The debut of the female birth control pill in 1960 was revolutionary. The combination of progesterone and estrogen allowed women to control their reproductive lives much more easily and effectively. But the pill had many unpleasant and even dangerous side effects. In fact, some doctors argue that it wouldn’t win government approval today. So why haven’t scientists tried to create a birth control pill for men? It turns out they have. In the 1950s scientists created a really good one. But it had one problem—you can’t drink alcohol when you take it.
As we now know, the science behind WIN-18446 was pretty straightforward. Inside our bodies, we all have an enzyme called ALDH. ALDH takes the vitamin A in food and converts it into a related compound called retinoic acid.
In men, retinoic acid helps sperm cells form. Specifically, it takes immature, preliminary sperm cells in the testes and helps them grow and change into mature sperm cells that can fertilize an egg. Without retinoic acid, mature sperm cells simply won’t form.
Overall, it really seemed as simple as that. On WIN-18446, men were shooting blanks. Off it, they were normal. It was a completely effective, completely benign, completely reversible male contraceptive.
Of course, things are never so simple.
Well, it turns out that our bodies have several different kinds of ALDH, each with a slightly different architecture. As we’ve heard, one form of ALDH is active in the testes and helps produce sperm. But another form is active in the liver, and this version of ALDH interacts with booze.
Unfortunately, the WIN-18446 drug gums up both versions of the ALDH enzyme—both the version that helps sperm production and the version that helps metabolize booze. As a result, if you take WIN-18446 and then drink alcohol, toxic acetaldehyde will start to accumulate in your body.
In fact, some modern forms of alcohol-abuse treatment involve giving people a drug that has the same effect as WIN-18446, in gumming up the ALDH enzyme. People who drink after taking it feel so sick that booze loses all appeal.
Now you might be asking yourself, what’s the big deal? Why can’t men still take WIN-18446 and just promise to lay off the sauce?
Well, as one cynic put it, If people couldn’t drink, then they wouldn’t need contraceptives. But the real answer is that male contraceptives are somewhat unusual in medicine. And to understand why they’re unusual, it helps to compare them to female contraceptives.
Through the 1950s, men generally took responsibility for contraceptives, usually condoms. But the debut of the female pill in 1960 changed everything. Since that time, the responsibility for contraceptives has shifted onto women, and many feminist critics have complained, not unfairly, about this burden.
It’s especially burdensome because many female contraceptives have unpleasant side effects. High blood pressure, mood swings, vaginal bleeding, even strokes. Some doctors, in fact, have argued that if the first female pill from 1960 was introduced today, it would never win government approval. The side effects were that harsh.
So why does the government approve these contraceptives, despite the side effects and potential health risks? Well, because the alternative is pregnancy—and pregnancy itself is a health risk.
For men, the calculus is different. Men don’t get pregnant, and therefore don’t suffer the health complications of pregnancy. So according to the cost-benefit analysis, male contraceptives aren’t really allowed to have side effects. Even a tiny increased risk of, say, blood clots or strokes will doom a male contraceptive—as did the harsh, potentially fatal interaction with booze.
Now, that double standard might or might not sound reasonable to you, but that’s the reality. Male contraceptives cannot have side effects.
Source: Why Don’t We Have a Male Birth Control Pill Yet? | Science History Institute