Thursday briefing: The long, long wait for a male contraceptive pill may soon be over
Good morning. Since the first vasectomy was performed in the 1890s (imagine being that volunteer), the male contraceptive armoury has barely advanced. The last reversible method was added to this repertoire centuries ago: while rubber condoms hit the mass market in the 1850s, earlier versions date back beyond ancient Egypt. This looks on the cusp of change. In a landmark announcement last week, the World Health Organization said it expects reversible male contraceptives to be available on the market within five to 10 years. But no major medical breakthrough has just been announced - the fundamentals of male hormonal contraceptives have been known for decades. So what is the science, how does it work and why has it taken so long to get here? That’s the subject of today’s First Edition. Before that, this morning’s headlines. Five big stories Politics | Senior Downing Street officials have been reaching out to thinktanks and pollsters as they look to test public support for the UK rejoining the EU. Middle East | One of the pilots of a plane flying from the United Arab Emirates to Israel stabbed his co-pilot and appeared to try to crash the aircraft, Israeli prime minister Benjamin Netanyahu has said, as Israeli officials said they were investigating whether the incident was an attempted terror attack on Israelis. UK news | There are “strong indications” that Iran played a role in events in which five men were arrested near RAF Fairford in Gloucestershire as part of a terror investigation, Andy Burnham has said. Immigration and asylum | The UK government’s “one in one out” deal with France, which was supposed to help deter small boat arrivals, is expected to expire on Thursday, as talks stall over French demands for an EU-wide scheme. Television | Esther Rantzen, the Bafta-winning TV presenter and founder of Childline, has died aged 86. In a statement, her family paid tribute to “the most wonderful mother” and “cherished grandmother”. In depth: The ‘agonisingly slow’ wait for male contraceptives
It’s estimated that 70% of women in the UK have used the contraceptive pill at some point in their lives, having first been introduced here in 1961 (for married women only). The pace at which the pill proliferated is remarkable - the first trials of hormonal contraception for women began in the United States in the 1950s: by 1960 it was available, and within two years, 1.2 million American women were using it. Despite the pill’s wide uptake and high efficacy, the need for further effective methods of reversible contraception has remained consistent. Nearly half of all global pregnancies are unintended, with many resulting in unsafe abortions. An array of options have been developed for women to use - coils both hormonal and metal; implants, injections, patches, pills and vaginal rings. Men have condoms, and, well, coitus interruptus. Even with these limited options, about 30% of couples already rely on a male method. Male hormonal contraception targets sperm, which are constantly produced. “This requires continuous, steady suppression, suppression all day, every day,” Richard Anderson tells me, “but it is proven to work”. Anderson is a professor of clinical reproductive science at Edinburgh University, and has spent decades in the field. It’s close to 50 years since the first hormonal contraceptives were tested on men, but their development has since been “agonisingly slow,” says Anderson. It’s not that scientific successes weren’t there. “While there have been refinements focused on optimal drug formulations, the fundamentals have remained the same.” *** How do male hormonal contraceptives work? While some research looks to target either sperm function or transport, most male contraceptive science today focuses on sperm production. A testosterone-based treatment can trick the brain into switching sperm creation off, while ensuring bodily hormones remain at a healthy level. In the late 1980s, proof-of-concept clinical trials were conducted by the WHO with weekly testosterone injections. “In the first trial, over 60% of men achieved a zero sperm count and successfully used it as their sole contraceptive for a year,” says Anderson. He was involved in a subsequent trial of 450 couples which confirmed hormonal suppression is “highly effective” in reducing sperm count. By the 1990s, the science was further fine-tuned. With the addition of progestin (a synthetic hormone also widely used in hormone replacement therapy), these male hormonal contraceptives became far more effective, with a success rate equivalent to female hormonal methods. The quantity of testosterone required also decreased with this new formulation, potentially improving long-term patient safety. More recently, the US National Institutes of Health funded a major international study of a testosterone/progestogen gel, with participants rubbing it into their shoulders daily. Trials have been conducted across North and South America, Africa and Europe (Anderson has overseen Edinburgh’s 40–couple cohort), with “surprisingly effective” early results and an “extremely low” pregnancy rate. The global findings are still being reviewed, but Anderson’s patients recorded zero pregnancies. As with any hormonal interventions, side effects such as mood shifts can occur. But worldwide, in this study “participant dropouts due to side effects were extremely low at only a few per cent,” says Anderson. And in Edinburgh, at least, “participants tolerated it exceptionally well, with female partners often thrilled to take a break from birth control.” Crucially, this suppression of fertility proved reversible. “Across all trial follow-ups (typically after up to 18 months of use), sperm counts returned to normal, and many couples have subsequently conceived healthy children.” *** The unequal burden of contraception In her brilliant (and surprisingly funny) new documentary It’s Different For Girls film-maker Billie J D Porter explores the sluggish evolution of hormonal male contraception. Years of filming confirmed what gut instinct told her on day one: “It boils down to corporate greed and systemic misogyny.” After experiencing a series of severe contraception side effects herself, Porter started questioning why there have never been widely available male equivalents. She looked at how business, medicine and culture approached hormonal contraception over decades. “There is a deep-rooted reluctance to tinker with male bodies,” she says, a concern that’s not afforded to women. The WHO classifies combined oral contraceptives for women as a group 1 carcinogen; during 1970s US congressional hearings on the safety of women’s birth control pills, not a single woman who had taken the pill was invited to testify. Powerful male execs have also long projected their own reluctance to take hormonal contraceptives into the market. Take German pharma giant Bayer: despite having run a trial that had proved to be “efficient, with a tolerable side-effect profile”, the multinational cut all funding to male contraceptive research in the early 2000s, because bosses felt that for men, taking the medication would be “inconvenient”. “The physical trauma, health risks, and burden of contraception have been forced entirely onto women’s bodies, while protecting male bodies from potential discomfort,” says Porter. Plus, the female hormonal contraceptive market is worth billions globally, and forecast to hit nearly $30bn by 2034. Male birth control represents disruption and risk. Major clinical trials have therefore historically been run by public health bodies on tight budgets. *** What could change? There’s a nuanced picture here. Women’s bodily autonomy was - and continues to be - hard fought for across the world. Despite the risks and complications women’s contraceptives can create, an alternative timeline, in which men kept a tight grip of the contraceptive keys, isn’t necessarily an ideal outcome. It’s a question of equity and increasing options for everyone. Social attitudes shifted, even if big pharma didn’t. A recent WHO study found nearly 75% (72.3% male, 76.2% female) of respondents across a diverse range of countries reported willingness to use new male contraceptives, with more than 85% of women saying they would trust their male partners to take responsibility for contraception. “Men today are increasingly open to gender equality and sharing contraceptive responsibility,” Dr James Kiarie, who heads up contraception and fertility care at the WHO, tells me. “Concerns about side effects are the leading reason women discontinue birth control,” he says. “Soon, if one partner experiences side effects, the other will be able to try.” The biggest obstacle remains “limited research financing,” says Kiarie. “We urgently call on funders to invest in this area… it is a gamechanger for public health and human relationships.” This couldn’t come at a more opportune time. Globally, 40% of women live in countries with restrictive abortion laws. After overturning Roe v. Wade in 2022, the US supreme court ended the constitutional protection for abortion, with millions of Americans now unable to access safe and legal abortion services and living in contraceptive deserts. In the US, interest in male contraceptives increased from 39% to 49% after the supreme court’s decision. Still, in the era of antivaxers, peptide-injections and crackpot conspiracy theories emanating from the US’s uppermost political echelons, what effect actual scientific evidence will have on uptake if and when male contraceptives reach the market is another question. “The rise of hyper-masculine ‘red pill’ subcultures obsessed with testosterone and sperm retention” is a real concern in the sector, Porter says. During filming, Porter spent time with couples who’d been on recent trials. “The male contraceptive option transformed their relationships,” she says. “It fostered deep mutual respect, relief, and shared responsibility. It offers men a meaningful way to share a burden that women have historically carried alone under immense social judgment.” What else we’ve been enjoying
After writing about romantasy for First Edition, I’m super-interested in the expectation-busting that goes on within the genre and these thoughtful reflections from men who read about love. Libby In this week’s Long Wave newsletter (sign up here!), Nesrine Malik has written a loving ode to the “long, long diaspora phone call” at once about “nothing and everything”. Charlie Lindlar, newsletters team If you want to understand why Andy Burnham has yet to convince Scottish Labour colleagues that he gets the scale of his challenge north of the border, read Herald deputy political editor Rebecca McCurdy’s excellent analysis (£). Libby England coach Sarina Wiegman dropped heroes Chloe Kelly and Ella Toone from her next World Cup qualifying squad – Tom Garry has an excellent analysis of why it could be a managerial masterstroke for all involved. Charlie I’ve suffered a serious allergy to coorie (Scots: snuggle, nestle, cuddle) culture for a decade now, so I was intrigued by Lucy Knight’s more forgiving take on the interior decor obsession with Highland cows. Libby Sport
Football | The Premier League will face pressure from Manchester City’s rivals to push for a sanction that will result in a prolonged absence from the top flight after the club was found guilty of more than 100 charges of financial rule-breaking. Football | Chelsea claimed a valuable point against OL Lyonnes as they played out a goalless draw in the Women’s Champions League, while Arsenal threw away a two-goal lead to draw 2-2 with Paris FC. Rugby | In a candid and absorbing interview, Irish former professional rugby union player Peter O’Mahony speaks with Donald McRae about allowing his own feelings after excelling in “a game of hard men”. The front pages
The Guardian leads with “Pilot attacker tried to crash plane, says Netanyahu”. The Times splashes with “Passengers storm cockpit to head off Israel’s 9/11”, while the Telegraph goes with the “Hero who stopped Israel’s 9/11”, and The i Paper says “Hero passengers storm cockpit to save Israel flight from disaster”. The Daily Mail runs with “Kemi to stop school leavers going straight on the dole” and the Financial Times has “‘Strong indications’ Iran was involved in Fairford incident, warns Burnham”. In tributes to TV presenter Esther Rantzen, the Mirror leads with “Esther: See you on the other side” and the Sun: “That was a great life, Esther.” The Latest
Mid-air panic as pilot attacked on Israel-bound flight A commercial flight travelling from Dubai to Israel was forced to make an emergency landing after an apparent brawl between its pilots. The flight was in Jordanian airspace when it diverted to Saudi Arabia, after the plane fell 16,000ft in two minutes during the incident, which raised fears of an attempted hijacking. Authorities are investigating a number of lines of inquiry including a hijacking attempt or a mental health incident. Lucy Hough speaks to the Middle East correspondent Will Christou. Cartoon of the day | Ben Jennings
The Upside A bit of good news to remind you that the world’s not all bad
The coastline of Achiltibuie, a string of hamlets and villages in Scotland’s Summer Isles, is dotted with beds of maerl – a 9,000-year-old pink seaweed whose coral-like skeleton provide nurseries for scallops and fish. Ten years ago, this biodiverse habitat was being devastated by scallop dredging, until a group of locals successfully fought to have the practice banned in a 600 sq km (150,000 acre) zone – now the biggest protected area in the world for maerl. They have since seen a dramatic revival of marine life, including the recovery of scallop populations and increased sightings of whales, porpoises and dolphins. Sara Nason, founder of Sea Change (later BHA), one of the groups that led the campaign, says the protection of the maerl beds is “beyond priceless … We’ve achieved recovery of the whole ecosystem.” To read more from Karen on how the battle for the maerl beds was won, sign up for Down to Earth, our climate newsletter, before noon today Sign up here for a weekly roundup of The Upside, sent to you every Sunday Bored at work? And finally, the Guardian’s puzzles are here to keep you entertained throughout the day. Until tomorrow. Quick crossword Cryptic crossword Wordiply
