Babies are a joy – but so is life without them. For those who want to keep their uteruses tenantless for the foreseeable future, there are a plethora of options available.
They can pop a pill, of which there are hundreds of versions, each containing a slightly different balance of synthetic hormones.
They can implant a plastic tube into their arms, clamp anchor-like devices to their cervixes, wear patches, get injections – and so the list goes on.
But, for those at risk of getting someone else pregnant, the options are much more limited: use condoms, get a vasectomy or rely on your partner.
That’s all very well if your partner is happy to take on the responsibility of avoiding pregnancy, but studies indicate that people are becoming increasingly disillusioned with available contraceptive options.
In fact, a 2025 study by the British Medical Journal found that women who don’t want to become pregnant seem to be turning away from pills and other contraceptive devices. Instead, they are relying on cycle tracking apps or just going contraception-free.
And it makes sense. The potential risks and side effects of female contraception are numerous and potentially severe. Depending on the method, they might include mood swings, acne, libido changes, heavy or irregular periods, weight gain – even an increased risk of suicide or stroke.
But, despite the growing unpopularity of female contraception, it remains difficult to pass the contraceptive buck to partners without wombs.
Why are there so few male contraceptives? There’s more than one answer. In part, biology and money are both to blame – but so is a hidden double standard that makes developing male contraception much more difficult.
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Biology makes things complicated
One of the obstacles to developing male contraception is simply a matter of biology. As Prof Richard Anderson, from the University of Edinburgh's Centre for Reproductive Health, explains, it’s easier to prevent someone from getting pregnant than to prevent someone from getting another person pregnant.
“What you’re trying to achieve is very different,” he says. “In women, you’re preventing one cell being released once a month, whereas in men, you’ve got to stop millions of sperm every minute.”
Let’s take a trip back to sex-ed class for a moment. In a female reproductive system, one egg is released per cycle – on average every 28 days – in a process governed by fluctuating hormones.
Dr Channa Jayasena, reproductive endocrinologist at Imperial College London, says: “It’s relatively easy to disrupt the menstrual cycle with hormone exposure, because you just wreck the balance that’s involved in growing eggs and releasing them.”
So, most female contraceptives – such as pills, implants, patches, injections and some coils – introduce extra female sex hormones, namely synthetic versions of progesterone (and sometimes oestrogen) to prevent any eggs from being released at ovulation.
(In the case of the non-hormonal coil, copper is introduced into the uterus to make it hostile to sperm.)
On the flipside, Jayasena explains: “Men are fundamentally different, because they make their gametes all the time, and they make millions of them.
“It takes three months to make sperm, so there’s this constant conveyor belt, and any contraceptive has to inhibit the testes for a very long time.”
That means any male contraceptive would need to be used for three months before reliably preventing pregnancy, otherwise there might still be sperm in the system.
To put that into perspective, female hormonal contraception is usually effective after seven days – or immediately – depending on when in the cycle someone starts to use it.
But that’s not the only reason female contraception is an easier task. Jayasena explains: “It is much easier to suppress female hormones because they’re at much lower quantities – orders of magnitude lower than testosterone.”
So, for male hormonal contraception to work, it has to pump far more hormones into the body compared to female hormonal contraception.
The male sex hormone is testosterone, but that much testosterone can come with health risks. So, to avoid dangerous side effects, male hormonal contraception can’t just rely on extra testosterone.
Instead, it combines testosterone with a female sex hormone, called progesterone. Males do have progesterone in their bodies naturally, but in very small quantities.
And progesterone comes with side effects – but more on that later.
There's no money in male contraceptives
So, sperm may be a more difficult opponent for hormonal contraception than eggs, but it can be defeated by a combination of testosterone and progesterone.
In which case, why isn’t male contraception available yet, when there are hundreds of female pills already on the market?
“The problem is there’s no money in it,” says Jayasena, explaining that the pharmaceutical companies who would usually develop this kind of medical technology “don’t think it’s going to be a lucrative market”.
But, with so many women rejecting their contraceptive options, how can male contraception be so profitless?
For author and women’s health campaigner Kate Muir, speaking on the Instant Genius podcast, the answer is simple: “New research costs billions. Nobody’s going to spend it on men when women are already doing the work.”
In other words, because women are on contraception already, pharmaceutical companies see little point in developing alternatives for men.
Anderson agrees with Muir. He says: “There’s been a perception, going back many decades, that female contraception has got the market sewn up and there’s nothing more to be done.”
Also, Anderson explains that decades of development in female contraception – since they became available in the 1960s – has pushed the public’s expectations higher and higher.
“If you’re developing a new contraceptive, it’s got to be very cheap, because female contraception is generally very cheap,” Anderson says. “It’s got to be 100 per cent perfectly effective, and it’s got to have zero side effects, because that’s what people want for contraception.”
That means developing entirely new forms of contraception requires a lot of money, and is “a risky business,” Anderson says.
And part of the problem, he believes, is that many pharmaceutical companies “are still run by conservative middle-aged men whose bottom line is their financial spreadsheets.”
The double standard of risk and reward
When it comes to developing a male contraceptive, there are biological hurdles and there’s little financial backing – but that’s not all. There may also be a hidden double standard that judges the risks and rewards of male contraception differently to female contraception.
Muir has written about this very issue. She says: “Men are judged by a different set of standards than women in this research, because they don’t have a risk. They are not going to get pregnant.
“So, if there’s a little bit of a side effect – that counts against their perfect health, whereas for us, it counts against a risk of pregnancy.”
As evidence of this, Muir refers to a 2016 trial that was cut short because too many men reported side effects.
In this study, 350 men were injected – once every two months – with a combination of hormones: testosterone and a form of progesterone called norethisterone enanthate, which worked together to switch off sperm production.
The injection was found to be 96 per cent effective. That means it was almost as reliable as the female pill and far more reliable than condoms (with typical use).
Three quarters of participants said they would be willing to continue using the jab, but there were nearly 1,500 complaints about side effects (that’s more than four complaints for every person involved in the study) and 20 men dropped out.
The most commonly reported adverse events were acne, changes to libido and low mood – all of which are already accepted side effects of female hormonal contraception.
Anderson, who was a co-author on the study, isn’t convinced by Muir’s belief that there’s a double standard going on.
“People say that, but frankly, it’s b******t,” he says. “It’s used as a way of saying ‘men just don’t man up to these side effects.’ There’s no objective evidence that there’s a different standard applied.”
In the case of this specific trial, Anderson explains: “It had nearly finished anyway, but there were reports of a lot of mood disturbances in men. And it was decided that it probably wasn’t worth carrying on.
“If you’re developing a medicine, you want it to have as minimal side effects as possible.”
However, Anderson does admit that, historically, male and female contraception has been judged differently.
“That’s perhaps been the slightly simplistic way of looking at these things,” he says. “Pregnancy is always dangerous, and a female contraceptive has to be pretty bloody awful to be riskier than that. But that isn’t how most people think.”
But Jayasena is more willing to agree with Muir’s view, that the risks and benefits of contraception are judged differently for men and women.
Researchers may not accept so many side effects in male contraception, he explains, because “men feel they may not directly benefit from the treatment,” since they’re not personally at risk of pregnancy.
And, adds Jayasena, the hormones used in contraception complicate things further, because of the hormones that men and women expect to have in their bodies.
“Fundamentally, men have the same level of hormones all the time, bar some daily variations,” he says, explaining that testosterone levels are highest in the morning.
In contrast, says Jayasena: “Women have a fundamentally cyclical relationship with their hormone environment and, particularly in the premenstrual phase, they will have different symptoms.”
That means women expect – and are expected – to cope with changing hormones and side effects associated with that, whereas, for men, Jayasena says this is “an alien concept”.
In other words, menstruating people already deal with the side effects of progesterone on a monthly basis, so introducing some in the form of contraception may not be so objectionable, compared to men, who are accustomed to relatively stable hormones.
But Anderson says that contraception is increasingly considered a joint endeavour, with risks and benefits shared between a couple.
“It’s a sum of positives and negatives for both partners,” he explains. “One of the positives for male contraception is not just avoidance of pregnancy, it’s the avoidance of the side effects of their partner taking female hormonal contraception.”
Male contraceptives on the (distant) horizon
All these obstacles may have slowed down the development of male contraception, but they haven’t stopped it in its tracks. Now, there are a plethora of potential male contraceptives on the horizon.
One of these is a shoulder gel, containing testosterone and progesterone, called Nestorone/Testosterone Transdermal Gel (NES/T).
The gel is rubbed on the shoulders every day and, after three months, it lowers sperm count to almost zero.
More than 750 men have tried it out in clinical trials, and so far, so good. In fact, Dr Regine Sitruk-Ware, a reproductive endocrinologist at the Population Council and co-director of one of the trials, said in a 2024 statement that the acceptability of NES/T was “very high”.
“Men in the trial were asking when the method will be available or whether they could re-enrol in the study to continue using the gel,” she said. “Their female partners indicated that this method was much better than the female oral contraceptive pill.”
NES/T is owned by a relatively small company called Contraline – which is also developing a long-lasting non-hormonal contraceptive, a bit like the male equivalent of the female copper coil.
This product is called ADAM, and Contraline’s website describes it as “the first major development in male contraception since the vasectomy”.
Rather than pumping hormones into the body to prevent sperm from being created, ADAM works by blocking sperm from making it out into the outside world.
When sperm is ready to leave the body, it travels out of the testes to the urethra via a tube called the vas deferens.
But if ADAM is injected into this tube – a procedure that takes less than 30 minutes, under local anaesthesia – it blocks sperm in its tracks, while allowing liquid to pass through.
This contraceptive doesn’t come with hormonal side effects, nor does it affect how anything feels ‘down there’, and it can be easily dissolved with another injection when it’s no longer wanted.
There’s even a non-hormonal male pill in very early stages of development. This drug uses a chemical called YCT-529 to target a chemical called retinoic acid in the testes, to block sperm production. It’s only been tested for safety among 16 men for 15 days, but further trials are on their way.
Yet, despite all these possible avenues, Anderson and Jayasena aren’t hopeful that a male contraceptive will appear on the market any time soon.
“It’s been a long saga, and remains a somewhat distant prospect, to be honest,” says Anderson.
Jayasena says the situation is promising, but that, realistically, he doesn’t expect any of these new contraceptives to be available within the next few years.
“There’s a real prospect of having new, genuinely practical, safe and reversible options – within the next 10 years,” says Jayasena. Without the money from big pharmaceutical companies backing these developments, he believes this will be a slow process.
But Anderson says this is something people want, “women as well as men”.
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