New hope in the search for a male contraceptive

New hope in the search for a male contraceptive

Scientist looking at a beaker.  (Image: Artem Podrez of Pexels.)

Hallelujah and congratulations to the Norns, it looks like there might finally be an effective form of AMAB birth control on the horizon. It’s fast-acting, effective, and free of the terrible side effects that caused the last AMAB birth control to be canceled! It’s a dream come true, especially for potentially fertile couples where hormonal birth control isn’t on the table for the AFAB partner, but neither person is ready to end their fertility for good just yet. .

The potential contraceptive was discovered almost by accident in 2018, while testing an experimental drug for the treatment of eye diseases. It works by stopping sperm development in its tracks. But the effect only lasts for a limited time: two and a half hours in mice, with twelve hours projected in humans. This allows normal sperm development to resume within a same-day window. Best of all, no hormonal manipulation is needed, as the drug instead targets an enzyme, soluble adenylyl cyclase (sAC). It appears that the sAC can be safely blocked for discrete periods of time without any ill effects on the subject.

How it works?

The idea came to Melanie Balbach, then a postdoctoral researcher at Weill Cornell Medicine, when a colleague asked for her help during the animal experimentation phase of her project. Although the drug is intended to treat eye disease, Balbach was aware that the biochemical process it was targeting is crucial for male fertility. She agreed to participate in exchange for permission to examine the impact on the fertility of the mice tested. The results were revolutionary: the total immobility of sperm. A colleague described Balback’s findings as “the holy grail” in the search for an effective male contraceptive.

The two most exciting parts of Balbach’s discovery are the apparent safety and reversibility of the contraceptive in question. Most of the previous research on AMAB contraceptives was based on hormones, which, due to the development cycle of sperm, can only be used as a long-term method. These methods also take several weeks to take effect. Hormonal contraception can also be dangerous, although still less dangerous than pregnancy itself. Yet, there is a small percentage of serious or even fatal results for users of established AFAB-specific methods.

However, since pregnancy and related risk factors are not a possibility for AMAB patients, the acceptable level of risk for an AMAB hormonal contraceptive is set at a lower level than the standard for AFAB birth control. . There is no equivalent to the dangers of pregnancy to offset it. Add to that the fact that AMAB hormonal contraceptive research lags AFAB decades behind, and the severe psychiatric effects seen in a small percentage of users in the canceled study that exceeded even what would be allowed in a AFAB pill, and a safe and effective hormonal method could still be a decade or more away.

Meanwhile, the contraceptive proposed by Balbach would be an “on demand” method. The contraceptive allows AMAB people and their partners to have spontaneous, safe sex and then immediately start trying to conceive the next day if they decide that is what they want. Even better, it seems that the risk of negative side effects is minimal. The study that inspired Balbach to try his experiment featured two cis men who lacked the gene that allows the body to produce sAC. The main negative outcomes were infertility and an increased risk of kidney stones, which is likely the result of long-term absence or inhibition of the sAC, rather than the result of turning it off and on again ( so to speak) for short periods. .

Long to come

Infuriatingly, the impact of sAC on male fertility has been known for some time – almost twenty years, in fact. However, pharmaceutical companies lost interest in this drug almost immediately, largely due to the widespread belief that cis men simply did not want the pharmacological contraceptives they were responsible for taking. Add to that concerns about inhibiting these types of enzymes in the event of unforeseen side effects, and sAC was put on the back burner until Balbach had a chance to test his hypothesis.

Now, with the loss of Roe vs. Wade sparking interest in AMAB-specific birth control, the environment is very different. Weill Cornell lab co-directors Jochen Buck and Lonny Levin have enough confidence in Balbach’s discovery to found a startup, Sacyl Pharmaceuticals. The startup will try to produce a viable AMAB birth control pill.

Unfortunately, the contraceptive is still a few years away from human testing. We’re all going to be stuck with the birth control we’re using now for some time to come. But all the same, it is an exciting discovery. And in the meantime, another non-hormonal contraceptive for AMAB users should be tested later this year. So an alternative may become a possibility sooner than we think.

(Featured image: Artem Podrez via Pexels)

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