as Bethy Squires of Broadly — who wrote a widely-read (and brilliantly crafted) history of the oral contraceptive — reports, the pharmaceutical company funding the study released the drug anyway (the oral contraceptive has since been refined to now include far less of the hormones necessary for preventing pregnancy, though still with significant health risks and impacts for many who take it).
Part of the reason that the pill was introduced to the public, Squires writes, is that “It was believed women would tolerate side effects better than men, who demanded a better quality of life.” It is expected that women will sacrifice their physical and mental health for the sake of contraception; that, though it takes two people to make a child, women are solely responsible for contraception. Though male birth control could mean a viable option for men to take contraception into their own hands (until now, pretty much the only birth control for those with penises were condoms or a vasectomy), it is simply not important enough to warrant investigation because of the assumption that men’s lives will not be impacted to the degree that women’s will. Though the reasons behind this are sexist, it is largely true. Birth control has meant so much for women’s rights and empowerment: it means family planning, it means that women are more free to enter and leave relationships, and that they can actively choose pregnancy and parenthood, rather than simply be subject to it.
The introduction of readily available oral contraception has meant a massive gain in women’s wages since the 1960s, higher college enrollment, and a vast increase of women with skilled careers. Teen pregnancy has declined 86 percent between 1970 and 1990, due to access to contraception. With all of that in mind, it is no wonder that the majority of women choose the health risks associated with hormonal contraception over the risk of a pregnancy.
Which is why discontinuing the research into male hormonal birth control is so particularly cutting — because it demonstrates that women’s health and safety comes so secondarily to men’s experiences. That a contraception option that might keep women from having to put their health on the line is not even warranting exploration when confronted with a few side effects (which are, frankly, to be expected at this stage of a groundbreaking drug trial). What’s more is that these side effects are not even comparable in terms of danger to the one’s women face. While the 4.7 percent of men who experienced mood swings and the 2.8 percent who experienced depression during the trial should not be ignored by any means, we should also consider that every kind of hormonal birth control for women carries a higher risk of depression than that. One IUD on the market, Liletta, reportedly causes mood swings in 5.2 percent of its users and depression in 5.4 percent. “A woman using Liletta has a higher chance of experiencing the same side effects than a man using the injectable birth control that was deemed too risky,” demonstrating just how vastly the difference in quality of life standards there is between the genders.
This is not even to mention the fact that the official reason cited for discontinuing the study was that it may have longer-term impacts on male fertility than originally anticipated. After the fifty-two week recovery period, eight participants had not returned to full fertility. Of these eight, five eventually reached their normal sperm counts after a more lengthy amount of time. All in all, medical professionals consider this a relatively minor side effect that could, again, be fine-tuned with more scientific study.
Elisabeth Lloyd, a faculty scholar at the Kinsey Institute and a professor of biology as well as an adjunct professor of philosophy at Indiana University Bloomington, said in an interview with CNN that "These risks of fertility damage are not fatal risks like the women endure with their birth control."
"You have to compare what women are doing in terms of taking hormones with what men are doing in terms of taking hormones," Lloyd said. Are they taking their life in their hands when they take the hormones? Women are. And that needs to be put right up in front when considering the risk." Women are expected to put their lives on the line (and even fight to do so, such as when they have to undertake legal battles to have their employer’s pay for their birth control coverage), while men are not expected to put themselves at any degree of risk or discomfort.
The exact process of how the decision came to be made to discontinue the testosterone-based birth control method is not disclosed to the public. I, nor any other writer, was in the room when the medical panel met to review that course of the study, and I do not know precisely what was said and how they weighted their arguments. This was a significant study, however, and a long-overdue one at that. The side effects suffered by the study participants, though significant and warranting address by the study’s conductors, are no more severe than the side effects already risked by those who take ‘female’ (estrogen and progesterone-based) oral contraception. What is considered too great of an impact on these men’s lives is something that women and nonbinary people who take the pill have to face everyday -- and if they do not, then they are forced to live with the repercussions of pregnancy, which are also forced upon people with uteruses and them alone. To not explore this avenue of medical research is sexist and a further expression of the patriarchy's impact on both the scientific community and upon the everyday lives of millions. It is another way in which male comfort is prioritized above female health and safety — and that is not alright.
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