A decade after celebrating their control over contraception with the invention of the pill, women were informed of the health risks, and began to feel that they were the ones being controlled. Though more than three million women currently take the pill in the UK, with each new health scare the search for a viable alternative intensifies. One potential solution is the so-called male pill. Scientists have been messing with men's hormones for more than 10 years in their quest, and now, with the backing of drug companies, a male contraceptive is promised within three to five years. But do we really want it?
The latest trial of the male contraceptive has just been announced by the Royal Free hospital in London and the Manchester Royal Infirmary. It does not involve pills at all, but an implant of progestin - changed once a year - under the skin of the upper arm which drips the hormone into the bloodstream. It works by switching off the production of hormones in the pituitary gland responsible for stimulating the production of sperm.
"Switching off" sounds a neat and tidy little operation, but is it so simple? Researchers maintain it is. Progestin is a male version of progesterone, and is, says Dr Pierre-Marc Bouloux, one of those coordinating research at the Royal Free, 97% effective in suppressing sperm production, making it as safe as the female pill. It takes two months to become effective, and sperm production returns to normal 10 weeks after the implant is removed. Bouloux maintains that the process is "virtually free of side-effects".
"It knocks the sperm count down to less than a million - compared with normal levels of between 20 and 300 million," he says. "During that time you would expect the person to be infertile, which studies show you can achieve safely. Then, when you stop treatment, the man returns to normal fertility within two to three months."
Unfortunately, the hormones which trigger sperm production are also responsible for producing testosterone, without which men are liable to feel weary, moody, and get fat. "You get complaints of weak muscles, weight gain, feeling tired and irritable," says Bouloux. "The best way to put back testosterone is by injection every three months in the buttocks - we can teach people to do it themselves. Testosterone injections used to produce see-saw effects and mood changes - first you'd get a sexual high, moodiness, then depression two weeks later. We have put a huge effort into finding the correct formula to produce the right effect."
Testosterone supplements were until recently only used by body-builders, or by men suffering from hypogonadism, but boosting testosterone levels - and with them energy, physique and libido - has become big business in the US, with a new gel surpassing Viagra in popular demand. (Taking testosterone orally can cause liver damage.) The hormone is now marketed as a cure for the so-called male menopause.
A male contraceptive that also improves sex drive, cures depression and fights fatigue seems eminently desirable. But is it safe? Hormone therapy is always controversial - particularly since recent research revealed that HRT can be associated with increased risk of breast cancer and strokes. Dr Richard Anderson, who is involved with trials at Edinburgh University's human reproductive sciences unit, maintains the effects of the progestin implants in men are fully reversible, with "no significant side-effects".
Testosterone, on the other hand, carries its own health warning: it is linked to prostate cancer and has been described as "fuelling" the disease, which is why sufferers used to be castrated (solving their contraception problems at a stroke). It is also associated with raised red blood cell count, increasing the risk of blood clots.
The Edinburgh trials involve a synthetic testosterone, which, it is hoped, will not stimulate the prostate. Anderson claims overproduction of red blood cells is related to too much testosterone, which may be balanced by an even supply. Other side-effects are the development of breasts, and shrinking of the testes - neither of which could be deemed desirable for a man hoping to have sex, which, after all, is the point of all this. Anderson agrees that the testes will get marginally smaller, but not noticeably so, and claims you would not see the development of breasts in men with normally consistent levels of the hormone.
Still, the doubters and dissenters will not go away. David Neal, professor of surgical oncology at Cambridge University and urologist at Addenbrooke's Hospital, says: "A quarter of men aged between 50 and 60 at autopsy are found to have a small, insignificant prostate cancer. The question is, what makes the switch between a small, insignificant prostate cancer and one that can kill you? Factors such as diet and environment come into play, but levels of testosterone could be influential."
The long-term risks of giving men progestin cannot be dismissed, according to John Stud, professor of gynaecology at Chelsea and Westminster Hospital. "It can cause testicular atrophy and low sperm count, a combination of testosterone and progestin could cause weight gain, acne, sleep apnoea and increased red blood cells. I don't believe there are no health risks at all. The people in Edinburgh, who are good scientists, have been working on this for over 10 years, and they have yet to come up with a solution."
Even more significant than the health risks, says Stud, are the social disadvantages of the male pill. "There's an inherent problem in male contraception: a 20-year-old woman would never trust a man to take it in a million years, and she'd be a fool if she did."
Once the drug companies have got the male contraceptive right, will men take it?
Anderson says that trials have been greeted with enthusiasm, especially among those in their late 30s who have had problems with other types of contraception: "The market will be people in longer-term relationships, who are spacing out their children, or don't want any more, but want an alternative to a vasectomy."
The Edinburgh team conducted a survey of 1,500 unselected women, and only 2% said they would not trust a man to take the pill.
Steven Driver, 33, has just started his fifth trial: a couple of rods are snugly implanted under the skin of his upper arm. Did he worry about losing his virility as his sperm count dwindled? "Not in the slightest. The first time, it was a relief when the trial was over and my sperm count was back to normal, I have to admit. But now I know it will be fine. One of the trials involved taking a pill every day, and I was a bit apprehensive that I wouldn't remember, but it was fine, you just get used to taking it every morning when you brush your teeth."
Bouloux expresses the view of many when he says: "You can't expect a man to take a pill every day, men are going to be bloody hopeless at it. You have to trust people to take these things every day."
"I am sick of this outdated sexist dogma," says Marcus, 43 and father of three. "No one ever points to the men whose lives have been ruined because they trusted a woman to take the pill."
The male contraceptive would not directly increase men's sexual freedom, because women on a one-night stand would never rely on that. But it could protect those such as Marcus from unwilling fatherhood, which would mean they were available for sex with new partners. "It would definitely increase shagging," he says cheerfully.
This might be a marketing line the drug companies will want to pursue.
"You have to look at the way commodities are marketed to us," says feminist writer Lynne Segal. "How would you market this? 'You won't lose your potency if you take this pill.' If you could prove that it reduced sperm count and increased potency, men would take it like a shot. But I don't think it will ever take off at all. Men's potency is all about having all this sperm, that you could go about inseminating hundreds of women."
Segal is ambivalent about the benefits of the female pill - applauding women's freedom to make sexual choices, but decrying the health risks that were glossed over in the way it was sold to us. "The marketing of the pill for women was tied into that moment in the 60s when women's sexuality outside marriage had become acceptable. You would not have got the ideology of the 60s without the pill. Then there was a shift as feminists exposed the double standards and hypocrisy: once women could control their own reproduction, they asked, why should they be controlled and conquered by sex?"
Instead of a shared responsibility, could the male pill become part of a process of sexual subjugation? Certainly, as any ill-effects on men's health became evident, men might feel less in control. In marketing terms, feeding men the idea of an optimum, regulated level of testosterone could be very powerful. But first, the drug companies will have to overcome deep-rooted fears.
"Messing with your hormones: there's a profound anxiety about that," says Oliver, a 44-year-old father of two. "Nor would I want to take testosterone: it would be like uppers and downers - 'This male pill will diminish your masculinity so we'll artificially pump it up afterwards.' I wouldn't take the male pill because of fears about chemical castration."
· Volunteers in the Edinburgh area who would like to take part in a trial can contact Dr Melanie Walton on 0131 242 6361. If you feel strongly about this issue, contact us at women@theguardian.com.
