Why the male pill won’t replace the female pill

A picture of a blue packet with yellow pills arranged in an elongated oval shape, with a tri-fold insert with patient information on it.
Oral contraceptive pill with insert, 1970s

Earlier today I saw a tweet by one Mohamad Safa, a diplomat at the United Nations (he does not say from which country) and CEO of “Patriotic Vision”, about birth control and whose responsibility it is:

This looks like impeccable logic, on the face of it. But if you look at it any closer, it is revealed to be rather silly. It resembles a child whinging that something is not fair when it is just a fact of life.

First, the reason the female birth control pill has been in widespread use since the mid-20th century is simply that it was easy enough to develop as it harnessed an already known biological process by developing synthetic analogues to existing female hormones (or in some cases, used animal derived hormones). That fact removed an awful lot of the research and development. This also means that many female pill preparations have been out of patent for decades and available cheaply as generics, while any new male pill, unless funded philanthropically or by the state, will be expensive as it will be under patent. This is because it is a novel chemical which induces the body to do something it would not normally do, as it has no need to do so, namely to cease sperm production. They do not only have to synthesise the chemical but to actually invent it. Scientists have also been trying to find a medication that could suppress erections, mostly so as to avoid pain after surgery on the penis, and have never been able to find one; a anti-fungal agent which showed some promise a few years ago was found to have no more than placebo effect.

You sometimes hear women complain that the male pill that was developed never made it to market because the men that the drug was tested on found the side effects intolerable; this is followed by a list of the side effects the female pill has, or the difficulties of pregnancy itself. The answer is that these effects happen to some women and not others, while the side effects of the male pill were reliably found before the drug hit the market. This may well have been a sign that if the men continued taking said pill, it could have had lasting health complications. In any case, it’s not ethical to release a medication that makes people ill while having no benefit for the person taking it. It’s true that the female contraceptive pill can have devastating complications, such as strokes, but it’s also true that many women take it for years with no such ill effects. Clearly, the benefits outweigh the risks although it is important that women who are particularly prone to such ill-effects are identified and not prescribed it. It helps that there are multiple preparations based on different types of hormones.

Another problem with any male pill is that it only protects women that man might have sex with, and only if he is diligent in taking it. If a woman changes partners, she would have to persuade each new partner to take it, and if she decided to have sex with someone other than her partner, she would not be protected unless he was taking the pill; similarly if she is raped. This means that in a country where stranger rape is a major problem (as it has been in South Africa, for example), the male pill would not be a serious option except where there is a strong counter-indication for the female pill, and even then it would be a very poor second choice. Some women also take the pill to regulate (or, increasingly, to eliminate) menstrual periods. The husband taking a pill will have no more effect on this than the next door neighbour’s tablets for whatever medical condition they may have.

There would, obviously, be benefits to a male pill. These include for couples where the wife or girlfriend cannot tolerate synthetic female hormones and for religious couples who will not countenance a contraceptive pill they regard as an abortifacient because it prevents a fertilised egg from implanting itself rather than preventing contraception in the first place (many Catholics and some Muslims fall into this category). There are other categories of men who are “sowing their wild oats” or otherwise are promiscuous, but this again requires a pill with minimal adverse effects for them to continue taking it unless forced to. It’s clearly beneficial for any couple to have a choice about who is medicated and who takes what risk.

However, there seems to be an assumption that the reason the male pill has never made it to market and “all the burden falls on women” is because science is male-dominated and “the patriarchy” does not want to reduce men’s potency. This is a ludicrous assumption; vasectomies have been available for years and the usual takers are middle-aged married men who do not intend to have more children, and pharmaceutical companies want to make money and have developed medications which have all sorts of unpleasant side effects for both men and women (cancer and mental health drugs spring to mind — in the latter case, the effects are so awful that many people will not take them unless forced). The reasons are more mundane: that the female pill was easier to develop and cheap and the attempts to develop a male equivalent have failed, and even if they succeeded, they would not perform all the functions of the female pill. Finally, the obvious reason why the female pill will never be replaced by a male equivalent is that if you want to induce or prevent a given thing to happen in a given person’s body, the first (and usually only) option is always to treat that body, not someone else’s. If a woman wishes not to become pregnant, her first choice will always be to take medication herself, not rely on another. This is why, even if the side effects are overcome, the male pill will remain a niche product and this may well be a disincentive to continue investing in it.

Image source: US Food and Drug Administration via Wikipedia.

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