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You're listening to shortwave. from

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NPR.

0:21

Hey, short wavers Emily Kwang here with scientists

0:23

and residents, Regina Barber, one of my

0:25

favorite people. Hello, Regina. Oh,

0:28

thank you. Hey, ma'am. I

0:30

actually want to share with you a story of

0:32

sperm stopping science in Seattle.

0:36

And why we don't have more male contraception

0:38

on the market? I wanna know the answer to this

0:40

question very badly. So

0:43

let's talk about it. And let's talk about sex.

0:46

Let's talk about sex. But let's talk about

0:48

Philip Shaw's sex life back in twenty

0:50

nineteen. He was part of clinical

0:52

trials at the University of Washington to test

0:54

a new male contraceptive.

0:55

It was underground at

0:58

the U Dub medical campus that

1:00

they have there. I had to go, like, literally

1:02

underground.

1:03

So he would visit the campus roughly

1:05

once a month for his sperm levels to

1:07

be checked. But this study was for

1:09

couples. So his girlfriend, now

1:11

wife, was also part of the study.

1:13

Cool. What do they have to do? Well,

1:15

Philip had to keep a record of his moods.

1:17

I had to basically review

1:20

my like how I felt, was

1:22

I said, was I angry,

1:25

did I feel ill, so

1:27

I had to be very introspective. But

1:30

I did not have to write

1:32

some racy sex journal

1:34

like my wife had to.

1:37

What? So the

1:39

researchers divvied up the labor of

1:41

chronically in their life during the study. And

1:44

his girlfriend at the time, wife now

1:46

had to log when they had sex. Interesting. Okay.

1:49

And what kind of contraception was

1:51

part of this study. The kind of

1:53

male contraception used in this study is

1:55

a gel like that you apply like a

1:57

lotion. It's clear and it has

1:59

the consistency

1:59

of hand sanitizer. So it was

2:02

this gel that I would rub on my shoulders,

2:04

both shoulders, once a day.

2:06

And the gel is designed to reduce fill

2:09

sperm count. Interesting.

2:11

We'll get into the science of how that works later.

2:13

Okay. But the bottle of gel had this pumps,

2:15

so researchers would make sure everyone was

2:17

getting the right amount daily.

2:18

And then I would have to wash my hands because

2:20

apparently if it were to get on anybody else

2:22

that could be detrimental to them.

2:24

Why is that? It's because the gel contains

2:26

testosterone. Okay. Right.

2:28

And any prolonged exposure for a woman

2:31

or child to testosterone could mess

2:33

up their hormonal balance. Now,

2:35

this study is still going on. It's not over,

2:37

but researchers at U Dub have already

2:40

found that there's little risk of hormonal

2:42

transferring. and short term exposure

2:45

is safe. Mhmm. But to be

2:47

extra careful, the researchers ask participants

2:49

like fill up too. To

2:50

make sure that my shoulders are always covered. made

2:52

sure that I did it every single day.

2:54

And

2:54

he wore that t shirt until the gel was

2:56

fully absorbed. Regina, I have never

2:59

ever heard of contraception that works

3:01

like this. of a gel that a man

3:03

would apply to ultimately

3:06

prevent pregnancy? Yeah. No, I hadn't either.

3:08

This was like really fascinating. And

3:10

in all of this work, you know, applying this

3:12

gel, it seemed like a small inconvenience

3:15

to Philip because he was actually really eager

3:17

to join the study. he got a

3:19

little cash and he got to share some

3:21

of the burden of birth control with his partner.

3:23

I was happy to to participate because

3:25

I think this is a really important sort of scientific

3:27

advancement. and also, I guess,

3:29

social advancement too because generally

3:32

are faced with the brunt of contraceptive

3:34

choices.

3:35

And he says he didn't have any side

3:37

effects.

3:37

I never once felt

3:40

moody. I didn't feel any quicker

3:42

to anger. I didn't feel any annoyance. I

3:44

didn't feel anything like

3:46

food cravings or anything

3:48

else that's unusual for me. I know I love

3:51

food, so I'm always craving food. But I

3:53

never felt anything unusual

3:56

that I would ever attribute to the

3:58

gel that I was using. So we

3:59

don't know how effective the gel is yet.

4:02

That's what the studies for. And the hope

4:04

is that the person producing sperm can

4:06

take partial to full responsibility for

4:08

preventing pregnancy

4:09

too.

4:12

Today on the show, we ask

4:14

some questions of male contraception. Why

4:17

haven't we seen birth control for men? and

4:19

when will there be contraception on the shelves

4:21

that includes more options for those who

4:23

produce sperm. I'm Emily Kwang.

4:25

I'm Regina Barber, and this

4:26

is Shorewave. The Daily Science podcast

4:29

from NPR.

4:40

Support

4:41

for this NPR podcast and the

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following message come from the UPS

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store. At the UPS store, not

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every small business needs the same thing,

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5:09

Before we get into this story, I just want to

5:11

acknowledge that all the language in these studies

5:14

and in this episode is gendered.

5:16

Researchers are working on making it more inclusive,

5:18

but these studies are typically done on

5:20

cis males between eighteen and fifty.

5:22

Alright. Good to know. Okay.

5:24

Pop quiz for you. I'm ready. What

5:26

was the last male contraceptive to

5:29

hit the market?

5:31

I think it

5:32

has to be condoms. I I can't

5:34

think of anything really

5:36

honestly targeted to men

5:38

beyond condoms. Dinkdinkdinkdinkdinkdink. You are

5:40

totally right and that was like two hundred

5:42

years ago. two hundred years ago. Yeah. That's

5:44

the last thing. What? A man can just buy

5:47

specifically for a male

5:49

contraceptive. Alright. And you're

5:51

here because it sounds like there are

5:53

other male contraception options in

5:55

progress. And we could

5:58

really use them. So what are researchers working

6:00

on right now? Well, I

6:02

spoke with professor and medical researcher

6:03

Dr. Stephanie Page at the University

6:05

of Washington. Her team

6:06

is trying to get the next male contraceptive

6:09

to the public. So

6:10

they've got a few projects going on at once, including

6:13

the gel that Phil described earlier. we

6:15

would like to create a menu of options

6:17

for men similar to what women have

6:19

available to them. And that

6:21

would include and things we are

6:23

actually working on transdermal

6:25

gel that men would apply every day

6:28

an oral birth control pill

6:30

for men -- Mhmm. -- and long acting

6:32

injections. And in

6:34

all cases, those method

6:37

that

6:37

we're developing would be reversible. So

6:39

interesting. Wow, okay. So Stephanie

6:41

works exclusively with hormonal

6:44

methods. And what's the difference between hormonal

6:46

and non

6:46

hormonal? How do they work? Hormonal

6:48

contraception works by interrupting

6:50

the signals from the brain to

6:52

in men, the testes that they cause

6:54

them to create new sperm. That's

6:56

Logan Nichols. the research director at male

6:59

contraceptive initiative. He says

7:01

that when the hormonal gel or pills are

7:03

taken regularly, they lower testosterone

7:05

levels. reducing the ability to

7:07

produce sperm. The male

7:09

contraceptive initiative focuses on helping

7:11

researchers working on potential non

7:13

hormonal methods. Some

7:15

of those methods are drugs that

7:17

target proteins in the body that when absent

7:20

will slow down the speed of sperm,

7:22

reducing their ability to reach the egg.

7:25

Other options are more physical,

7:27

for instance, a way to block the vest

7:29

difference. The tube that carries the sperm

7:31

from the testes to the urethra oh,

7:33

okay. And what do those physical methods

7:35

look like? So Logan says it would

7:37

be something that can be implanted. Implanted.

7:40

What do you mean? Think of like a

7:42

small object that can be implanted into

7:44

the sperm carrying tube we

7:45

were just talking about. That acts as a alternative

7:48

to vasectomy. unobasectomy, very

7:50

effective, very cheap, very easy, not

7:52

always reversible. These new methods are

7:54

a hydrogel, kind of a

7:56

gel like substance that gets injected into

7:58

the Vasylephrine that blocks

8:00

the transport of sperm over

8:02

time and then don't ejaculate sperm, but they

8:04

still produce sperm and then eventually

8:06

that gel either degrades or is reverse

8:08

via second injection and

8:10

then restore fertility.

8:11

So which method hormonal

8:14

or non hormonal will make it to the market first,

8:16

do you think? Yeah, this was my top

8:18

question for everyone. I asked all

8:20

my sources. Stephanie Logan and

8:22

even another researcher, Dr. Brian

8:24

Nguyen. He's an OBGYN and

8:26

a professor at the University of Southern

8:28

California. Like Stephanie, he

8:30

conducts clinical research on hormonal contraception

8:33

for men, including the

8:35

gel fill up used. I'll tell you what I'm

8:36

most excited about first, which is the

8:38

method that we are closest to getting

8:40

the market, which is a hormonal method

8:42

of nail contraception, hormonal contraception,

8:45

gel. that essentially sends a

8:47

signal up to the brain to shut down the

8:50

signals for producing

8:52

sperm. and that way

8:54

we decrease men's sperm count

8:56

and then at some point when

8:58

they want to stop using the drug and

9:00

the signals restart all over

9:01

again. This is so fascinating, Regina. I'm

9:04

wondering, do we know how effective

9:07

these birth control methods are? I know the

9:09

research is still happening, but Ultimately,

9:11

do we know if these methods can be used

9:13

to prevent pregnancy entirely

9:15

all on their own? I mean, the idea

9:17

is yes. Right? Okay. That's what they're doing now

9:19

in the study is to measure how effective this

9:21

method is to reduce the sperm count to

9:23

levels that will not produce a pregnancy. And

9:25

when will this gel be available

9:28

to those who want it? Most

9:30

researchers I talk to seem to think we'll have

9:32

something within the

9:32

decade. An optimistic but

9:35

still realistic timeline

9:37

is in the order of

9:38

seven to ten years. The seven to

9:40

ten years is due to how long clinical

9:43

trials take. but

9:45

Logan says the non hormonal method of

9:47

physically blocking sperm with an

9:49

implant could be really sooner.

9:50

They've just started their first in human

9:52

studies in Australia. But

9:54

because it's regulated as a device, it has

9:56

a theoretically much shorter

9:59

approval pathway than a drug

10:01

does.

10:01

Okay, so that's the status of these

10:04

contraception methods. But I gotta say,

10:06

Regina, why has it taken

10:08

so long to develop

10:10

contraception for men. Yeah,

10:12

Stephanie says the first priority was

10:14

for those who can have children,

10:15

initial Conceptive efforts

10:17

were really focused on women appropriately

10:20

as women bear the life

10:22

threatening burden of pregnancy. And

10:24

so the initial energy went

10:26

into ensuring that women had

10:29

control of their own reproduction. and

10:31

she says developing male contraception

10:34

is more complicated. The fact that

10:36

women ambulate

10:36

once a month

10:38

two or three eggs and that they have a

10:40

finite reproductive time period is

10:42

very different than

10:43

men. So men are making literally

10:46

millions and millions of sperm

10:48

per day. And in the ejaculate,

10:50

there's more than two hundred

10:52

million sperm. There's a lot to

10:54

parse through. Yeah. Like researchers had to

10:56

figure out a threshold

10:56

on how much sperm needs to be blocked.

10:59

And then she says there's a lot

11:01

of regulatory controls that have to be worked

11:03

through too. For one, the

11:05

criteria for the FDA to approve a

11:07

new male contraceptive is

11:09

vague. And

11:10

two, all

11:11

the risk calculations are different across

11:14

people of different biological sexes. You

11:16

know, male contraception is a funny

11:18

thing because when we think

11:20

about risks, what are we protecting

11:22

the man from? And in the

11:24

case of female contraception, the

11:26

woman is being protected from the risk

11:28

of pregnancy, and

11:30

of potentially unsafe abortion.

11:33

So but with men,

11:35

they're really using

11:36

a contraceptive to protect

11:38

their partner. And

11:40

so

11:40

if we just think about the man

11:43

as a single unit, the risk

11:45

equation is not very

11:47

good. Right? There should be absolutely no side effects

11:49

and no risk. but I think we really need to move

11:51

to thinking about couples as a diet

11:53

and this is shared risk. And

11:56

Stephanie says there are financial barriers in

11:57

drug development. The way that drug

11:59

development happens in the United

12:02

States ultimately is funded

12:04

by the pharmaceutical industry.

12:07

and that's

12:07

really because the final

12:09

phase three trials are exceedingly

12:11

expensive. Logan agrees. Drug

12:13

companies want to know they have something

12:15

that sells.

12:16

drug companies invest

12:19

millions and millions and millions of dollars

12:21

into a drug before they ever see a dime of

12:23

profit. And if a drug has

12:25

really high barriers of safety and efficacy

12:27

once that they maybe aren't sure they're going to be

12:29

able to hit, they might not even take the effort

12:31

at all.

12:31

Overall, after talking to everyone, I

12:33

noticed that they are all optimistic

12:35

that a male contraceptive would be

12:37

out on the market in the next decade.

12:39

They also all agreed that we and the

12:41

media and society need to start thinking

12:44

about contraception as something that

12:46

everyone should be involved with. Absolutely.

12:48

Yeah. Be it to give a man a chance

12:50

to take more responsibility or

12:52

to recognize that an unwanted

12:54

pregnancy would affect a couple, not just the

12:56

person carrying the baby.

13:01

Regina

13:04

Barber, thank you so much for bringing us this

13:06

reporting. I have learned a lot from it.

13:08

Yeah. You're welcome. And I I've learned

13:10

a lot from this one definitely. This

13:12

episode was produced by Rebecca

13:14

Ramirez. It was edited by supervising

13:16

senior editor, Jizelle Grayson, and

13:18

fact checked by Brent Hanson. The

13:20

audio engineer was Trey Wong. Brandon

13:23

Crump is our podcast coordinator. Beth

13:25

Donovan is our senior director and Anja

13:27

Grenman

13:27

is our Senior Vice President of Programming I'm

13:30

Emily Kwang. I'm Regina Barber, and thank you

13:32

for listening to Shortwave, daily science

13:34

podcast from NPR. See

13:36

you tomorrow.

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