Alternative to the condom?: So men will definitely not use contraception soon

The Germans prevent pregnancies most frequently with the pill.

Alternative to the condom?: So men will definitely not use contraception soon

The Germans prevent pregnancies most frequently with the pill. Hormone therapy for men was long considered taboo, but interest in new contraceptives for men is growing. Work is being done on vas deferens plugs, testicle baths and testosterone gels. Not all methods are equally promising.

Contraception in permanent heterosexual partnerships is still often a woman's job. You can choose between different spirals, the pill and apps to determine the fertile days. There is hardly any alternative to the condom for men. The most used is vasectomy - the cutting of the vas deferens. In theory, this can be reversed, but fertility is not restored in all cases. That is why scientists have been researching temporary contraceptive methods for some time.

Michael Zitzmann is Senior Physician at the University Hospital in Münster. He specializes in internal medicine, hormone medicine and men's medicine and is involved in international research projects. He knows what ideas there are for new contraceptives for men. For example, a gel that is used to block the vas deferens and that is suctioned out again if necessary. "The problem is: as soon as you injure a vas deferens, the sperm are exposed to the immune system," Zitzmann told A shell of antibodies can then form around the majority of the sperm, which makes it more difficult for them to penetrate the egg cell and thus prevent a possible pregnancy. Any direct intervention on the vas deferens therefore reduces the chance of regaining full fertility.

Zitzmann also sees this danger in the so-called vas deferens valve, which a carpenter living in Switzerland developed. According to developer Clemens Bimek's website, the closed valve cuts off the supply of sperm, so the semen remains sterile. With a toggle switch, the wearer can open the valve if necessary and be fertile again. Zitzmann criticizes that there are no studies that prove that the sperm are fully functional after the valve has opened. So far, only the developer himself has carried the valve. So far, Bimek has only been able to collect one percent of the one million euros for a first clinical study.

The testicles are located outside the body in the scrotum because that's where the optimal temperature for sperm production is - about two to four degrees below the general body temperature. If the testicles become too warm, the quality and number of sperm can decrease. So-called thermal briefs and ultrasonic baths for the testicles make use of this principle.

The thermal briefs are a type of underpants with a ring or hole in the front. Wearers can pull the penis and scrotum through this opening. The testicles themselves remain behind the hole and thus lie close to the body in the groin area, where they warm up. According to the expert, one of Zitzmann's patients also reported on his successful contraception with thermal slip. However, there is a lack of studies comparing fertility before and after use, says Zitzmann. "Also, we don't know how the whole thing recovers when you stop using it. So it's a nice idea, but you can't rely on it ."

An industrial designer from Munich, Rebecca Weiss, has designed a kind of mini bathtub into which you can sink your testicles. At the push of a button, an ultrasound turns on, which is supposed to make the sperm unproductive through deep heat. Together with other experts, Weiss supports the hypothesis that men can use contraception in a reversible manner. That means: Without a bath, fertility comes back. The inventor still collects money for human studies. Senior physician Zitzmann estimates that "perhaps 10 to 20 percent of the men then have no more sperm and others few." But even a few sperm would be enough for a pregnancy. "It's not a safe option, I can already say that."

What about a pill for men? Zitzmann considers this an unrealistic solution, because the body would break down the supplied hormones too quickly in the liver. But you can inject testosterone or apply it as a gel. Because too much testosterone can be bad for the sperm. This is what hormonal contraceptives for men build on. If testosterone and progestin are supplied to the body from outside, the body's own production of hormones stops. "The control center in the brain then thinks: The hormones are already there," explains Zitzmann. If the testicles are not instructed by the brain to produce their own testosterone, no sperm will be produced either. This temporary infertility could be reversed.

From 2007, the Tübingen doctor co-led an international study for the World Health Organization with a contraceptive injection. Men who wanted contraception received it every eight weeks. However, 10 to 15 percent of the participants sometimes complained about mood swings, weight gain and reduced desire for sex. Therefore the study was terminated. Zitzmann is annoyed about this: "We're talking about side effects like with the contraceptive pill for women. But here the World Health Organization said: That's too much for us. I think that there is a very different perception of what side effects we men and trust women". The contraceptive effect, on the other hand, is even better than that of the pill for women. However, research on the syringe was discontinued and approval was not pursued any further.

According to Zitzmann, the most promising is currently a testosterone gel that men would have to apply to the upper arm every day. He expects the first study results from the USA in about three years. According to Zitzmann, research on contraceptives for men is generally too slow. "The pharmaceutical companies that started the first experiments 15 years ago were bought up and disappeared. At a congress this year I realized that there was a new attempt." Zitzmann sees opportunities for couples who want children. "New methods not only benefit men alone, but women and couples. They give them the opportunity to decide together how to prevent."

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