Birth Control Options for Men
Birth control is often up to the female partner in a relationship. But, there are several safe and effective birth control options available just for men. The most common types of male birth control are condoms, vasectomy, and withdrawal (pulling out). Newer methods, including hormonal birth control and sterilization devices for men, have been studied for many years and some are in U.S. clinical trials.
Condoms are one of the most common forms of birth control. Sometimes called a “rubber,” a condom is a thin, plastic or latex covering that fits snugly over your penis. It prevents pregnancy by physically blocking semen from getting into the vagina where it can fertilize an egg. Condoms can be up to 98% effective at preventing pregnancy when you use them correctly every time you have sex.
In addition to preventing pregnancy, condoms are the only form of birth control that can protect against sexually transmitted diseases (STDs). Condoms work for vaginal, anal and oral sex.
In addition to preventing pregnancy and STDs, there are other benefits to using condoms:
- Condoms are easy to get—you can purchase them at grocery stores, drugstores, vending machines, and health clinics.
- Condoms are inexpensive—they cost about a dollar each and are sometimes free at health clinics.
- Condoms don't affect overall fertility—a woman can get pregnant when not using a condom, assuming she isn't using any other type of birth control.
However, not everyone likes using condoms because:
- Condoms can reduce spontaneity—you have to stop and put it on before you have sex.
- Condoms may decrease sexual sensations.
- Condoms can only be used with water-based lubricants.
- Condoms can tear—never open a condom package with your teeth!
- Condoms may not work if you don’t put them on correctly.
A vasectomy is a permanent and effective (99%) way to prevent pregnancy. It is a surgical procedure in which a surgeon cuts the tube that carries sperm from your testicle to your penis.
You will still produce sperm after you have a vasectomy. But it cannot move out of your testicles and through your penis during ejaculation. There is no measurable decrease in the amount of seminal fluid released during male orgasm; there is just no sperm. Family practitioners or a urologist may perform a vasectomy. Urologists are doctors who specialize in treating the genitourinary tract, which includes the genitals. The procedure costs $350-$1,000; most insurance companies cover the cost of vasectomy.
Vasectomy is permanent birth control. A vasectomy frees both partners from having to worry about other birth control methods. While it may be possible to reverse a vasectomy, vasectomy reversal procedures can be costly and complicated. Many times they don't work. Only have a vasectomy if you’re positively sure you don’t want to have future biological children.
Vasectomy side effects are usually minor but may include:
- Granuloma, which is a benign lump at the surgery site
- Swelling and infection
- Post-vasectomy pain syndrome, which is chronic pain for longer than three months after a vasectomy; this occurs in 1 to 2% of vasectomies.
Vasectomy does not provide protection against sexually transmitted diseases (STDs). Use a condom every time you have sex to prevent STDs.
Withdrawal, sometimes called “pulling out” or “coitus interruptus," is when a man removes his penis from his partner’s vagina right before he ejaculates. Withdrawal is 82% to 96% effective at preventing pregnancy. Effectiveness depends on your ability to withdraw before releasing any semen in or near the vagina. Withdrawal requires a fair amount of self-control and affects the intimacy of vaginal sex.
Withdrawal can be a good birth control option to use when you combine it with other birth control methods, such as a cervical cap, sponge, or natural family planning (rhythm method). Talk to your healthcare provider to learn about your birth control options. Together you can decide the right birth control option.
Females have used hormone-based birth control since the 1960s. Hormonal birth control for women is progestin only or progestin combined with estrogen. Studies and clinical trials of hormone-based birth control for men use the androgen (“sex hormone”), testosterone, either alone or combined with a progestin.
Clinical trials show male hormonal birth control shots work as well as female hormone-based birth control. Male hormonal birth control is also reversible. However, testosterone-only shots produce negative side effects, including acne, weight gain, and changes in cholesterol.
The addition of progestin lowers the amount of testosterone necessary to be effective. Still, a 2016 trial of testosterone plus a progestin was stopped early because many of the participants experienced side effects, including mild, but sometimes severe mood swings. Further studies are necessary to understand the connection between testosterone and mental health, as well as the long-term health effects of testosterone.
Other testosterone-only and combination regimens are in clinical trials, including skin patches, gels and creams and intramuscular injections. Researchers are also testing modified testosterones in pill form, such as 11-beta-MNTDC. Trials are in the early stages, but the results are promising so far.
To date, there is no FDA-approved hormonal birth control for men in the United States.
Vaso-occlusive birth control blocks (occludes) sperm movement through the vas deferens, the tubes that carry sperm to the urethra in the penis. The two forms of vaso-occlusive birth control are RISUG and Vasalgel. RISUG is being studied in humans, but Vasalgel has not yet reached that stage.
RISUG: Reversible Inhibition of Sperm Under Guidance
Doctors in India have been working more than 40 years on RISUG as a long-term contraceptive; it is currently in phase III clinical trials in India. It does not rely on hormones, it lasts many years and, as the name implies, it is reversible (as shown in animal studies). The procedure involves injecting a polymer gel, styrene-maleic anhydride (SMA), behind the penis into each vas deferens. SMA blocks sperm from moving into the urethra and out of the penis during ejaculation. Injecting another chemical dissolves the gel. One way to think of it is as a nonsurgical, but easily reversible vasectomy.
Published results of RISUG clinical trials involved 139 men. There were no severe side effects, but it took 1 to 6 months to stop releasing sperm, and it wasn’t as effective as other forms of birth control (such as vasectomy or hormone-based birth control for females). The study authors also did not test SMA reversal on the male subjects. Results from the larger phase III trial will help determine RISUG’s future as an effective and reversible form of birth control for men.
The procedure is the same as RISUG, but instead of SMA, Vasalgel uses SMA acid, which is easier to make. Early studies in rabbits show Vasalgel stops sperm progression. In monkeys, Vasalgel prevented pregnancy for two years. Reversing the effects of SMA acid in rabbits restored sperm counts, but there were some sperm abnormalities.
In either case, it may be up to 10 years before a vaso-occlusive form of birth control is available in the United States.