FOR Steven Driver, the decision to try out a new male pill was a simple one. His long-term girlfriend had struggled with the side-effects of her own contraceptives for 11 years and he felt it only right that he take his turn.
So, when he heard of a clinical trial in Edinburgh of a male hormonal contraceptive, he did not hesitate. "I thought it was absolutely great, to be honest. Why should it be up to the female to take the pill? It was very effective for me."
But the
re was more to the trial than he anticipated - it was not a straightforward case of taking a daily pill, as women have done since the 1960s. Instead, in a four-year trial, Driver had to endure implants into his arm and stomach, dozens of sperm-count tests and regular hospital visits, not to mention the unpleasant side-effect of temporarily shrunken testicles.
"It did not bother me in the slightest," he insists. "But shrinking testicles was seen to be a stumbling block for some men because of their sense of virility. I think it would put quite a lot of gentlemen off."
The 36-year-old coastal inspector for the Northern Lighthouse Board and his 35-year-old girlfriend Jinan Bottrill were not deterred. He insists he would jump at the chance of taking part in another trial, proud of his place in the vanguard of a new sexual revolution.
The idea of a male pill has been mooted for almost as long as the female pill has been in existence. But despite widespread trials - the biggest taking place in Scotland - progress has been slow, and there have been estimates that it could take a decade before the male pill is in everyday use.
Last week, however, the question of the male pill and its place in a couple's relationship came back into focus as an urgent medical issue. New research revealed that taking the contraceptive pill gives women an overall reduced risk of cancer - but only if they take it for less than eight years. After that, the risk increases.
The scenario this suggests is that at some point early in her reproductive life, a woman will be forced to reconsider what she does for contraception. While the pill may offer the best option for some years, there will come a point - probably when she is in her late 20s or early 30s - when she would be safer changing her method. And what to? If she is still childless she won't want sterilisation. And many won't want to rely on condoms or diaphragms.
This is where her partner could play a vital role if a male contraceptive pill were available. But while scientists appear to have been on the verge of a breakthrough, there seem to be many hurdles yet to cross. So why is it taking so long to develop a male pill? Will men actually take it? And will women trust them to?
In 1961, when the female contraceptive was launched, the biggest question asked by men was whether women could be relied on to take it. Insulting as it seems now, there were genuine concerns.
Now, there are dozens of brands of the female pill offering various formulations and side-effects, and the pill is taken by nearly a quarter of British women aged 16 to 49 - the vast majority of whom take it regularly each day and do not suffer accidental pregnancies.
Yet, according to last week's study, there are pros and cons. The risk of large bowel, uterine and ovarian cancer was up to 12% lower among those women who had taken the pill. But women who used the pill for more than eight years had a higher risk of developing cervical and central nervous system cancers.
So why is there no viable contraceptive equivalent for men? Is it because the area of reproductive health is dominated by women's issues, and men are neglected? Or is there a more pertinent reason - a concern that even if men were willing to take the pill, many women would be sceptical when assured by a would-be lover that there was nothing to worry about.
Rebecca Findlay, spokeswoman for the Family Planning Association, takes an optimistic view and believes men's partners would be prepared to trust them.
She said: "Men want to be involved in contraception, and the only methods currently available to them are condoms and sterilisation. But we know they are happy to take responsibility and women are happy to trust them, such as people in committed relationships.
"If they are not, and a man says, 'don't worry, I'm on the pill', that has to be judged on an individual basis, in the same way that it would for a woman. Trust is important and women should take responsibility for themselves and not necessarily rely on their partner to do so. But we know from the calls to our helpline that men are looking forward to the time when the male pill is available to them. Men are talking about it and asking if they can get it, so we know they are interested in it."
Some observers of the pharmacological industry are less rose-tinted in their view. The male pill might make sense for couples in stable long-term relationships, but what about people who are single and sexually active? Does the male pill have as much relevance for casual sex? On a one-night stand, would a woman - who would quite literally bear the consequences - believe a man who said he was on the pill?
The lack of progress is not a question of sexual politics, insist scientists at the forefront, but more the fact that it is much easier to create temporary infertility in women than men. Put simply, it is apparently easier to stop the production and implantation of a single egg each month in a woman than to stop the production of millions of sperm in men.
One of the biggest hurdles scientists are trying to overcome is producing a pill that has no or few side-effects. While cancer patients may be willing to put up with nausea, vomiting and hair loss in their treatment, because their condition is a matter of life or death, men who are otherwise healthy will not want to take a drug that is going to cause them any ill effects.
Work on a male contraceptive has been under way in laboratories and in trials for several years and scientists have narrowed their efforts down to two potentially viable options: hormonal and non-hormonal.
At Edinburgh University, Driver trialled a contraceptive that consists of two hormones: progestin and testosterone. Progestin stops the pituitary gland making the hormones that stimulate sperm production, while testosterone stops fatigue and hair loss, and replaces the libido.
Much of this was delivered via implants into the skin, because orally delivered testosterone can have serious side-effects, such as liver damage. This is one of the key reasons why male hormonal methods are not seen as user-friendly. Some experts also believe minor hormonal changes can increase the risk of prostate cancer.
Although the trials were extremely promising, and succeeded in making the men temporarily infertile, drug companies have more or less turned their backs on hormonal methods. There was a lack of commercial interest in the Edinburgh University trials, because it took three months before men's sperm count dropped. That was seen as simply too long in a world where the female pill works from day one.
Another development that is showing promise, but which may ultimately be limited, is a non-hormonal pill that works by preventing ejaculation when a man reaches a climax. The prospect of a 'dry orgasm' may not appeal to many men, but the researchers behind the development insist it does not affect sexual pleasure.
Dr Christopher Smith, a biomedical researcher from King's College London, is in talks with three pharmaceutical firms interested in developing his work in this field.
He said: "People are just not going to try methods that involve injections and implants. Men are willing to engage in contraception, but they want something like the female pill, not great big implants."
Some new approaches are being examined by US scientists, and so far they appear much more acceptable to men.
The World Health Organisation and other major funding bodies are investing millions in non-hormonal methods, because they are seen as the safest way to deal with the population crisis in poor countries.
One major project under way and funded with £3.7m from the US National Institute for Child Health and Human Development involves several centres examining ways to stop sperm maturing, to stop sperm mobility and even to stop them being able to penetrate an egg.
Dr Joseph Tash, from the Department of Molecular and Integrative Physiology at the University of Kansas, believes this kind of research is going to be the field that will eventually lead to a viable drug.
"Our focus is on non-hormonal methods, because hormones don't just affect tissue. They affect things such as emotions as well. Our work is on preventing the testes from producing mature sperm, so there's semen but no sperm.
"All this is based on animal work, but we have a pretty good feeling about it."
Tash dismisses the idea of men not remembering to take the pill. He said: "Four decades ago, the question being asked was: would women remember to take the pill? It is most likely to be used by stable couples with a level of commitment. From what we have heard, there's enough willingness from men to participate.
"The problem is the reluctance of pharmaceutical companies to do something new. Most reformulate and repackage old formulations, unless they can come up with a blockbuster. That's the pharmaceutical industry. So it's really down to these trials done by centres and government agencies to pick up where they are leaving off. A drug company will not step in until the drug is ready for major clinical trials.
"I hope in 10 years time we will actually have a few different male approaches."
Even though pharmaceuticals may take their time in getting there, family-planning experts are keen to see as many new developments in the field as possible, because the key philosophy in contraception is choice. The more choices there are, the theory goes, the fewer unwanted pregnancies there will be.
For example, just 1% of British women use a diaphragm, but it is still seen as the best choice for the few who do use it.
Driver is more cautious about whether many men will follow in his footsteps. "We are now back to using various methods of contraception," he said. "I would definitely do it again. For it to work, you have to be cautious and prove that it is an effective method. But what would be a stumbling block is the male psyche - it's not seen as right to stand up and be the one to do these things. A lot of guys don't see it as macho. And until that changes, it's going to be a niche market."
The full article contains 1872 words and appears in Scotland On Sunday newspaper.
