I’ve been hearing for years that “male birth control” is coming soon.
If you’re someone with compulsive sexual behavioral disorder (CSBD), are a man in the arena raw-doggin some randoms, fear getting “baby trapped,” or want extra optionality… then male birth control may be a welcome development.
Based on trends within developed countries, young people aren’t really fucking much anymore, so I’m not sure how high uptake would actually be.
And sure, men can always get a vasectomy, but most don’t want this. If you don’t currently have kids — but want them in the future — a vasectomy is an irreversible procedure with potentially serious complications.
There’s always a militant faction within the right-wing political regime beating the drum about “banning birth control.” Not only is this unrealistic, it’s dumb as fuck.
Quality > quantity. Sure some people would be acutely aware of the higher stakes associated with sexual intercourse… but many would not… and intuitively I don’t think the net effects would be ideal.
We don’t want to accelerate making the movie Idiocracy a reality.
I welcome any new innovation, including male birth control.
However, after reviewing the mechanisms of “male contraceptives” in development and thinking through the mechanisms and risks… from my perspective the risk/reward for most men will be skewed heavily negative.
Note: I’m strongly in favor of paying substance addicts to get sterilized. They often have serious, genetically-mediated mental illness and other sexually transmitted infections (e.g. HIV) and aren’t even remotely equipped to bring children into this world. For this reason, I view Project Prevention as one of the smartest, most ethical charities in existence. Makes me feel physically sick to learn that people are against it and that it isn’t a larger charity.
Thoughts on clinical trials for male birth control
Lack of long-term data: Even assuming future “FDA approval” (who knows when that will be) it takes a long ass time to get serious long-term post-marketing adverse event data. I’d consider avoiding the stuff for at least a few years (probably more) until the risks and dangers are clear. Even if nothing shows up, you should think through the mechanistic logic. Clinical trial data are typically skewed toward framing drugs favorably (“safe” and “effective”). You won’t know anything about chronic long-term effects because they haven’t happened yet… you have to wait for the lawyer commercials in 10-20 years “if you or a loved one took (insert drug here), call the law offices of…”.
Female birth control is already safe and cheap: Female birth control is generally safe and inexpensive, on average. We have data from chronic long-term users. Sure there are random anecdotes about weird side effects (e.g. depression, anxiety, bloating, whatever)… but these are rare. Cherry-picking correlational and heavily confounded studies to push a narrative (e.g. “birth control causes depression”) isn’t smart. I’ve noticed that it’s become somewhat of a social status symbol to not use birth control these days (I’m 100% natural, non-GMO, organic, hormonally optimal, healthier than thou, etc.). Yeah people have adverse events… but people have adverse events from eating apples broccoli, beef, carbs, olive oil, vaccines, gluten, whey protein, you name it… can always dig up crazy reactions from across the interwebs. Female birth control options are numerous, inexpensive, and very safe. My logic goes: male are taking far bigger risk from novel birth control due to lack of long-term data.
Hormonal and/or neurobiological effects: Many preliminary male birth control interventions are hormonal. They alter hormones away from what’s normal (i.e. biological homeostasis). Even if they technically remain within “normal ranges,” subtle long-term shifts could yield adverse long-term effects. With chronic regular use, risk could compound. I’d carefully think through the mechanistic logic and use your own judgment.
Physical damage risk (possibly permanent): Select types of emerging male birth control involve physical injection/insertion. The male anatomy is highly sensitive and anytime you start injecting things you introduce injection-related risks. A male “IUD” or “gel” that is forcibly inserted inside the lumen of the vas deferens (the tube that carries sperm from the epididymis toward the urethra) could lead to epididymitis, granulomas, epididymal rupture, PVPS, and other myalgias. Also possible that there could be immune, cellular, and/or carcinogenic reactions to the substances inserted over an extended duration.
So for these reasons, I just don’t envision uptake of male birth control being high. But who knows, I could be misreading this.
The Core Problem With Male Contraception
Most people don’t realize why male birth control has taken so long to develop. It’s not just funding or interest, it’s male biology.
Sperm production is a long conveyor belt (weeks). Any method that lowers sperm count usually has a slow onset and slow offset. You’re not popping a pill before sex and calling it good. Most methods require weeks to months of consistent use before they’re effective, and weeks to months after stopping before fertility returns.
This reality shapes adoption. Casual sex? You still need condoms. Long-term relationships? Maybe there’s a case here. But the “take it when you need it” scenario most guys imagine doesn’t exist yet—and won’t for a long time.
What Men Have Today
Condoms
Non-hormonal, immediate, reversible, also reduces STI risk (the only method that does).
Downsides are adherence, “in the moment” friction, pleasure reduction, and typical-use failure rates.
But from a health-risk perspective, this is as low as it gets. No systemic effects, no long-term concerns.
Vasectomy
Non-hormonal, extremely effective, but intended as permanent. Reversal exists but success isn’t guaranteed. Requires a semen test later to confirm sterility.
The main long-term concern is post-vasectomy pain syndrome (PVPS)—chronic scrotal pain affecting quality of life in roughly 1-2% of patients (some estimates range up to 5% depending on how you define it).
There’s been debate about a vasectomy-prostate cancer link. A 2025 meta-analysis of 19 cohort studies found a small association (RR ~1.09), but Mendelian randomization analysis didn’t support a causal link—screening behavior (guys getting more PSA tests after vasectomy) is the more likely explanation. The AUA guideline states no causal link has been established.
What’s In The Male Contraception Pipeline (2026)
Included below is a list of male contraception in preclinical and clinical trials.
1. Hormonal Gel (NES/T: Segesterone Acetate + Testosterone)
Status: Phase 2b completed; preparing for Phase 3 (timing depends on funding/partners/regulators). This is the most advanced male contraceptive in development.
Mechanism: Uses a progestin + testosterone combo to suppress LH/FSH via the hypothalamic-pituitary axis. This tanks intratesticular testosterone, which collapses sperm production. You apply it to your skin daily.
Onset: Median time to sperm suppression is ~8 weeks, with ~82% suppressed by 12 weeks. So you’re looking at 2-3 months of backup contraception before it’s reliable.
This is the closest to approval. But it fails the “doesn’t wreck hormones” test by design.
Risks: The best data we have on hormonal male contraception side effects comes from a large injectable trial (NETE + TU) that was terminated early after safety review concerns. A critical appraisal extracted these frequencies:
Acne: 45.9%
Increased libido: 38.1%
Mood changes: 31.7%
Injection-site pain: 23.1%
Myalgia/musculoskeletal pain: 20.7%
Gynecomastia: 5.6%
Among serious adverse events classified as “possibly/probably related”: depression, intentional paracetamol overdose, and tachycardia with paroxysmal atrial fibrillation.
There was also one suicide judged unrelated, but it should be questioned given that this medication can cause mood changes.
Beyond the tolerability stuff, exogenous testosterone exposure raises theoretical concerns:
Erythrocytosis: Testosterone can raise hematocrit, increasing blood viscosity and thrombotic risk. In men on testosterone therapy, those who developed polycythemia (hematocrit >52%) had higher MACE/VTE risk (5.15% vs 3.87% in the first year).
Arrhythmia: The TRAVERSE trial (testosterone gel vs placebo in older hypogonadal men) found similar major cardiac events overall, but higher rates of atrial fibrillation and pulmonary embolism in the testosterone group.
Prostate effects: Androgens stimulate prostate tissue. Long-run exposure could theoretically increase BPH or cancer risk, though modern TRT evidence is somewhat reassuring.
Approval timeline estimate:
Best case: ~2030-2032
More realistic: Early-to-mid 2030s
Still need Phase 3 efficacy (pregnancy endpoints), reversibility follow-up, and regulatory review.
Cost estimate: Unknown until launch. If priced like other branded hormone products, plausible range is $30-$150/month out-of-pocket before insurance.
2. Oral Hormonal Pills (DMAU & 11β-MNTDC)
Status: Early-phase human studies (weeks-long dosing trials).
Also in human trials: oral hormonal agents like DMAU and 11β-MNTDC. These are synthetic androgens with progestational activity that suppress gonadotropins (LH/FSH) similar to the gel approach, but in pill form.
Mechanism: Same hormonal axis suppression as NES/T gel—suppress pituitary signaling, tank intratesticular testosterone, collapse sperm production.
Current evidence: Early-stage (28-day) studies showing gonadotropin suppression compatible with contraception. But they’re nowhere near a couples-based pregnancy endpoint trial.
Why they matter: If a daily pill works with acceptable side effects, it’s more convenient than a gel. But they carry the same hormonal concerns and are further behind NES/T in development.
Approval timeline estimate: Mid-to-late 2030s at earliest—these are behind the gel.
3. Non-Hormonal Pill: YCT-529 (RAR-α Antagonist)
Status: Phase 1a (single-dose safety) completed. Phase 1b/2a repeat-dose trial now underway.
Mechanism: Blocks retinoic acid receptor-alpha (RAR-α) signaling in the testes. Retinoic acid signaling is required for germ cell differentiation—block it, and sperm production drops. No hormonal manipulation involved.
This is the most relevant candidate if you want to avoid hormones.
What the Phase 1a data show (Nature, 2025):
Single doses were well tolerated in a small sample
No meaningful changes in testosterone/LH/FSH/SHBG
Sexual function and mood comparable to baseline after single dosing
Half-life ~51-76 hours; developers plan once-daily dosing in repeat-dose trials
Important: Phase 1a was single-dose safety/PK only. The real test is repeat dosing. A Phase 1b/2a study is now underway with 28- and 90-day daily dosing to track sperm parameters and tolerability.
What we still don’t know:
Efficacy in preventing pregnancy (requires longer dosing and couples trials)
Long-term safety with repeated dosing over months/years
Off-target risks: retinoic acid biology is involved in multiple tissues (skin, mucosa, immune function). Selectivity helps, but long-term data are the proof.
The Nature paper explicitly highlights historical non-hormonal male candidates that failed for safety reasons: WIN 18,446 caused alcohol-disulfiram-like reactions, gossypol caused hypokalemia. This class has to clear a very high bar.
The concern nobody talks about: Retinoid signaling is a master differentiation pathway deeply involved in development/differentiation and cancer biology. RAR signaling can be anti-cancer in some contexts, but dysregulated RA signaling can also be implicated in cancer progression. Chronic systemic RAR-α antagonism in non-testis tissues could theoretically alter tissue homeostasis in ways that matter long-term. That’s not a claim it will—it’s the reason we need years of exposure data.
Onset: Likely weeks to months (affects sperm development, not instant).
Approval timeline estimate:
Best case: Early-to-mid 2030s
More realistic: Mid-to-late 2030s
Still in early Phase 1/2, needs large efficacy trials.
Cost estimate: If it’s a first-in-class branded drug, initial pricing could be $50-$300/month out-of-pocket. Long-run could drop with competition/generics, but that’s a long horizon.
4. Vas-Occlusive Hydrogels / “Male IUD” (ADAM, Plan A/Vasalgel)
Status: Early human feasibility studies.
Mechanism: A material is injected into the vas deferens (the tube carrying sperm from the epididymis toward the urethra) to block sperm transport and/or disable sperm.
RISUG: Styrene maleic anhydride polymer in DMSO injected into the vas deferens, forms charged precipitates, layers the inner wall, and can also occlude the lumen. Sperm passing through are damaged by ionic/pH/charge effects.
Vasalgel: Intravas injection of a polymer solution that forms a hydrogel. In rhesus monkey studies, it prevented conception with few complications (similar to vasectomy), though one sperm granuloma occurred.
ADAM (Contraline): Hydrogel inserted inside the vas deferens by injection, designed to block sperm. Company claims blocked sperm degrade and are absorbed; hydrogel later liquefies.
ADAM trial details: The first-in-human feasibility trial targets ~25 participants, assessing safety/feasibility of implantation into the vas deferens. Company-reported results: 2 participants reached azoospermia at 24 months with no treatment-related serious adverse events. Phase 2 in Australia was planned to begin Q3 2025.
Plan A/Vasalgel note: Unlike NES/T and YCT-529, Plan A/Vasalgel has limited public clinical data so far; most details are development-tracker/organization statements rather than large peer-reviewed human datasets.
The pressure/congestion problem: This is the real concern. After vasectomy (same “sperm can’t get through” premise), the body absorbs sperm, which is usually harmless. But with obstruction, pressure can rise in the epididymis/proximal vas, potentially causing:
Epididymal congestion (aching, pressure)
Sperm granuloma (inflammatory lump from sperm leakage)
Epididymal “blowout” (duct rupture from back-pressure)
These are proposed mechanisms of post-vasectomy pain syndrome. Symptoms can include pressure or pain after ejaculation and epididymis swelling.
Ejaculate volume usually doesn’t change much because sperm are a small fraction of semen volume; most volume comes from prostate and seminal vesicles.
For products designed to fully block sperm transport, congestion risks are conceptually close to “closed-ended” obstruction (i.e., similar to vasectomy complications). If a method is less occlusive and mainly disables sperm while allowing flow, it could theoretically reduce pressure problems—but that depends on how occlusive it actually is in practice.
Key unknown: Human reversibility. “Intended reversible” ≠ “proven at scale.” Most public claims aren’t yet backed by large published clinical datasets.
Approval timeline estimate:
Best case: Early 2030s
More realistic: Mid 2030s
Regulators will want robust efficacy + reversibility + complication rates.
Cost estimate: Procedure/device could be in the hundreds to low-thousands (similar to IUD insertion + device costs for women, or a vasectomy-like outpatient procedure). Insurance coverage is a big unknown.
5. On-Demand Sperm-Function Inhibitors (sAC Inhibitors)
Status: Preclinical.
How it works: Inhibits soluble adenylyl cyclase (sAC), which is essential for sperm motility and capacitation. In mouse studies, a single dose rendered males temporarily infertile, with fertility returning the next day.
This is the “take it before sex” holy grail—but it’s nowhere close to human trials.
Risks: sAC is expressed outside sperm and acts as a bicarbonate/CO₂ sensor in other tissues. Systemic inhibition could perturb signaling in heart/kidney/epithelia depending on selectivity, tissue penetration, and dosing. The mitigating factor is that short, on-demand exposure usually lowers long-term risk compared to chronic daily use.
Approval timeline estimate: Late 2030s to 2040s, if it works out.
Cost estimate: Pure speculation at this point.
Comparison to Female Birth Control
Female Methods Have Massive Advantages
Data depth: Decades of population-level safety surveillance. We can quantify rare outcomes with confidence.
Cost: Often $0 with insurance under ACA coverage rules. Among people who do pay out-of-pocket, GoodRx estimated average annual costs around $20 insured / $84 uninsured (pill users who pay). OTC Opill runs about $15-20/month. IUDs cost $0-$1,800 depending on insurance (often $500-$1,800 without).
Variety: Pills, patches, rings, shots, implants, hormonal IUDs, copper IUDs. Multiple formulations with different hormone profiles.
Efficacy: LARC methods (IUDs, implants) have failure rates under 1%. Pills are ~93% effective with typical use (~7% failure).
Female Contraception Risks are Quantified
1. Combined hormonal contraception (estrogen + progestin)
VTE risk: ~3-15 per 10,000 woman-years in users vs ~1-5 per 10,000 in non-users
Stroke/MI: A large Danish cohort found adjusted rate ratios of about 2.0 for ischemic stroke and MI with combined oral contraception vs no use. Absolute risks are low in healthy young women.
Cancer tradeoffs: Associated with increased breast and cervical cancer risk during use/recent use, but reduced endometrial/ovarian/colorectal cancer risk (some effects persist after stopping).
2. IUDs
Expulsion: 2-10% in the first year
Perforation: ~1 per 1,000 insertions
Depression signal: A large Danish cohort study found increased rates of first antidepressant use with hormonal contraception (combined OCs RR 1.23, progestin-only pills RR 1.34), with higher relative estimates in adolescents. This is association, not proven causality.
Progestin-only methods: Generally safe with no or minimal VTE risk. DMPA (Depo-Provera) is the exception where VTE risk appears increased.
The Bottom Line on Comparison
If you define “safe” as “we can quantify rare outcomes confidently,” female methods win today and will for years.
If you define “safe” as “no systemic hormone manipulation,” male vas-occlusive options and YCT-529-like drugs are the best directional match—but they’re earlier, with bigger uncertainty.
Men will be taking bigger risk and paying more. At least initially.
Predicted Male Birth Control Uptake if Approved
Prelim Surveys (Take With Salt)
Three-quarters of straight-men surveyed were willing to use new male contraceptives
A large multinational survey found >55% willingness
Willingness is always higher than real-world uptake. People answer aspirationally.
Market Modeling
A Contraception Journal analysis estimated ~13% (7+ million) U.S. men would potentially use novel male contraceptives.
Current Baseline
Per CDC data (2017-2019), 65.3% of women aged 15-49 reported currently using contraception. Most common methods: female sterilization (18.1%), pill (14.0%), LARC (10.4%), male condom (8.4%). Male sterilization was 5.6%.
Male-controlled methods (condom + vasectomy) are roughly 14% of all women 15-49, and ~21% of contraceptive users.
My Predictions
If hormonal gel is first to market (~2030-2035):
5 years post-approval: ~8-15% of men using a new non-barrier method as primary pregnancy prevention. Biggest users: stable relationships, couples where the woman can’t tolerate hormones, “shared responsibility” couples. Many will still dual-cover with condoms.
If a credible non-hormonal pill also arrives and looks clean long-term:
10-15 years post-first approval (~2040-2045): ~15-25% of men using a new male method as primary. Higher end requires good insurance coverage + minimal mood/sexual side effects + easy access + strong norms.
What happens to female method use?
I don’t think female use collapses. Women have stronger incentives to retain control (pregnancy burden is asymmetric).
My estimate: Women using female-controlled methods as primary stays at ~55-70% of contracepting couples by the 2040s.
Male contraception will add a meaningful share, but won’t create a 50/50 world quickly.
Forces Pushing Uptake Up
Women’s increasing desire to avoid hormones (visible “side effects discourse” online)
Abortion restrictions / higher consequences of unintended pregnancy
Demand for shared responsibility in long-term relationships
Forces Pushing Uptake Down
Trust problem: in casual sex, many women won’t rely solely on a partner’s pill/gel
STI reality: condoms remain central for non-monogamous contexts
Male side-effect intolerance: if mood/libido/skin changes are common, adoption will stall. The injectable trial termination shows this is real.
Will Male Birth Control Have Other Clear Medical Uses?
Female hormonal contraception has multiple uses beyond pregnancy prevention: treating dysmenorrhea, endometriosis, PCOS, acne, heavy menstrual bleeding, etc. This expands the user base and insurance coverage.
Male methods don’t have obvious analogs.
Hormonal methods: Could theoretically treat hypogonadism symptoms, but that market is already served by TRT products. There’s no clear “off-label” expansion path.
Non-hormonal pills (YCT-529 class): RAR-α antagonism doesn’t have obvious therapeutic applications in men outside contraception. Retinoids have dermatologic uses, but those work differently.
Vas-occlusive devices: No secondary uses. You’re either blocking sperm or you’re not.
sAC inhibitors: Potentially useful in research contexts, but no therapeutic expansion path is obvious.
Most likely: Male contraceptives will remain single-purpose products. This limits market size, insurance coverage arguments, and adoption incentives compared to female methods.
Final Thoughts on Male Contraception
I’m in favor of new technology. Great to give men optionality and control over whether they impregnate a woman. However, risk seems asymmetrically skewed to the downside until a large cohort serves as guinea pig test subjects for ~5-10 years minimum with each method.
My logic
Female birth control already safe, cheap, with variety.
Long-term effects of female birth control are known.
Male birth control will be more expensive and likely won’t treat any common medical conditions in men.
I’d avoid rushing into novel male contraceptives.
Which of the birth controls would I be most willing to use?
Again, I don’t know the precise biological intricacies of each medication/substance and most haven’t been tested much. Gun-to-my-head I have to use one for years? I’m rolling the dice and going for the vas-occlusion (despite injection-related risks).
The vas-occlusion has minimal hassle, isn’t fucking with hormones, and theoretically should be mostly safe other than if a doctor botches the injection or you have an uncanny reaction. My major concerns with this over an extended term: (1) possible immune reaction to a foreign substance (probably unlikely for most) and (2) possible localized carcinogenic/tumorigenic reactions as a byproduct of inflammation and/or whatever substance sits there for a long time (probably unlikely for most).
If I wanted short-term as needed, I’d consider the sAC inhibitor depending on the mechanistic specifics. The risk with sAC inhibitors is how much of your life you’d spend with sAC functionally inhibited (PK/PD + residence time + tissue exposure). In sAC KO phenotypes this can increase intraocular pressure and kidney stones.
If I couldn’t opt for either of the first two options, I’d go with the NES/T gel and hope for the best. The problems with hormonal suppression here is that we already know it causes mood/behavior changes in men. It can change vigor, attraction, skin, body composition, etc. Additionally, your hormones may not return to pre-NES/T gel baseline (i.e. homeostasis) after stopping. May shrink testicular size while using (something Rich Piana — R.I.P. — touted as a good thing for optimal dick-to-balls ratio). The other risk here is that discontinuation may result in slow recovery to hormonal homeostasis (assuming your hormones do actually recover).
What about the RAR-α pill? I wouldn’t fuck with retinol anything. Vitamin A (retinol) is converted into retinoic acid (RA) and RA is the ligand that activates RAR/RXR nuclear receptors to drive gene transcription. Taking this form of birth control could create a “functional vitamin-A signaling deficit” via RAR-alpha. Even if your “vitamin A levels are normal” you won’t be getting proper signaling and will have no way of knowing the level of signaling you’re getting! RAR-alpha is implicated heavily in immune tolerance, gut-immune programming, myeloid/granulocyte formation, etc. So immune dysfunction, cancer/tumor risk, etc. Not sure why anyone would try this.
The market for male birth control exists: couples where the woman can’t tolerate hormones, guys who want shared responsibility, people in stable long-term relationships who trust reversibility claims.
But for the average guy? Far from ideal + too many unknowns.