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Still no pill for men? Double standards & demarcating values in biomedical research
Abstract
Full text: https://authors.elsevier.com/a/1eC3z8yuQtYUI
Double standards are widespread throughout biomedicine, especially in research on reproductive health. One of the clearest cases of double standards involves the feminine gendering of reproductive responsibility for contraception and the continued lack of highly effective, reversible methods for cisgender men. While the biomedical establishment accepts diversity and inclusion as important social values for clinical trials, their continued use of inequitable standards undermines their ability to challenge unfair social hierarchies by developing male contraception. Thus, the gender/sex bias present in contraceptive research raises the “New Demarcation Problem”: If we accept that values can and will play important roles in science, how can we nevertheless distinguish positive influences of values from more corrosive bias? I argue that biomedical researchers ought to aim their clinical trials at equity and utilize methodologies that actually achieve that aim. More specifically, I contend that we can avoid the problem of double standards by gender/sex in contraceptive research by utilizing more equitable standards. My demarcation strategy captures dynamic interplay between values and their effects, with direct policy implications for institutions conducting, funding, and evaluating clinical trials. For male contraceptive trials, this involves shifting risk assessment from an individual model to a shared model for sexual partners.
Feminist scholars have identified pervasive gender discrimination in science as an institution, as well as gender bias in the very content of many scientific theories. An ameliorative project at heart, feminist philosophy of science has inquired into the social and epistemological roots and consequences of these problems and into their potential solutions. Most feminist philosophers agree on a need for diversity in scientific communities to counter the detrimental effects of gender bias. Diversity could thus serve as a unifying concept for a potential consensus of the field. Yet there are substantial differences in the kinds and roles of diversity envisaged. This element argues that we need diversity, both in terms of social locations and of values, to overcome former biases and blind spots. Diversity as such, however, is insufficient. To reap its epistemic benefits, diversity also needs to be institutionalised in a way that counters various forms of epistemic injustice.
Die ‚Pille für den Mann' wird seit mehreren Jahrzehnten als verheißungsvolle Perspektive anvisiert, die zu einer gleichberechtigten Verhütungspraxis beitragen könne. Trotz einem damit verbundenen Potenzial, geschlechterideologische Annahmen einer scheinbar natürlich gewordenen reproduktiven Verantwortungsübernahme zu transformieren, scheint ein Konzept von geschlechtsbezogener Natürlichkeit im Bereich der Reproduktionspraxis noch immer hegemonial zu sein. Dieser Artikel macht auf Begründungszusammenhänge jener reproduktiven Verantwortungsübernahme als vergeschlechtlichte aufmerksam. Die vorsorgliche Tätigkeit des Pillenehmens begreifen wir als Sorgearbeit. Entlang eines technofeministischen Ansatzes (Haraway) sowie eines philosophisch-anthropologischen Konzeptes von natürlicher Künstlichkeit (Plessner) diskutieren wir, ob die Pille für den Mann als eine feministische Technologie zu betrachten ist.
To clarify the proper role of values in science, focusing on controversial expert responses to Covid-19, this article examines the status of (in)convenient hypotheses. Polarizing cases like health experts downplaying mask efficacy to save resources for healthcare workers, or scientists dismissing “accidental lab leak” hypotheses in view of potential xenophobia, plausibly involve modifying evidential standards for (in)convenient claims. Societies could accept that scientists handle (in)convenient claims just like nonscientists, and give experts less political power. Or societies could hold scientists to a higher bar, by expecting them not to modify evidential standards to avoid costs only incidentally tied to error.
In this paper, I argue that men should take primary responsibility for protecting against pregnancy. Male long-acting reversible contraceptives are currently in development, and, once approved, should be used as the standard method for avoiding pregnancy. Since women assume the risk of pregnancy when they engage in penis-in-vagina sex, men should do their utmost to ensure that their ejaculations are responsible, otherwise women shoulder a double burden of pregnancy risk plus contraceptive responsibility. Changing the expectations regarding responsibility for contraception would render penis-in-vagina sex more equitable, and could lead to a shift in the discourse around abortion access. I describe the sex asymmetries of contraceptive responsibility and of pregnancy-related risk, and offer arguments in favour of men taking primary responsibility for contraception. My arguments centre on: (1) analogies between contraception and vaccination, and unwanted pregnancy and disease; (2) a veil-of-ignorance approach, in which I contend that if a person were not told their sex, they would find a society in which men were expected to acquire and use effective contraceptives the fairest arrangement for everyone.
Even after decades of research men still lack reliable and reversible contraceptive methods comparable to female methods of contraception. Traditional methods of male contraception present a high failure rate and also involve high risk both when used for contraception and for protection against sexually transmitted diseases. Various chemical, hormonal, immunological, vas based and herbal methods of contraception have been examined by scientists world over during the past four decades. Among the possible lead approaches, exogenous hormonal contraception, either alone or in combination with progesterone or antiandrogen, is being viewed at low profile because of their insufficiency in inducing uniform suppression of spermatogenesis and steroid related long term complications. As an alternative to vasectomy, among various intravasal devices being examined, RISUG® (Reversible Inhibition of Sperm Under Guidance), a co-polymer of styrene and maleic anhydride offers long term contraception with safety, efficacy and it can be delivered by no-scalpel injection. Thus it is the only male contraceptive procedure currently under Phase- III Clinical Trial. The non-invasive reversal technique, successfully demonstrated in langur monkeys and functional reversal achieved with dimethyl sulphoxide (DMSO) and sodium bicarbonate (NaHCO3) in rats and rabbits with safety at F1 generation (first filial generation) have projected RISUG® as a better alternative to vasectomy. In this narrative review we revisit the long journey of RISUG® beginning with formulation on a bench towards reaching the market as a safe and effective contraceptive method, discussing various milestones and roadblocks of this expedition awaiting the mandatory regulatory clearance from the Government of India. Successful completion of ongoing phase III clinical trials with demonstration of reversal in human volunteers will give an indigenously developed male contraceptive to the world.
© The Author(s). 2020.
There is an urgent need to develop new methods for male contraception, however a major barrier to drug discovery has been the lack of validated targets and the absence of an effective high-throughput phenotypic screening system. To address this deficit, we developed a fully-automated robotic screening platform that provided quantitative evaluation of compound activity against two key attributes of human sperm function: motility and acrosome reaction. In order to accelerate contraceptive development, we screened the comprehensive collection of 12,000 molecules that make up the ReFRAME repurposing library, comprising nearly all the small molecules that have been approved or have undergone clinical development, or have significant preclinical profiling. We identified several compounds that potently inhibit motility representing either novel drug candidates or routes to target identification. This platform will now allow for major drug discovery programmes that address the critical gap in the contraceptive portfolio as well as uncover novel human sperm biology.
Low contraceptive uptake among men remains significant issues in Indonesia. Hence, this study seeks to understand the association between socio-demographic factors and men’s contraceptive adoption in Indonesia by utilizing the 2012 Indonesia Demographic and Health Survey (IDHS), couple dataset. Bivariate analysis was conducted by performing a chi-squared test of independence to analyze the relationship between selected socio-demographic factors and the dependent variable. A binary logistic regression model was considered to identify the effects of covariates. Place of residence, husbands approve family planning, husbands and wives heard family planning from newspaper/magazine, and the perception that contraception is woman’s business were significant predictors according to the 2012 IDHS. Programs related to gender-sensitive campaign about family planning and gender-sensitive curricula in schools are needed for encouraging men to use contraception.
Contraceptive failure is a major contributor to unintended pregnancy worldwide. DHS retrospective calendars, which are the most widely used data source for estimating contraceptive failure in low‐income countries, vary in quality across countries and surveys. We identified surveys with the most reliable calendar data and analyzed 105,322 episodes of contraceptive use from 15 DHSs conducted between 1992 and 2014. We estimate contraceptive method‐specific 12‐month failure rates. We also examined how failure rates vary by age, education, socioeconomic status, contraceptive intention, residence, and marital status using multilevel piecewise exponential hazard models. Our failure rate estimates are significantly lower than results from the United States and slightly higher than previous studies that included more DHS surveys, including some with lower‐quality data. We estimate age‐specific global contraceptive failure rates and find strong, consistent age patterns with the youngest users experiencing failure rates up to ten times higher than older women for certain methods. Failure also varies by socioeconomic status, with the poorest, and youngest, women at highest risk of experiencing unintended pregnancy due to failure.
Unplanned pregnancy is a concern for emerging adult men, but their contraceptive options are limited. With male hormonal contraception clinical trials in progress, it is important to investigate men’s attitudes toward alternative contraception. Many social factors, such as masculine norms, may hinder their interest. This study used the prototype–willingness model to investigate college men’s willingness to pursue hormonal contraception. Male college students ( N = 160; Mage = 19.37, SD = 1.33; 61.9% White) read a description of male contraception clinical trials and filled out a questionnaire assessing prototype–willingness and masculinity constructs. Multinomial logistic regression revealed that men perceiving greater male contraceptive use and more favorable prototypes of a typical user had higher odds of having high willingness compared with no willingness (norms: odds ratio [ OR ] = 29.78, 95% confidence interval [CI] [5.79, 153.18]; prototypes: OR = 3.93, 95% CI [1.96, 7.87]). Men rating higher avoidance of femininity had lower odds of having high willingness compared with no willingness ( OR = .60, 95% CI [.40, .92]). Perceived risk of unplanned pregnancy failed to associate with willingness to use contraception, suggesting the importance of men’s social cognitions (norms and favorable images) and identity (masculinity) when promoting male hormonal contraception. Men’s avoidance of femininity may hinder their willingness, but promotion of male norms and favorable male users may enhance clinical trial recruitment and eventual public health campaigns to expand men’s contraceptive options. Future studies should examine diverse college and noncollege samples to determine the generalizability of these results to the broader emerging adult male population.
The continued and rapid expansion of the Earth's population mandates the need for safe and effective measures of contraception. While a plethora of options exist for women, methods of contraception for the male partner are limited to condoms and vasectomy. The sequela of this discrepancy has led to the family planning burden falling disproportionately on the female partner. For the past several decades, extensive research has been undertaken exploring the feasibility of hormonal male contraception. This proposed method of contraception has focused on suppressing spermatogenesis by exploiting the hypothalamic-pituitary-gonadal (HPG) axis. Beginning with proof of concept studies in the early nineties, administration of testosterone in healthy male subjects has been shown to be an efficacious method of inducing sterility. Owing to ethnic differences in spermatogenesis suppression and the comparatively low rate of azoospermia in Caucasian men with androgen-only regimens, investigators have explored the addition of progestins to further enhance the efficacy of hormonal contraception. Though studies have revealed promise with androgen-progestin regimens, the lack of long-term studies has precluded the development of a marketable product. Recently, more research has been directed towards identifying non-hormonal alternatives to male contraception. These non-hormonal options have ranged from the development of devices facilitating reversible occlusion of the vas deferens lumen to medications disrupting various pathways in the process of spermatogenesis. Underlying the development of hormonal and non-hormonal strategies is the shared enthusiasm men and women have towards these male directed methods. The willingness of couples to pursue these alternatives combined with the global need to reduce the psychological and socioeconomic implications of unintended pregnancy ensures that research will continue to bring this goal to fruition.
This article analyzes online interactions between British men and other online readers’ comments in response to two news articles focused on a male contraceptive pill. The aim of the study was to explore how British men’s online accounts construct a male pill as a potential contraceptive option for family planning. The two online articles reported the scientific innovations, as well as the production and marketing, of a nonhormonal, plant-based pill for men. Discourse analysis was used to analyze the online comments, from which two discourses emerged: (a) “Men as responsible health consumers” and (b) “‘Killing sperm’ and other side effects on semen.” When provided with the opportunity to take future responsibility for family planning, male readers were found to be unlikely to use a contraceptive pill. The men expressed the need for new options of contraception but, overall, felt a male pill was not the solution.
Context:
Contraceptive failure rates measure a woman's probability of becoming pregnant while using a contraceptive. Information about these rates enables couples to make informed contraceptive choices. Failure rates were last estimated for 2002, and social and economic changes that have occurred since then necessitate a reestimation.
Methods:
To estimate failure rates for the most commonly used reversible methods in the United States, data from the 2006-2010 National Survey of Family Growth were used; some 15,728 contraceptive use intervals, contributed by 6,683 women, were analyzed. Data from the Guttmacher Institute's 2008 Abortion Patient Survey were used to adjust for abortion underreporting. Kaplan-Meier methods were used to estimate the associated single-decrement probability of failure by duration of use. Failure rates were compared with those from 1995 and 2002.
Results:
Long-acting reversible contraceptives (the IUD and the implant) had the lowest failure rates of all methods (1%), while condoms and withdrawal carried the highest probabilities of failure (13% and 20%, respectively). However, the failure rate for the condom had declined significantly since 1995 (from 18%), as had the failure rate for all hormonal methods combined (from 8% to 6%). The failure rate for all reversible methods combined declined from 12% in 2002 to 10% in 2006-2010.
Conclusions:
These broad-based declines in failure rates reverse a long-term pattern of minimal change. Future research should explore what lies behind these trends, as well as possibilities for further improvements.
Context:
The development of a safe and effective reversible method of male contraception is still an unmet need.
Objective:
Evaluation of suppression of spermatogenesis and contraceptive protection by coadministered im injections of progestogen and testosterone.
Design:
Prospective multicentre study.
Setting:
Ten study centers.
Participants:
Healthy men, aged 18-45 years, and their 18- to 38-year-old female partners, both without known fertility problems.
Intervention:
Intramuscular injections of 200-mg norethisterone enanthate combined with 1000-mg testosterone undecanoate, administered every 8 weeks.
Main outcomes measures:
Suppression of spermatogenesis by ejaculate analysis, contraceptive protection by pregnancy rate.
Results:
Of the 320 participants, 95.9 of 100 continuing users (95% confidence interval [CI], 92.8-97.9) suppressed to a sperm concentration less than or equal to 1 million/mL within 24 weeks (Kaplan-Meier method). During the efficacy phase of up to 56 weeks, 4 pregnancies occurred among the partners of the 266 male participants, with the rate of 1.57 per 100 continuing users (95% CI, 0.59-4.14). The cumulative reversibility of suppression of spermatogenesis after 52 weeks of recovery was 94.8 per 100 continuing users (95% CI, 91.5-97.1). The most common adverse events were acne, injection site pain, increased libido, and mood disorders. Following the recommendation of an external safety review committee the recruitment and hormone injections were terminated early.
Conclusions:
The study regimen led to near-complete and reversible suppression of spermatogenesis. The contraceptive efficacy was relatively good compared with other reversible methods available for men. The frequencies of mild to moderate mood disorders were relatively high.
Social constructions of men towards the availability of a male hormonal contraceptive, the 'male pill', were explored. A qualitative approach applying semi-structured interviews and scenarios with 22 men (mean age 35 years) from the North East of England revealed two core constructs and six sub-constructs using a Thematic-Construct Analysis in line with the method of Toerien and Wilkinson and Clarke and Kitzinger. Verbal accounts were inductively used to balance the deductively created two core constructs 'Constructing the male pill norm: dominant system of sensemaking' and 'Living by the male pill norm' to represent a normative framework within a changing ideology of shared responsibility in contraceptive choice. Constructing the male pill norm was divided into two sub-constructs: 'Male pill: we are going to join the women and become responsible - too!' and 'Male pill: you look so girly - what are they going to think of me?' The 'Living by the male pill norm' was further divided into four sub-constructs 'Male pill - thank you for giving me promises not to have to become a dad as yet!'; 'Male pill: thank you for the idea of fun - sorry about my morals!'; 'Male pill: in stable relations - yes, I would have you now - sorry, I am too late!' and 'Male pill, we love you - but we are too anxious - we are not ready as yet!' From this male discourse, it is clear that discussions over the male pill follow the line of a vicious circle. In order to establish long-term side effects, Phase IV studies are necessary, and these cannot commence without the male hormonal contraception being a marketable product. So, unless this circle gets broken by some brave men, the male pill will remain a virtual rotating idea for a long time.
In both social science and medicine, research on reproduction generally focuses on women. In this article, we examine how men's reproductive contributions are understood. We develop an analytic framework that brings together Cynthia Daniels' conceptualization of reproductive masculinity (2006) with a staged view of reproduction, where the stages include the period before conception, conception, gestation, and birth. Drawing on data from two medical sites that are oriented to the period before pregnancy (preconception health care and sperm banks), we examine how gendered knowledge about reproduction produces different reproductive equations in different stages of the reproductive process. We conclude with a new research agenda that emerges from rethinking the role of men and masculinity in reproduction.
This article interrogates the modes by which cultural constructions of male contraceptive use emerge in Costa Rica by analyzing men's narratives of vasectomy. Drawing on ethnographic research data, I examine men's contraceptive decision making and perspectives on vasectomy and specify the ways they work through their vasectomy to rearticulate the relationship between masculinity and contraceptive responsibility and tensions in an emerging Costa Rican social modernity. Following Oudshoorn's (2003) analysis on male contraceptive research, this article highlights contraceptive technologies and men's narratives of these technologies as key sites for examining gender politics in contemporary societies and the materialization of new social orders. In the discussion, I argue that the men's narratives examined here potentiate creation of an "alternative technosociality" (Oudshoorn 2003) in Costa Rica, in which men taking contraceptive responsibility does not constitute performing a subordinate masculinity, but simply another way of acting as men.
Even though years of research on the male contraceptive pill have been conducted, a marketable product is still absent from the arsenal of male and female products of contraception. In this paper, the following psychosocial and cultural factors have been elicited from the literature in order to reveal explanations for this delay: acceptability, trust, fear of side-effects, perceptions of contraceptive responsibility and fear of losing connotations of masculinity. Regardless of cultural variation, overall there seems to be a positive attitude towards the acceptability of male contraceptive for both males and females, especially males in stable relationships. Some indication shows that the media have played an important role in distorting the results of research regarding male and female trust. Ongoing and future researches into several projects on psychosocial and cultural factors are described.
The biological basis for male contraception was established decades ago, but despite promising breakthroughs and the financial burden men increasingly bear due to better enforcement of child support policies, no viable alternative to the condom has been brought to market. Men who wish to control their fertility must rely on female compliance with contraceptives, barrier methods, vasectomy or abstinence. Over the last 10 years, the pharmaceutical industry has abandoned most of its investment in the field, leaving only nonprofit organisations and public entities pursuing male contraception. Leading explanations are uncertain forecasts of market demand pitted against the need for critical investments to demonstrate the safety of existing candidate products. This paper explores the developments and challenges in male contraception research. We produce preliminary estimates of potential market size for a safe and effective male contraceptive based on available data to estimate the potential market for a novel male method.
This article describes the technological inequity and social injustice surrounding contraception and reproductive responsibly today. The author argues that females must accept the financial and social burdens to acquire contraception because there are 11 approved methods of female contraception and only 2 methods for men. Moreover social constructs dictate that women are the primary caretakers of children resulting in less involvement from male sexual partners. The argument is two-fold--it calls for an increased effort to create male contraception and increased an effort to reverse the social injustice that women must take responsibility for contraception.
There is now a general consensus amongst philosophers in the values in science literature that values necessarily play a role in core areas of scientific inquiry. We argue that attention should now be turned from debating the value-free ideal to delineating legitimate from illegitimate influences of values in science, a project we dub “The New Demarcation Problem.” First, we review past attempts to demarcate the uses of values and propose a categorization of the strategies by where they seek to draw legitimacy from. Next, we propose a set of desiderata for what we take to be a satisfactory solution and present a case study where conflicting sets of values clearly impinge on science, but where the legitimacy of their influence is ambiguous. We use these desiderata and the case study to illustrate what we take to be the strengths and weaknesses of current strategies. To be clear, our goal is not to answer the question we pose, but to articulate a framework within which a solution can be judged.
Sexual and reproductive issues are essential elements of well-being in cisgenders as well as for the transgender population. Gender-affirming hormonal treatments (GAHTs) aim to induce phenotypical changes congruent with the desired gender and subsequent reduction of gender dysphoria. While genital surgical procedures including hysterectomy and/or adenectomy cause permanent loss of ability to conceive, GAHT may induce a varying degree of reversible loss of fertility. For these reasons, transgender men and women need to be counseled concerning contraceptive options and potential effects of treatment on reproductive function before initiating GAHT. The literature reports that sexual activity with genital involvement is performed by less than half of transgender persons who have been sexually active with a partner in the past. Testosterone (T) is the most commonly used compound in transmen and usually leads to amenorrhea within 1–12 months from first administration, however cessation of menses does not mean anovulation. Some studies report cases of unintended pregnancies among transgender men under masculinizing therapy, therefore T treatment cannot be considered a contraceptive option. Currently available contraceptive options have pros and cons in transmen and scarce literature exists on their use. The effects of GAHT on fertility in transwomen are even less well known. Prolonged estrogen exposure induces sperm suppression and morphological changes of the spermatozoa, however the degree of resulting pregnancy protection is unclear. Further research to inform the contraceptive counseling in this population is mandatory.
This essay examines the career of feminist journalist Barbara Seaman and her contribution to the circulation of health feminist ideas in the 1970s. Seaman, author of the influential exposé The Doctors' Case Against the Pill (1969), became a noted critic of women's health care and of gynecologists in particular. In her next book, Free and Female (1972), and in newspaper articles, interviews, and television appearances, she implored women to "liberate" themselves from their gynecologists and empower themselves in the arena of health care. Seaman's media engagement contributed to the development of a "popular health feminism" that took the ideas of the women's health movement public for mainstream audiences to consume and engage with.
The field of transgender health continues to expand rapidly, including research in the area of family planning. While much attention has been given to fertility preservation and the parenting intentions of transgender individuals, far less has been paid to pregnancy prevention and contraceptive needs of people along the transmasculine gender spectrum (transgender men and gender-nonbinary persons who were assigned female at birth). Existing research illustrates that many clinicians and transmasculine individuals falsely believe that there is no risk of pregnancy while amenorrheic. These studies also show inconsistent counseling practices provided to transmasculine persons surrounding contraception and pregnancy while falling short of providing robust clinical guidance for improvement. Clinicians report a lack of adequate training in transgender reproductive health, and consequently, many do not feel comfortable treating transgender patients. The aim of this publication is to consolidate the findings of these prior studies and build upon them to offer comprehensive clinical guidance for managing contraception in transmasculine patients. To do so, it reviews the physiologic effects of testosterone on the sex steroid axis and current understanding of why ovulation and pregnancy may still occur while amenorrheic. Gender-inclusive terminology and a suggested script for eliciting a gender-affirming sexual history are offered. Common concerns (such as the effects on gender dysphoria and gender affirmation) and side effects of available contraceptive methods are subsequently addressed and how these may have a unique impact on transmasculine persons as compared with cisgender women. Lastly, a model is provided for approaching contraceptive counseling in the transmasculine population to assist clinicians and patients in determining the need for and selection of the type of contraception. To center transmasculine voices, the development of this publication's guidelines have been led by reproductive care clinicians of transgender experience.
Unplanned pregnancies are an ongoing global burden, posing health and economic risks for women, children, and families. Advances in male contraception have been historically stymied by concerning failure rates, problematic side effects, and perceived market limitations. However, increased interest in reliable and reversible options for male contraception have resulted in resurgent efforts to introduce novel contraceptives for men. Hormonal male contraception relies on exogenous androgens and progestogens that suppress gonadotropin production, thereby suppressing testicular testosterone and sperm production. In many men, effective suppression of spermatogenesis can be achieved by androgen-progestin combination therapy. Small-scale contraceptive efficacy studies in couples have demonstrated effectiveness and reversibility with male hormonal methods, but side effects related to mood, sexual desire and cholesterol remain concerning. A number of novel androgens have reached clinical testing as potential contraceptive agents; many of these have both androgenic and progestogenic action in a single, modified steroid, thereby holding promise as single-agent contraceptives. Currently, these novel steroids hold promise as both a “male pill” and long-acting injections. Among non-hormonal methods, studies of reversible vaso-occlusive methods (polymers that block transport of sperm through the vas deferens) are ongoing, but reliable reversibility and long-term safety in men have not been established. Proteins involved in sperm maturation and motility are attractive targets, but to date both specificity and biologic redundancy have been challenges for drug development. In this review, we aim to summarize landmark studies on male contraception, highlight the most recent advances and future development in this important field of public health and medicine.
Most research investigating how men and women in heterosexual relationships negotiate contraceptive use focuses on the women’s point of view. Using a sample of 44 interviews with men attending a western US university, this study examines norms governing men’s participation in contraceptive use and pregnancy prevention and their responses to those norms. The paper demonstrates how competing norms around sexual health decision-making and women’s bodily autonomy contribute to unintended outcomes that undermine young people’s quest for egalitarian sexual relationships. While men largely agree that responsibility for sexual health decision-making should be shared with women, they also believe that women should have power over their own bodies and sexual health. However, the coexistence of these two competing norms – which call for both equal responsibility in decision-making and women’s bodily autonomy – results in a disconnect between men saying that sexual health decision-making should be equal, but not always participating equally. Thus, men largely give contraceptive decision-making power over to women, putting the burden of pregnancy prevention onto women and letting men off the hook. It is concluded that men’s negotiation of these competing norms reinforces unequal power and inequality in sexual relationships.
World population continues to grow at an unprecedented rate, doubling in a mere 50years to surpass the 7-billion milestone in 2011. This steep population growth exerts enormous pressure on the global environment. Despite the availability of numerous contraceptive choices for women, approximately half of all pregnancies are unintended and at least half of those are unwanted. Such statistics suggest that there is still a gap in contraceptive options for couples, particularly effective reversible contraceptives for men, who have few contraceptive choices. Male hormonal contraception has been an active area of research for almost 50years. The fundamental concept involves the use of exogenous hormones to suppress endogenous production of gonadotropins, testosterone, and downstream spermatogenesis. Testosterone-alone regimens are effective in many men but high dosing requirements and sub-optimal gonadotropin suppression in 10-30% of men limit their use. A number of novel combinations of testosterone and progestins have been shown to be more efficacious, but still require further refinement in delivery systems and a clearer understanding of the potential short- and long-term side effects. Recently, synthetic androgens with both androgenic and progestogenic activity have been developed. These agents have the potential to be single-agent male hormonal contraceptives. Early studies of these compounds are encouraging and there is reason for optimism that these may provide safe, reversible, and reliable contraception for men in the near future.
The Multiple Risk Factor Intervention Trial was a randomized primary prevention trial to test the effect of a multifactor intervention program on mortality from coronary heart disease (CHD) in 12,866 high-risk men aged 35 to 57 years. Men were randomly assigned either to a special intervention (SI) program consisting of stepped-care treatment for hypertension, counseling for cigarette smoking, and dietary advice for lowering blood cholesterol levels, or to their usual sources of health care in the community (UC). Over an average follow-up period of seven years, risk factor levels declined in both groups, but to a greater degree for the SI men. Mortality from CHD was 17.9 deaths per 1,000 in the SI group and 19.3 per 1,000 in the UC group, a statistically nonsignificant difference of 7.1% (90% confidence interval, —15% to 25%). Total mortality rates were 41.2 per 1,000 (SI) and 40.4 per 1,000 (UC). Three possible explanations for these findings are considered: (1) the overall intervention program, under these circumstances, does not affect CHD mortality; (2) the intervention used does affect CHD mortality, but the benefit was not observed in this trial of seven years’ average duration, with lower-than-expected mortality and with considerable risk factor change in the UC group; and (3) measures to reduce cigarette smoking and to lower blood cholesterol levels may have reduced CHD mortality within subgroups of the SI cohort, with a possibly unfavorable response to antihypertensive drug therapy in certain but not all hypertensive subjects. This last possibility was considered most likely, needs further investigation, and lends support to some preventive measures while requiring reassessment of others.
Gender-medicine has been very successful in discovering gaps in medical knowledge, disclosing biases in earlier research, and generating new results. It has superseded a more androcentric and sexist medicine. Yet, its development should not be understood in terms of a further approximation of value-freedom. Rather, it is a case of better value-laden science due to an enhanced pluralism in medicine and society. This interpretation is based on an account of the origins of gender-medicine in the feminist women’s health movement and an analysis of the debate on inclusion of women in clinical trials. Consequently, the history of gender-medicine provides support for a procedural account of objectivity that stresses the importance of a diversity of perspectives.
Recent advances mean that a pill for men could be around the corner, writes Mark Greener
There are three stages at which procreative outcomes can be prevented or altered: (1) prior to conception (2) during pregnancy and (3) after birth. Daniel Engster (Soc Theory Pract 36(2):233–262, 2010) has ably argued that plans to prevent or alter procreative outcomes at stages (2) and (3)—through abortion and adoption—introduce financial, physical, and emotional hardships to which women are disproportionately vulnerable. In this paper, I argue that plans to prevent or alter undesirable procreative outcomes at stage (1)—through contraception use—similarly disadvantage women. I suggest that accounts proposing moral responsibilities to delay or permanently avoid procreation are insufficiently attentive to the methods through which undesirable procreative outcomes might be prevented and how such methods unfairly burden women. In conclusion, I propose several ways that men and women might more equitably share contraceptive responsibility.
Sexual orientation typically describes people's sexual attractions or desires based on their sex relative to that of a target. Despite its utility, it has been critiqued in part because it fails to account for non-biological gender-related factors, partnered sexualities unrelated to gender or sex, or potential divergences between love and lust. In this article, I propose Sexual Configurations Theory (SCT) as a testable, empirically grounded framework for understanding diverse partnered sexualities, separate from solitary sexualities. I focus on and provide models of two parameters of partnered sexuality-gender/sex and partner number. SCT also delineates individual gender/sex. I discuss a sexual diversity lens as a way to study the particularities and generalities of diverse sexualities without privileging either. I also discuss how sexual identities, orientations, and statuses that are typically seen as misaligned or aligned are more meaningfully conceptualized as branched or co-incident. I map out some existing identities using SCT and detail its applied implications for health and counseling work. I highlight its importance for sexuality in terms of measurement and social neuroendocrinology, and the ways it may be useful for self-knowledge and feminist and queer empowerment and alliance building. I also make a case that SCT changes existing understandings and conceptualizations of sexuality in constructive and generative ways informed by both biology and culture, and that it is a potential starting point for sexual diversity studies and research.
Much research suggests that attitudes towards responsibility for use of contraception amongst young people are strongly gendered. However, decision making, if 'decisions' happen at all, is bound up with notions of hegemonic masculine and feminine roles as well as factors concerning relationship status. Data from two earlier qualitative studies were re-analysed with an emphasis on findings related to gender and responsibility for use of contraception. The first study investigated unintended conceptions amongst 16-20-year-old women. Interviews focused on knowledge and views about contraception, sex education and sexual health services. The second study involved focus groups with two groups of 14-18-year-old men to explore their views on sex education, sexual health and contraception. Almost all the young women said that young men viewed contraception as 'not their job'. In contrast, the young men thought that responsibility should be shared. The key issue, however, related to relationship status, with decision-making being shared in long-term relationships. There are some gender differences in accounting for decisions about use of contraception, however the key issue revolves around relationship status.
WE have induced reversible infertility, with little effect on libido, in
five healthy young men by giving them tablets containing
methyltestosterone and ethynyloestradiol. There were no undesirable side
effects and we feel that this treatment may offer a practical approach
to male oral contraception.
Philosophy of Science After Feminism is an important contribution to philosophy of science, in that it argues for the central relevance of advances from previous work in feminist philosophy of science and articulates a new vision for philosophy of science going in to the future. Kourany’s vision of philosophy of science’s future as “socially engaged and socially responsible” and addressing questions of the social responsibility of science itself has much to recommend it. I focus the book articulation of an ethical-epistemic ideal for science, the Ideal of Socially Responsible Science, compare it to recent work in the same vein by Heather Douglas, and argue for some advantages of Kourany’s approach. I then ask some critical question about the view, particularly with respect to the source of values that are to be integrated into science and the status of values that are to be so integrated. I argue that Kourany is too sanguine about where the values that inquirers will use come from and that these values seem to be accorded too fixed a status in her account.
Contraceptive decision making is likely to become more complex when male oral contraceptives are marketed and as sex‐role preferences become more egalitarian. A mailed survey of 47 married couples selected from a newspaper “Birth Listing” column in Columbus, Ohio was used to contrast spouses' views, to assess levels of actual and perceived consensus among partners, and to identify predictors of greater stated likelihood of male pill usage. Modest support was found for the hypothesis that more egalitarian sex‐role preferences are positively related to a greater belief in contraception as a shared responsibility, wives: r = .35, p < .01, husbands: r = .21, p < .10. No support was found, however, for the hypothesis that beliefs in shared contraceptive responsibility would lead to greater acceptance of a male pill. Wives were also more accurate, r = .57, p < .001, than husbands, r = .21, p < .08, in perceiving then‐spouse's attitudes toward male pill adoption. Results suggest that researchers need to focus on the process by which contraceptive usage is negotiated and renegotiated among married couples.
In this study 62 men were surveyed as to their attitudes toward male birth control methods and expectations regarding female responsibility for contraceptive practice. A statistically significant relationship was found between these two variables indicating that men who tend to assign contraceptive responsibility to women have more negative attitudes toward male contraceptive use. Education and marital status were found to be significantly related to these attitudes as well.
One hundred and fifty‐one men were interviewed in regard to contraceptive practices, life history, and personal outlook. In response to the question “Would you use a contraceptive pill for males if one were available?” 55.6% said yes, 18.5% said probably yes, 18.5% said probably no, and 7.3% said no. Dummy values of 3–2‐1–0 were assigned to these categories and then correlated with social‐demographic variables, test scores, and descriptions obtained from spouses and interviewers. Men who expressed greater willingness to use the pill preferred smaller families, scored lower on the California F scale, were more favorably disposed to population planning and abortion, and rated vasectomy, tubal ligation, and the contraceptive pill for females as acceptable methods of birth control. Observers described potential users as more introspective, labile, and prosocial, whereas potential nonusers were seen as more assertive, conventional, and self‐seeking.
Perspectives in Biology and Medicine 47.4 (2004) 617-623
The Male Pill traces the kaleidoscopic history of hormonal methods of contraception for men, exploring why such methods have been so long in coming when those for women have been available for nearly 40 years. The common features of pituitary endocrine control, whereby gonadotropin withdrawal switches off the function of both gonads, could surely have led to the parallel development of such methods in both sexes, despite the widespread belief that millions of sperm daily were harder to suppress than a single egg ovulating each month. New male contraceptive methods could replace less effective male methods and would occupy niches, e.g., when delaying vasectomy, when female methods were not tolerated, and during the post-partum period. As an early investigator remarked, the much longer fertile life of men makes them a target population of great significance.
We now know that preparations of androgens, given either alone for the suppression of gonadotropin hormones or combined with progestins (derivatives of natural progesterone) or with gonadotropin-releasing-hormone antagonists, effectively and reversibly suppress spermatogenesis in men (Anderson and Baird 2002; Kamische and Nieschlag 2004). Licensing one or another of these regimens will depend on their contraceptive efficacy in clinical trials, such as those recently conducted by the World Health Organization (Waites 2003). Interestingly, while novel androgens from a WHO steroid synthesis program were being ignored by the pharmaceutical industry, Chinese pharmacologists formulated an injectable testosterone undecanoate, an out-of-patent drug originally designed for oral administration. A trial involving over 1,000 couples testing the contraceptive efficacy of monthly injections of this newly-formulated long-acting androgen is nearing completion in China. It is likely that this monthly injectable will be the first male contraceptive drug to achieve registration in a national family planning program (Handelsman 2003).
This represents the present scientific situation. The Male Pill also discusses the social and cultural revolutions needed to turn what the author, a social scientist, calls "the established sociotechnical networks" away from their exclusive focus on women and onto men. Nelly Oudshoorn, Professor of Gender and Technology at the University of Twente in the Netherlands, has had unprecedented access to the scientists and policy makers involved in the WHO's research and development program to develop male contraceptive methods. Her interviews reveal that the investigators themselves, building on earlier pioneering clinical studies, provided the commitment that has advanced the field so dramatically in the last two decades.
Oudshoorn identifies the formidable opposition faced by advocates for the development of male contraceptive drugs. She relates how WHO and other public-sector agencies were forced to develop an R&D network "to compensate for the pharmaceutical industry's reluctance" to be involved. This network established the infrastructure for laboratory and clinical research through the so-called WHO Male Task Force, whose considerable public health achievements are described elsewhere (Waites 2003).
Oudshoorn explains how the clinical investigators overcame the difficulties of recruiting men to participate in trials that risked pregnancy in their partners. This was undertaken in a medical climate rooted in the resistance of gynecologists and urologists and in a social climate influenced by media-driven distortions. The recently embedded view that fertility control was solely the woman's domain led to the pursuit of the development of the pill for women in the late 1950s, with the enthusiastic support of the pharmaceutical industry. By contrast, studies to develop contraceptive methods for men were left to academic scientists to pursue, with the support of public sector agencies only.
Unfortunately, Oudshoorn's arguments are sometimes obscured by terms unfamiliar to the non-social scientist. For example, in a chapter entitled "Designing Technology and Masculinity: Challenging the Invisibility of Male Reproductive Bodies in Scientific Medicine," we are told that "the stabilization of...
To judge from the rash of recent law review articles, it is a miracle that research with human subjects in the U.S. continues to draw breath under the asphyxiating heel of the rent-seeking, creativity-stifling, jack-booted bureaucrethics that is the current system of research ethics oversight and review. Institutional Review Boards (IRBs), sometimes called Research Ethics Committees (RECs), have been accused of perpetrating “probably the most widespread violation of the First Amendment in our nation's history,” resulting in a “disaster, not only for academics, but for the whole nation.” One member of the President's Council on Bioethics went so far as to assert, “There has been no greater damage to academic freedom in the United States in my lifetime. And my lifetime encompasses McCarthy and it encompasses political correctness, both.” Locked in the bureaucratic “iron cage” of IRB oversight, critics charge that researchers have been transformed into a vulnerable, exposed population, subject to domination, that has been likened in one case to a kind of “Tuskegee in reverse.”
Recently, mainstream English-language news organisations have been reporting that a 'male pill' will soon be available. A common theme running through many published articles is that women will not trust men to use these new male contraceptives, though rarely is evidence provided to support this claim. In order to understand this disconnect between women's distrust for men as a group and their trust in their male partners, this paper examines three dominant ideologies of masculinity that inhibit men's contraceptive trustworthiness as a group. First, there is a cultural belief that men have an uncontrollable sex drive, which interferes with their ability to contracept. Second, there is a commonly held idea that men are incompetent in domestic tasks, which impairs their ability to correctly use contraception. Third, there is a social perception that men are not committed to pregnancy prevention, or at least not to the degree that women are.
Objective: To determine contraceptive efficacy of hormonally induced sperm suppression to severe oligozoospermia or azoospermia. Design: Prospective, noncomparative contraceptive efficacy study. Setting: Multicenter study in 15 centers in nine countries. Participants: Three hundred ninety-nine normal, healthy, fertile men requesting a male contraceptive method. Intervention: Weekly IM injection of 200 mg T enanthate. Main Outcome Measure: Incidence of pregnancies in efficacy when couples relied on T injections alone for contraception. Results: Four pregnancies occurred during 49.5 person-years involving men with oligozoospermia (0.1 to 3 x 10⁶/mL) and none during 230.4 person-years in azoospermic men: pregnancy rates 8.1 (95% confidence interval [CI] 2.2 to 20.7) and 0.0 (95% CI, 0.0 to 1.6) per 100 person-years, respectively, or 1.4 (95% CI, 0.4 to 3.7) per 100 person-years for oligozoospermia and azoospermia (0 to 3 x 10⁶/mL) combined. Pregnancy rates were related to sperm concentration. Inadequate suppression of spermatogenesis occurred in eight men and escape from suppression occurred in four. Discontinuations were due to personal reasons (50 men, cumulative annual life-table rate 12.2% [95% CI, 9.1% to 16.1%]) and dislike of the injection schedule (21 men, 5.1% [95% CI, 3.2% to 7.9%]). Thirty-five men discontinued for medical reasons (9.4% 195% CI, 6.7% to 13.2%]), with no serious treatment-related side effects. After stopping injections, sperm output recovered; additionally, fertility was demonstrated in 33 couples. Conclusion: Suppression of spermatogenesis to azoospermia or severe oligozoospermia (≤3 x 10⁶/mL) induced by weekly T enanthate injections results in sustained, reversible contraception with good efficacy and minimal short-term side effects. New hormonal regimens with more convenient delivery and improved spermatogenic suppression would provide practical male contraception.
This paper concerns a comparison of risk assessment practices of contraceptives for women and men. Our analysis shows how the evaluation of health risks of contraceptives does not simply reflect the specific effects of chemical compounds in the human body. Rather, we show how side-effects were rated differently according to the risk model that was adopted. Our analysis shows an important new aspect of risk assessment: lay perspectives of men are taken more seriously by experts and policymakers than those of women. In the case of male contraceptives, men’s wellbeing when using contraceptives was a central issue from the very beginning. Men’s emotional wellbeing and sexuality has been put on the international research agenda by the reproductive scientists themselves, and the need for long-term data about male contraceptives has been emphasised by the pharmaceutical industry. In the case of female contraceptives, the concern for the long-term effects of contraceptives was put forward by women’s health movements, and research into women’s mental health and libido when using hormonal contraceptives was initiated only at the instigation of women’s health advocates. We therefore conclude that the incorporation of lay interests in the experts’ methods of risk assessment shows a clear gender pattern. Whereas the perspectives of male contraceptive users have been emphasised and negotiated by authoritative spokespersons within the medical establishment, the incorporation of the interests and needs of female contraceptives users depended on women’s health advocates.
Over the past twenty-five years, numerous articles in Hypatia have clarified, revised, and defended increasingly more nuanced views of both feminist empiricism and standpoint feminism. Feminist empiricists have argued that scientific knowledge is contextual and socially situated (Longino 1990; Nelson 1990; Anderson 1995), and standpoint feminists have begun to endorse virtues of theory choice that have been traditionally empiricist (Wylie 2003). In fact, it is unclear whether substantive differences remain. I demonstrate that current versions of feminist empiricism and standpoint feminism now have much in common but that key differences remain. Specifically, they make competing claims about what is required for increasing scientific objectivity. They disagree about 1) the kind of diversity within scientific communities that is epistemically beneficial and 2) the role that ethical and political values can play. In these two respects, feminist empiricists have much to gain from the resources provided by standpoint theory. As a result, the views would be best merged into “feminist standpoint empiricism.”
The underdetermination argument establishes that scientists may use political values to guide inquiry, without providing criteria for distinguishing legitimate from illegitimate guidance. This paper supplies such criteria. Analysis of the confused arguments against value-laden science reveals the fundamental criterion of illegitimate guidance: when value judgments operate to drive inquiry to a predetermined conclusion. A case study of feminist research on divorce reveals numerous legitimate ways that values can guide science without violating this standard.
This essay aims to clarify the value of developing systematic studies of ignorance as a component of any robust theory of knowledge. The author employs feminist efforts to recover and create knowledge of women's bodies in the contemporary women's health movement as a case study for cataloging different types of ignorance and shedding light on the nature of their production. She also helps us understand the ways resistance movements can be a helpful site for understanding how to identify, critique, and transform ignorance.
The idea of increasing men's participation in family planning has received periodic attention for the past 20 years, but there is no generally accepted understanding of what men's involvement actually means. This paper examines the gender implications of ‘male involvement’ for the staff and decision-makers of service delivery programmes, and the gender dynamics surrounding the use of contraceptives, particularly male-dependent methods. It discusses the importance of taking into account the interplay between men's and women's roles, rather than focusing on women's situation (or men's) alone, with the aim of increasing equality between women and men. Finally, it cautions against forms of ‘male involvement’ which result in men usurping what was formerly women's territory and thereby worsening existing male dominance.
Feminist philosophy of science has led to improvements in the practices and products of scientific knowledge-making, and in
this way it exemplifies socially relevant philosophy of science. It has also yielded important insights and original research
questions for philosophy. Feminist scholarship on science thus presents a worthy thought-model for considering how we might
build a more socially relevant philosophy of science—the question posed by the editors of this special issue. In this analysis
of the history, contributions, and challenges faced by feminist philosophy of science, I argue that engaged case study work
and interdisciplinarity have been central to the success of feminist philosophy of science in producing socially relevant
scholarship, and that its future lies in the continued development of robust and dynamic philosophical frameworks for modeling
social values in science. Feminist philosophers of science, however, have often encountered marginalization and persistent
misunderstandings, challenges that must be addressed within the institutional and intellectual culture of American philosophy.
Modern contraceptives—especially long-acting, reversible contraceptives, or LARCs—are typically seen as a boon for humanity and for women, the majority of their users, in particular. But the disparity between the number and types of female and male LARCs is problematic for at least two reasons: first, because it forces women to assume most of the financial and health-related responsibilities of contraception, and second, because men’s reproductive autonomy is diminished by it. In order to understand how to change our current contraceptive arrangement, I want to look at some of the historical and contemporary factors that contribute to this disparity, especially gender norms that associate women with reproduction and distance men from it.1
One reason we need male LARCs is that most of our current contraceptives target women’s bodies. Today, there are eleven contraceptive options for women and only two for men.2 This means that women assume all associated financial and health-related burdens. On the whole, female methods tend to be more expensive than male methods3 because most require at least one physician visit, and some involve a renewable prescription. Many insurance plans do not cover contraception,4 and a man cannot bill his partner’s contraceptives to his plan (assuming his plan covers them) since, according to our individualistic medical model, they are seen as being only for her use and benefit.5
Side effects for female methods are more serious than for male methods, as well, in part because various contraceptive methods for women involve hormones, while no methods for men do.6 The most common reason women discontinue contraceptive use is unwanted side effects,7 and most forms of contraception have discontinuation rates approaching fifty percent after one year of use.8 Also, side effects not only cause women to stop using contraception, but fear of them also prevents women from starting new methods.9 Finally, the two available male forms of contraception, condoms and vasectomy, also carry fewer health risks than their corresponding female methods, female barrier contraceptives and tubal ligation.10 It is no wonder that women sometimes continue to use a particular contraceptive even if they are not happy with it simply because it is their best worst option.11
Another reason we should develop male LARCs is so that men can more feasibly and effectively share contraceptive responsibility with their partners. Neither of the two male contraceptives currently available is well suited to the contraceptive needs of men in long-term, monogamous relationships. And for men who still want to maintain the possibility of having biological children, the only method available to them is the male condom. Yet given the condom’s high failure rate of 16 percent during typical use, men are not able to regulate their reproduction as effectively as women can—many female hormonal methods and IUDs have failure rates under three percent.12 The lack of effective and reversible options for men leads many men to rely on their partners for contraception. And even if men use a condom, they often depend on women to use another form of contraception concurrently to minimize the possibility of pregnancy.
This dependence on women reduces men’s reproductive autonomy. Men have to trust that their partners are correctly and consistently using contraception. If a pregnancy unintended by either or both partners does occur, men have no recourse. They cannot mandate that a woman get an abortion. Regardless of the circumstances under which the pregnancy transpired, men are still held socially and financially responsible for any children they father.
Women tend to be more associated than men with reproduction in general, and relatively recently, particularly with contraceptive responsibility. Prior to the invention of the birth control pill, contraceptive use was tied to the actual sex act, and for this reason men had to participate in it (for example, by using a condom or withdrawing). Additionally, men were often involved in decisions about and use of contraception because of their traditional role as heads of their households.13
Contraceptive responsibility began to shift from being a shared responsibility to being solely a woman...
Methods of contraception for use by men include condoms, withdrawal and vasectomy. Prevalence of use of a method and continuation rates are indirect measures of acceptability. Worldwide, none of these "male methods" accounts for more than 7% of contraceptive use although uptake varies considerably between countries. Acceptability can be assessed directly by asking about intended (hypothetical) use and assessing satisfaction during/after use. Since they have been around for a very long time, there are very few data of this nature on condoms (as contraceptives rather than for prevention of infection), withdrawal or vasectomy. There are direct data on the acceptability of hormonal methods for men but from relatively small clinical trials which undoubtedly do not represent the real world. Surveys undertaken among the male general public demonstrate that, whatever the setting, at least 25% of men - and in most countries substantially more - would consider using hormonal contraception. Although probably an overestimate of the number of potential users when such a method becomes available, it would appear that hormonal contraceptives for men may have an important place on the contraceptive menu. Despite commonly expressed views to the contrary, most women would trust their male partner to use a hormonal method.
Hormonal male contraceptive regimens effectively and reversibly suppress sperm production, but there are few large-scale efficacy studies.
The safety, contraceptive efficacy, reversibility, and feasibility of injectable testosterone undecanoate (TU) in tea seed oil as a hormonal male contraceptive was assessed.
This was a multicenter, phase III, contraceptive efficacy clinical trial. Participants: A total of 1045 healthy fertile Chinese men were recruited throughout China into the study.
Injections of 500 mg TU were administered monthly for 30 months. A definition of severe oligozoospermia (< or =1 x 10(6)/ml) was used as a criterion of spermatogenic suppression and as the threshold for entering the contraceptive efficacy phase.
The primary outcome was pregnancy rate in the partner. Other outcomes include: semen parameters, testis volumes, reproductive hormone levels, and safety laboratory tests.
Forty-three participants (4.8%) did not achieve azoospermia or severe oligozoospermia within the 6-month suppression phase. A total of 855 participants entered into the efficacy phase, and 733 participants completed monthly TU treatment and follow-up. There were nine pregnancies in 1554.1 person-years of exposure in the 24-month efficacy phase for a cumulative contraceptive failure rate of 1.1 per 100 men. The combined method failure rate was 6.1%, comprising 4.8% with inadequate suppression and 1.3% with postsuppression sperm rebound. No serious adverse events were reported. Spermatogenesis returned to the normal fertile reference range in all but two participants.
Monthly injection of 500 mg TU provides safe, effective, reversible, and reliable contraception in a high proportion of healthy fertile Chinese men.