The great gap in male contraception

Pill, patch, vaginal ring, injection, implant, intrauterine device… The range of contraceptives available to women has continued to expand over the decades. For men, however, the options are still largely limited to two methods: condoms and vasectomy.

The first is reversible and also provides something no other contraceptive can replace: protection against many sexually transmitted infections. Vasectomy, on the other hand, is highly effective, but it is intended as a permanent method. Between those two extremes lies a space that, despite decades of research, remains largely empty: a reversible, effective male contraceptive controlled directly by the person using it.

The search is not new, but it has gained fresh momentum. In 2026, the World Health Organization (WHO) published a specific framework to guide the development of these methods and this month is also examining what characteristics they would need for men and women to be willing to use them.

The question has been around for years: if the female contraceptive pill has existed for more than half a century, why do we still not have an equivalent for men?

The first obstacle lies in biology itself

The comparison with the female pill may seem logical, but the biological processes each method would need to target are very different. Many female hormonal contraceptives prevent pregnancy by stopping ovulation. In the male body, however, there is no single monthly event to block: the testes produce millions of sperm continuously.

That means the problem has to be approached differently. One possibility is to suppress spermatogenesis until sperm counts fall sufficiently; others aim to alter a function essential for fertilization or prevent sperm from reaching the semen. Hormonal approaches have shown for years that the first option is possible, although achieving it without affecting other functions in the body requires a careful balance.

Sperm production depends on very high concentrations of testosterone inside the testes, but the hormone also plays roles that extend far beyond fertility. That is why some experimental methods combine a progestin, which helps suppress sperm production, with enough testosterone to maintain adequate levels elsewhere in the body.

There is another difficulty: the contraceptive effect cannot happen overnight. Producing a sperm cell takes weeks, and the body also needs time to restore production after treatment is stopped. Determining whether a method works therefore involves studying both how long it takes to achieve its effect and how fertility recovers afterwards.

The “male pill” is not just one pill

This helps explain why the male pill has seemed to be “just around the corner” for years without ever quite arriving. The term covers very different strategies, some hormonal and others that do not attempt to replicate the way female contraceptives work at all.

One of the candidates to attract the most recent attention is YCT-529, a non-hormonal oral compound that targets retinoic acid receptor alpha, which is linked to vitamin A and is necessary for sperm production. The aim is to interfere temporarily with that process without directly altering testosterone levels.

The first results in humans were published in 2025 from a small trial involving 16 men who received single doses. At that stage, the goal was not yet to demonstrate that the compound could prevent pregnancy, but to assess its initial safety and how it behaved in the body. No relevant changes in testosterone, sexual desire or mood were observed in association with the doses administered.

Development has since moved into a phase 1b/2a trial using repeated doses, where researchers are now studying what happens to sperm count and function when treatment is maintained. Even so, there is still a long way to go before it is clear whether it could become a contraceptive for routine use: its effectiveness, longer-term safety and whether fertility returns predictably after treatment is stopped will all need to be established.

And the first new method may not even be a pill

Focusing the entire conversation on a pill overlooks one of the male contraceptives that has progressed furthest in clinical development: a gel combining segesterone, also known as Nestorone, and testosterone, applied daily to the skin.

Segesterone reduces the hormonal signals that maintain normal sperm production, while the testosterone in the gel is intended to preserve adequate levels of the hormone throughout the rest of the body. The treatment has been tested in an international trial involving couples who used it as contraception while researchers assessed its effectiveness, safety, reversibility and acceptability.

The phase IIb study has now been completed. And the fact that one of the most advanced options is a gel highlights something that is often lost when we talk about the “male pill”: the next alternative to condoms and vasectomy may not come in pill form at all.

Other methods aim to target sperm directly

Hormones are not the only route being explored. The WHO framework includes strategies designed to reduce sperm production, alter sperm function or temporarily block their passage through the vas deferens.

This last approach is intended to occupy precisely the space between condoms and vasectomy. While vasectomy is regarded as a permanent procedure, even though reversal may sometimes be attempted, newer occlusion systems aim to prevent sperm from reaching the semen temporarily.

Researchers are also investigating molecules that target sperm motility, maturation or other mechanisms required to reach and fertilize the egg. If any of them can demonstrate sufficient efficacy, they could make it possible to develop a contraceptive without altering the hormonal system.

Effectiveness alone is not enough

Getting a male contraceptive to reduce sperm production effectively is only one part of the challenge. For it to become a viable option, it would also need to be shown to be safe, reversible and simple enough to fit into everyday life. That threshold is particularly high because it would, in principle, be used by healthy people.

This brings in questions that go well beyond efficacy: the time needed to achieve a contraceptive effect, how long fertility takes to recover after stopping the method, how often it needs to be used and what side effects it may cause.

The debate around acceptability also introduces a comparison that is difficult to ignore. Female contraception has relied for decades on methods that may require daily use, medical procedures or the acceptance of certain side effects. Some of those same issues are now being treated as decisive factors in determining whether a male contraceptive could succeed beyond clinical trials.

The WHO is studying precisely how factors such as route of administration, frequency of use and possible side effects influence acceptance. A daily pill is not the same as a gel, a periodic injection or a longer-lasting procedure, and preferences may also vary depending on the confidence a method inspires within a couple. A contraceptive can perform well in a clinical trial and still have limited real-world potential if the people who could use it are unwilling to incorporate it into their everyday lives.

A gap that has remained open for decades

The question of acceptability becomes even more important when the starting point is considered. Male contraceptive options are still concentrated at two very different ends of the spectrum: condoms, which are reversible, accessible and essential for preventing sexually transmitted infections, and vasectomy, which is highly effective but intended for people who do not wish to have children in the future.

That is precisely the space the methods currently under development are trying to fill. A pill, a hormonal gel or a reversible system targeting the vas deferens would not necessarily replace condoms or compete directly with vasectomy. Their role would be different: to expand the available choices and give men a way to control their own fertility directly without resorting to a permanent option.

None of the candidates currently being studied makes it possible to speak of a new male contraceptive becoming available in the short term. What has changed compared with earlier attempts is that some have moved beyond the laboratory and are now being tested in people. After decades of talking about “the male pill”, the future may therefore depend not on finding a single equivalent, but on something closer to what already exists for women: several different methods, with different characteristics, capable of filling a contraceptive gap that remains largely empty.