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A birth control pill for men includes a side effect that has frustrated women for decades

From oral contraception, to the IUD, to the patch, women have numerous options for birth control. Those same non-permanent options have been limited to men. (Video: Victoria Walker/The Washington Post)

This story originally published on the Lily.

It’s been more than a century since Margaret Sanger opened the first birth control clinic in the United States, and nearly 60 years since the first oral contraceptive was approved by the Food and Drug Administration. In 1965, the Supreme Court gave married couples the right to use birth control under the landmark court case Griswold v. Connecticut. It took until 1972 for birth control to become legalized for use among all citizens of the United States, whether they were married or not.

Since then, more options have emerged: IUDs, the Depo-Provera shot, the sponge, the ring, the patch. Birth control today is still far from perfect, but many rightly contend that access to the pill was the match that lit the fire of women’s liberation that is still burning today.

This week marks a new addition to the annals of contraceptive history: dimethandrolone undecanoate, a potential new birth control pill for men, is being touted as the “best hope” for a nonpermanent male contraceptive option yet.

Developed with funding from the National Institutes of Health by a team at the University of Washington, the formula is a tweaked version of previous failed attempts.

While it comes with caveats — the pill must be taken with food to be effective, tests showed that usage had slight negative effect on cholesterol levels and over time might raise the risk of heart disease — right now the drug has shown itself to be safe for short-term use. (The next step? A trial that will show whether the pill decreases sperm production, followed by another test that will measure its efficacy in control groups of married and long-term partnered men.)

But dimethandrolone undecanoate also comes with a side effect that has been frustrating women for decades. It caused men to gain weight  —  a fact that couldn’t help but make this woman wonder whether that will be the latest reason that the responsibility for preventing pregnancy will continue to rest largely on the shoulders of women.

The truth is, while the advent and evolution of birth control has fundamentally reshaped women’s place and participation in culture, for that to happen, women had to be willing to take on a certain level of risk and potential downsides.

Enovid, the first brand of birth control, which contained more hormones than necessary to prevent pregnancy, was linked to an increased (though rare) likelihood of heart attack and stroke. It took a decade for scientists to recognize those risks and reformulate a pill with a lower dose of hormones that was just as effective.

In the interim, for some women the costs — weight gain, water retention, nausea, dizziness, breast tenderness, headaches, vomiting — outweighed the benefits. For others, at a time when an abortion was either illegal or difficult to obtain, the downsides were worth it, if it meant not getting pregnant. It took congressional hearings, in 1970, to compel the FDA to include in each pack of pills a package insert detailing the potential side effects — a practice the American Medical Association initially opposed.

(The AMA contended that an insert would undermine a doctor’s authority with “his” patients. At the time, female physicians made up less than 10 percent of the field, which might in part be an explanation for why it took so long for women’s complaints to be taken seriously.)

Years later, the Dalkon Shield IUD would become another example of a birth control product ultimately deemed to pose too high a risk to women’s health, after hundreds of thousands of women sued the makers for knowingly marketing a product that increased the potential of life-threatening pelvic infections. It took decades for IUDs to recover as a preferred option for American women, and today women still have reason to be concerned that they don’t have all the health facts.

Then there’s the stress that women have endured, largely on their own, not just because of the risk factors but also because of the burden of responsibility to prevent pregnancy itself. This is unlikely to ever appear on a package insert, but taking a pill every day, or getting a shot every month, or changing an IUD every few years takes planning, access to medical care and financial resources. At a time when women’s reproductive rights are under siege and public health resources such as Planned Parenthood are fighting to keep funding, many women are finding their options strained.

It’s mentally draining, all this flux that could leave women in the lurch, which is another weight on our shoulders that often goes unacknowledged. Add standards of beauty and the pressure to maintain a certain size and shape to the mix, and it’s not particularly surprising that women are twice as likely to have an anxiety disorder as men.

Will dimethandrolone undecanoate make it to market and help rebalance the scale a bit?

I, for one, am hopeful. I like the idea of giving women — and their partners — more choices for family planning. I like the idea that men would have more power, and more accountability, when it comes to the prevention or the pursuit of pregnancy. I like the idea of a culture in which men can’t allege that a woman “trapped” them into fatherhood because they, too, had the ability to make an autonomous birth control choice beyond a condom. Where men also have to weigh whether their choice of birth control is worth the effect it could have on their physique, and whether that potential downside might make them a less desirable sexual partner.

I would never wish a birth control product on men that was anything less than optimal. I am grateful that men will benefit from the medical advancements and knowledge gained since the first oral contraceptives were brought to market, 58 years ago. But I also wonder whether the tip of the scale, both literal and otherwise, might be a good reminder for men who have had the luxury of a particular kind of privilege, and freedom: that women have been pulling this extra weight all along.


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