The Male Birth Control Problem: What's Finally Coming Next

For more than a century, men who wanted to take responsibility for male birth control have had two real options: condoms or vasectomy. A review published in the International Journal of Impotence Research argues that the narrow menu of male birth control options is finally about to expand.

The review, by M. Leach, V. Nguyen, D. Patel and colleagues, traces the history of male contraception and surveys the pipeline of hormonal and non-hormonal methods in development. The authors conclude that new reversible options for men are overdue, a point they say has taken on new weight since the Supreme Court's Dobbs v. Jackson Women's Health Organization decision ended the constitutional right to abortion access in the United States. Details of the review were reported by News-Medical, and the review states that additional reversible contraceptive options are urgently needed to broaden family planning choices for men and their partners.

A 5,000-year history of improvisation

Barrier male contraception was first recorded around 3000 BC, when a goat bladder was reportedly used as a penile sheath in Crete. Ancient Egyptians documented regular use of linen penile sheaths around 1000 BC, including for protection against schistosomiasis, and ancient Romans used linen or animal-intestine sheaths to help prevent sexually transmitted infections.

Charles Goodyear's development of rubber vulcanization paved the way for large-scale rubber condom production by 1860. Rubber condoms were issued to German and British soldiers during the First World War to prevent venereal disease. The arrival of latex in the 1920s improved strength, thinness, and shelf life, and condom use spread among Allied forces during the Second World War before the AIDS epidemic extended their use worldwide in the 1980s as sex education became more widespread.

Condoms are cheap and easy to get, but they only work when used correctly and consistently every time, and some people are allergic to latex or find sex less pleasurable with them. Vasectomy is more effective but is intended as permanent. That leaves a gap in male birth control: men who want reliable contraception but may want children later have no good option in between.

Vasectomy's own history is stranger than most people expect. It was first performed instead of castration to treat symptoms of benign prostatic hyperplasia. In the 1920s, Eugen Steinach promoted the procedure as an anti-aging treatment, and both Sigmund Freud and the poet W.B. Yeats underwent the so-called Steinach procedure. Governments also used vasectomy as a tool of involuntary sterilization under eugenic programs targeting people deemed undesirable. Voluntary vasectomy is now an established method of family planning, but its permanence makes it a poor fit for younger men.

The hormonal front: gels and pills

Hormonal male birth control has stumbled before. Earlier trials were discontinued because participants experienced side effects they found hard to tolerate, including changes in mood, libido, and lipid metabolism, plus acne and potential concerns about sexual development in adolescents.

The most advanced candidate is a daily gel combining testosterone and nestorone that a man applies himself. In a phase IIb trial completed in 2024, sperm counts fell to 1.0 million per milliliter of semen or less in 82 percent of participants by week 12, a level considered effective for contraception. Phase I trials are also evaluating dimethandrolone undecanoate as a novel hormonal contraceptive.

Non-hormonal bets: pills and reversible blockers

Among non-hormonal approaches to male birth control, the compound drawing the most attention is YCT-529, which targets the retinoic acid receptor. Animal studies reported it to be 99 percent effective and reversible. A phase Ia trial in 16 men found that a single dose was well tolerated, with no measured effects on heart rate, testosterone, luteinizing hormone, follicle-stimulating hormone, mood, or sexual desire, the researchers report. Separate animal studies are exploring on-demand contraceptives that target sperm motility.

Another track works by physically blocking sperm. A phase III clinical trial of RISUG, a vas-occluding injection marketed as reversible inhibition of sperm under guidance, produced azoospermia, the absence of sperm in semen, in roughly 77 to 97 percent of recipients three weeks after the injection. A similar product, Vasalgel, is under development in the United States, while polyurethane and silicone-based compounds have been studied in China, with human evaluation planned. The ADAM hydrogel was assessed in 25 subjects over 90 days with no reported procedural adverse events, and most adverse events were mild and occurred within the first 14 days.

The review's bottom line is that condoms and vasectomy remain the established options while the pipeline fills in the space between them. After a century of standing still, male birth control may finally get the choice that female contraception has had for decades. For more on related topics, see the health news topic page and this report on rising syphilis rates in Australia. The full review is available in the International Journal of Impotence Research.