Shoot Your Shot: Is Male Birth Control Finally Here?

00:00:25
Dr. Kaylee Byers: It’s one of those things that’s been almost here for a very, very long
time. For decades, we’ve heard that male birth control is just a few years away, and
then just a few more, and then a few more.

00:00:41
Clip 6: Why do you think it’s taken so much longer for us to develop male birth control
as opposed to female birth control?

00:00:47
Clip 7: I don’t know. I don’t actually know. It’s damn time, though.

00:00:50
Clip 8: Because men are big babies a lot of the time, and we do put the onus of birth
control and reproduction and all that stuff on women.

00:00:58
Clip 9: I don’t know, but my assumption would be because female birth control already
exists, maybe male birth control hasn’t felt like as much of a priority.

00:01:10
Dr. Kaylee Byers: Making birth control for sperm-producing people is not exactly
simple. There are some pretty big reasons we haven’t seen it on the shelves yet, and
they’re not all scientific. But now, after years of starts, stops, and maybe this time, we
might finally be getting close. So what’s all the holdup been about? What could male
birth control actually look like? And if these options do become available, could they
really turn contraception into more of a team sport?
You’re listening to Nice Genes! The podcast that busts out the genomic stories shaping
our world, brought to you by Genome British Columbia. I’m your host, Dr. Kaylee Byers.
Let’s talk about sex. From an evolutionary perspective, passing your genes on to the
next generation is kind of the whole name of the game. In over millions, nay, billions of
years, if you can have a lot of babies and they live long and prosper, well, you’re living
that natural selection dream, baby. But even though sex is a fundamental part of life,
humans have a bit of a complicated relationship with that particular evolutionary
imperative, because while we love making babies, we’ve also spent a very long time
trying to master the art of not making them. And let me tell you, our ancestors got
creative. Condoms, for one, have been around for a very long time. We have evidence
of ancient Egyptians using linen, Romans using sheep and goat intestines, yum, and
ancient Chinese civilizations using silk. How effective they were, hard to say. But hey,
gold stars for industriousness. And when it came to preventing pregnancy on the female
side, well, things got more adventurous and also dangerous. Some early approaches
included people inserting crocodile dung up there, drinking lead-contaminated
blacksmith water, consuming mercury, and my personal favorite, a reported practice
from New Brunswick involved dried beaver testicles steeped in alcohol.

00:03:30
Clip 10: One extra dirty beaver testini coming right up.

00:03:33
Dr. Kaylee Byers: So yes, contraception has not always been exactly evidence-based.
But then in the 20th century, scientists started figuring out what was actually going on
inside the reproductive system. And in 1960, the FDA approved the world’s first oral
contraceptive. And just like that, the pill was born. Today, people who can become
pregnant, and who have access to contraception, have an entire list of options: pills,

injections, implants, IUDs, patches, rings, you name it. But for the folks serving up the
sperm, the menu is considerably shorter.

00:04:14
Dr. Premal Patel: Generally, it’s going to be either condoms or a vasectomy at this
point.

00:04:19
Dr. Kaylee Byers: To get us in the mood for some reproductive health, here with me is
Dr. Premal Patel. He’s a urologist who specializes in men’s health and an assistant
professor at the University of Manitoba. Well, before we get started, the most important
question of this entire conversation is, have you had donuts from Oh Donuts?

00:04:40
Dr. Premal Patel: Of course. Love them.

00:04:42
Dr. Kaylee Byers: They’re so good. I would move to Winnipeg for Oh Donuts.

00:04:45
Dr. Premal Patel: Oh, it’s so good.

00:04:45
Dr. Kaylee Byers: I love Oh Donuts so much. Dr. Patel, welcome to the pod. Today
we’re talking about male birth control, and as a female, birth control is a very early
conversation. You’re talking about birth control pretty much as soon as you are
reproductively able. It’s a conversation. So what are the options for males when it
comes to birth control?

00:05:10
Dr. Premal Patel: So currently, when we think about what options actually exist, the
mainstay option is a vasectomy. So it’s either going to be getting a vasectomy done, you
can use condoms of course, which also has the added benefit of STI prevention as well.
There’s other methods such as pullout and so forth that have less success rates.

00:05:26
Dr. Kaylee Byers: Yeah, that last one, one that I was definitely warned against.

00:05:29
Dr. Premal Patel: Yes. Yes, 100%.

00:05:30
Dr. Kaylee Byers: It’s like unreliable form of birth control.

00:05:33
Dr. Premal Patel: Absolutely.

00:05:34
Dr. Kaylee Byers: Well, okay, so let’s talk about vasectomies. So what exactly happens
during a vasectomy?

00:05:40
Dr. Premal Patel: Yeah, so when you think about a vasectomy, generally speaking, it’s
a very, very straightforward procedure. It takes about 15 minutes to do in the office.
How we do it is that we make one small cut in the scrotum to get to the vas deferens,
which is like these tubes that deliver the sperm. We get that vas and then we cut it. We
may clip it, like put some titanium clips on it to block the sperm flow, or we cauterize the
edges. So there’s different ways we do it, but the whole goal is very simple. All you’re
doing is blocking the transport of sperm. There’s two sides, so two testicles, so we have
to block both sides. And then after the procedure, you generally don’t require any
stitches. We tell people you just have to take it easy for about a week, but it does take
some time for sperm to clear out of the system. So that’s usually about two to three
months where we will do a sperm test just to make sure it’s been successful.

00:06:30
Dr. Kaylee Byers: Before we get too deep into the vas, a little male bio 101 might be
helpful. The testicles are where sperm are made through a process called
spermatogenesis. And this is where our genes play a key part. Your DNA contains the
instructions for making sperm. And during sperm production, cells go through a special
kind of cell division called meiosis, which gives rise to our gametes or sex cells, like
sperm. And in the process, each sperm gets half of the genetic information needed to
make a new human. We’ll come back to that little genetic trick later, but once the sperm
are made, they travel through a series of tubes, including the vas deferens, or as Dr.
Patel so coolly calls it, the vas, and that’s the part a vasectomy is targeting. You’re not
stopping the body from making sperm, you’re just putting a roadblock up that says,
“Apologies swimmers, this lane is closed. Please vacate the swimming pool.” What is
the success rate for vasectomy?

00:07:36
Dr. Premal Patel: It’s over 99%.

00:07:37
Dr. Kaylee Byers: Over 99%. How many… I don’t expect you to actually have a
number, but I’m curious. How many procedures are there in medicine that are this
straightforward, that 15 minutes, you’re in the office, you’re out, has a really high
success rate? It feels not that common.

00:07:53
Dr. Premal Patel: Yeah, no, for sure. So many misconceptions or things about
vasectomy that, not to downplay a procedure, it’s easy for me to say it because we do it
all the time and I can understand patients are anxious and so forth, but generally
speaking, this is probably one of the simpler procedures we do as urologists. It’s a
bread and butter procedure and has less risk than a lot of other procedures we do.

00:08:13
Dr. Kaylee Byers: I’m sorry, but bread and butter is a hilarious way to refer to
something that involves ejaculation. Okay, so we talked a little bit about those
misconceptions. Can we get into them a little bit more? What are some common myths
that you see when folks come into office around getting a vasectomy?

00:08:31
Dr. Premal Patel: Okay, so number one, men, some of them, not everyone, assume
that they will not ejaculate anymore, that nothing will come out. The thing is most of
ejaculation actually comes from somewhere else, like your seminal vesicles, which
actually provide nourishment to the sperm. So when you actually block the vas, there’s
no difference in the quantity or the consistency of your ejaculate. So I think that’s one of
the biggest misconceptions. Number two, always concerns about that it will drop your
testosterone values, that it’ll lead to erectile dysfunction. Both are untrue. Other
misconceptions are is that, and this one has been actually studied, prostate cancer, is
that men who’ve had vasectomies have a higher risk of prostate cancer. That’s been
disproven. I guess the other piece is that people often wonder, as you mentioned, about
the success rate, so how successful is a vasectomy? Even after having a successful
vasectomy, the chance of sperm coming back is actually one in 2, 000. So there’s still a
chance that people can get pregnant years after having had a vasectomy. It’s just not
very common.

00:09:33
Dr. Kaylee Byers: But vasectomies are also reversible, correct?

00:09:36

Dr. Premal Patel: Yeah, absolutely. And that’s actually a big misconception, too, about
the success rates about a vasectomy reversal. So I do quite a bit of vasectomy
reversals, and the success rates can be actually over 95%.

00:09:45
Dr. Kaylee Byers: Oh, wow.

00:09:45
Dr. Premal Patel: Yeah. So if you’ve had a vasectomy less than 10 years ago, your
success rates of getting sperm back in your ejaculate can be over 95%.

00:09:54
Dr. Kaylee Byers: So vasectomies sound like a pretty good option. What are the other
ones?

00:10:00
Porky Pig: That’s all, folks.

00:10:06
Dr. Kaylee Byers: And even if it’s a pretty straightforward, reversible procedure, it’s still
a surgery and many people feel like it’s more commitment than they’re looking for. If you
compare it to something like the pill, you don’t really have the same level of control to
just decide to stop taking it. So the question becomes, for people with ovaries, we’ve
had the pill for 60 years, so why don’t we have an equivalent hormonal option, say, for
men?

00:10:34
Dr. Premal Patel: I think it stems a lot of it that nothing’s ever been really industry
focused. A lot of innovation always comes from industry because that’s where the big
bucks are when it comes to medical technology and medical innovation and so forth. So
a lot of it probably had to do with the fact that they didn’t feel that there was a market.
But the flip side is actually studies have shown this, that actually a number of men are
willing to take some sort of male contraceptive option. So I think when it comes to why
there’s never really been something that took off, it’s just industry has never felt that
there’s been a market there, but the signal is that men are interested in that option, but
it’s only been in the past few years now that there’s all this research coming out into
oral, hormonal, non-hormonal, and even different sort of injectable options that are
going through trials right now. So it’s coming down the pipeline and these things are
showing promise.

00:11:21
Dr. Kaylee Byers: Coming down the pipeline. You cannot make this stuff up.

00:11:23
Dr. Premal Patel: I thought you’d like that one.

00:11:24
Dr. Kaylee Byers: It’s incredible. Yeah, thank you so much.

00:11:25
Dr. Stephanie Page: I have this one that… Oh, I have to probably plug it in again. Ah-
ha.

00:11:35
Dr. Kaylee Byers: That is Dr. Stephanie Page.

00:11:37
Dr. Stephanie Page: Mic check one, two, but then I need to move my-

00:11:39
Dr. Kaylee Byers: She’s a professor of medicine and endocrinology at the University of
Washington in Seattle.

00:11:43
Dr. Stephanie Page: And I did a PhD in immunology right about the time the Earth
cooled. So I’ve been here since 1991 and have been working in the field of male
reproduction and development of male, primarily hormonal contraception for going on
25 years now.

00:12:01
Dr. Kaylee Byers: And with that breadth of experience, she’s seen firsthand the ebbs
and flows of getting these new options that, as Dr. Patel so eloquently put it, are coming
down the pipeline. So Dr. Page, this field has progressed and maybe in some ways it’s
regressed. Can you give us a little bit of a history of how we got to where we’re at?

00:12:21
Dr. Stephanie Page: Yeah. The history of male contraceptive development really goes
back to the ’70s and ’80s when the WHO, the World Health Organization, and a few
other nonprofits, were heavily invested, including some governments, in developing
male contraceptive methods. And at that time, even big pharma was investing in the

research to develop these kinds of products. Unfortunately, fast-forward to the 2000,
2010 era, and funding from governments really slowed down and funding from big
pharma essentially evaporated. The good news is in the last two to three years, there’s
been interest from venture capital pharma. And so now we’re seeing as some products,
and we’ll talk about this, have gotten closer to making it to the marketplace, there has
been some recent investment from new places, which is really exciting.

00:13:19
Dr. Kaylee Byers: But even if you throw some money at the problem, you still have to
contend with biology. And when we compare female to male targets for contraception,
we’re talking one egg a month to, well…

00:13:31
Dr. Stephanie Page: Men are actually making about a thousand sperm a second, so an
enormous number of sperms. So a normal ejaculate has between 20 and 200 million
sperm per milliliter. So we’re talking 60 million to 600 million sperm in a normal male
ejaculate. So there are a lot of sperm, and part of it is a numbers game. And so in the
early era, so again in the 80s, those WHO studies were critical in helping us
understand, when we try to develop a hormonal method that relies on decreasing the
number of sperm, did we need to get that number to zero or was it okay to have a few?
And it turns out actually that if we can reduce sperm production to less than a million
sperm per milliliter, that’s actually commensurate with effective contraception.

00:14:25
Dr. Kaylee Byers: In other words, the sheer number of sperm makes this a pretty
formidable task, but thanks to research that goes all the way back to Woodstock days…

00:14:36
Clip: Groovy, man.

00:14:36
Dr. Kaylee Byers: … researchers have found some pretty clever ways around it. So
okay, two hurdles: money and biology. But there’s one more big one that’s made male
contraception such a tough nut to crack. Something else I thought has been really
interesting in this conversation is when we’re thinking of new drugs or interventions, it’s
this cost-benefit ratio and how those differ if you are hosting the eggs and then
pregnancy or hosting the sperm. Can you talk to us a little bit about that, too, and what
goes into those calculations?

00:15:10

Dr. Stephanie Page: You bet. So people often ask, well, why is there such a focus on
female methods and why is it taking so long for male methods? And I think that really is
about exactly what you’re asking, which is risk-benefit. So it’s really important to
recognize that women bear the risk of pregnancy, and pregnancy is a life-threatening
condition. And so appropriately, making sure that women had agency over their bodies
and over their reproductive health was of paramount importance. So that’s one way of
looking at it, but now that we have effective female contraceptives, and some women
can’t use those for a variety of health reasons or other reasons, I think it’s important to
start to think about the couple as a dyad. So if you think about men and the risk-benefit
for them of a pregnancy, you would almost want a method that had absolutely no risk.
Because from a physical standpoint, the man has no health risk for fathering a
pregnancy. They do have social risks, mental health risks, economic risks, risks that are
difficult to quantify, but nonetheless, they don’t have a specific health risk from fathering
a pregnancy. So that makes it challenging. Almost no drug we have on the market has
absolutely no side effects in 100% of people. That’s just impossible. But if we start to
think about this as a dyad of two people, and what is there together their risk and their
benefit, that brings the bar to a different place for male contraceptive.

00:16:44
Dr. Kaylee Byers: This may be the most fundamental shift, a change in how we think
about contraception. Instead of viewing pregnancy prevention as something that
primarily falls on the person who becomes pregnant, we’re starting to see it as, well,
everyone’s responsibility. I really hate to say that that’s actually some innovative way of
seeing pregnancy, but with that kind of shift in thinking, we may finally be blasting off
into the future we’ve all been hearing about for so long.

00:17:13
Dr. Stephanie Page: We have been giving the same answer for a while, which has
been, oh, I think 10 years. I actually do think that we are at the precipice.

00:17:23
Dr. Kaylee Byers: After the break, what new approaches are really on the rise? What
might actually be available, and when? And of course, how genomics is a key player in
the game.
You’re listening to Nice Genes! A podcast all about the fascinating world of genomics
and the evolving science behind it, brought to you by Genome British Columbia. I’m
your host, Dr. Kaylee Byers, and we want to get more people to listen to the genomic
stories that are shaping our world. So if you like Nice Genes! hit follow on Apple

Podcasts or wherever you get your shows. If this episode has you fired up, leave us a
review or shoot it over to whoever you think could use a little scientific action.
There are a number of new drugs in development right now. One in particular that is
maybe one of the furthest ahead is a hormonal option that Dr. Page has been
developing for years. And I think you’re ready for this jelly. One option that you’ve been
working on in this space is a gel. Is it nestosterone? Nistosterone? Nestosterone.

00:18:37
Dr. Stephanie Page: It’s a combination gel using a progestin called Nestorone plus
testosterone. So we call it Nes-T.

00:18:45
Dr. Kaylee Byers: Oh, incredible. How does Nestea the beverage feel about that?
Have you communicated with them?

00:18:51
Dr. Stephanie Page: Well, surprisingly enough, no. But when they hear this podcast,
they might be contacting you.

00:18:57
Dr. Kaylee Byers: So what have you learned through the clinical trials so far?

00:19:01
Dr. Stephanie Page: So we’ve actually completed a phase two study of this gel, which
means we’ve evaluated it to prevent pregnancy in over 400 couples at 17 sites across
the globe. And the men put the gel on every day after they shower, it’s important that
they use it every day, and their sperm count gradually goes down. So it reaches this
either zero or less than a million, usually in about eight to 12 weeks. And at that time,
the couple starts to rely on the gel for contraception, and then we evaluated over the
course of a year how many pregnancies ensued. So I can share with you that the
results were very, very encouraging, and actually that resulted in the prototype product
being licensed by a company, which is going to take it to a phase three study. And
phase three studies are the big studies that are required for a product to get to the
market.

00:20:01
Dr. Kaylee Byers: Is the gel applied to the testicles?

00:20:04
Dr. Stephanie Page: Absolutely not. There’d be pros and cons to that, but nonetheless,
it’s not. It’s actually applied to the shoulders. The skin on the scrotum is very, very thin.
So yes, do not put it on the testicle. And importantly, should not be applied by the
partner because we don’t want a woman being exposed to that amount of testosterone.
So the man puts it on and then washes his hands. So men just work it into their routine.
They put it on after they shower or before they go to work or whatever works for them.
So it’s pretty straightforward.

00:20:46
Dr. Kaylee Byers: Birth control and a way to loosen up your shoulders? Sounds like a
win-win to me. This new gel is one of the hormonal methods that’s showing a lot of
promise, but a gel, or hormones in general, might not be everyone’s cup of Nestea.
Lucky for us, though, there are a number of other non-hormonal approaches in the
works. For starters, a more temporary vasectomy.

00:21:10
Dr. Stephanie Page: So instead of snipping the two tubes, in this case, the idea is to
put in a gel that would be injected and then would either gradually dissolve or could
dissolve with a re-injection of a solvent. So that is a very active area. Those studies are
in phase one, meaning very early, but in human studies.

00:21:33
Dr. Kaylee Byers: Or a pill that’s on-demand.

00:21:35
Dr. Stephanie Page: So the idea is that men would take a pill maybe two or three hours
before intercourse, and that when they ejaculated, their sperm would not be able to
swim, and then the medication would wear off within a day or so.

00:21:50
Dr. Kaylee Byers: Another option explores how to slow sperm production using retinoic
acid.

00:21:55
Dr. Stephanie Page: Instead of using hormones to do that, it turns out a compound
called retinoic acid is required for sperm production, and there’s a couple approaches to
trying to reduce the amount of retinoic acid in the testicle.

00:22:08

Dr. Kaylee Byers: And even an option for a dry ejaculate.

00:22:12
Dr. Stephanie Page: Most people think, “Wow, men would never put up with that. They
wouldn’t like that.” And that may be the case, but certainly they haven’t encountered that
yet. And maybe some men would like that, or their partners would. We don’t know.

00:22:22
Dr. Kaylee Byers: Yeah. People are into all sorts of things. What I’ve learned is there’s
no blanket statements, right? Some people might like that.

00:22:28
Dr. Stephanie Page: Exactly.

00:22:29
Dr. Kaylee Byers: Some people might not. And finally, there’s the approach making
headlines out of Cornell University, and this one is getting right into the genetic business
of making sperm.

00:22:41
Dr. Stephanie Page: So the work that’s going on at Cornell is to try and make inhibitors
of an enzyme called soluble adenylate cyclase, and that is an enzyme that is relatively
specific for sperm. So they came upon that in part from doing genetic screens of
animals, but then what often happens in those cases is you try and find a person or a
family that has a similar genetic variant in that particular enzyme, and some of the men
in that family were infertile. And the Cornell group is trying to develop molecules that
inhibit that enzyme with the idea of developing on-demand male contraception. So full
disclosure, I’m collaborating with that group to help them develop their first clinical trial.
But the point in terms of the genetics is that one of the ways to validate that a gene that
is required for fertility in mice is relevant in humans is to find individuals that have
variants in that gene and look at their phenotype, hoping, not for their sake but for a
proof of principle, that those individuals have a reproductive phenotype.

00:24:03
Dr. Kaylee Byers: Remember that genetic trick from earlier? Our genes are basically
the instruction manual for making sperm. Well, Cornell researchers are asking, “What if
we could interrupt those instructions?” They’re focusing on meiosis, and by using mice,
they used a molecule called JQ1 to interfere with the molecular machinery controlling
that process. And as a result, the mice stopped making sperm. Plus, when they ended
the treatment, sperm production came back and the mice were able to father healthy

offspring. Now, the team is looking for specific genes involved in that process that they
could potentially target. So thanks to genomics, they’re working towards a non-
hormonal, fully reversible way to stop sperm production at the source.

00:24:49
Dr. Stephanie Page: Yes. Well, it does always come down to the genes. So genomics
have played two very key roles. The first is that when we’re trying to develop male
contraceptives, one of the ways of thinking about that is to say, what’s a protein or
enzyme that is absolutely specific for the testis? Because we want to develop things
without side effects in the rest of the body. And so the identification of genes that are
specific in sperm or in the testis, and then knocking them out in mice and finding the
phenotype of infertility, has been a cornerstone of trying to develop novel molecules and
novel approaches. So that’s been foundational in the field. And then in terms of
hormonal contraceptives, there are some men, very few, about 5%, who don’t have
optimal responses. So we don’t know why some men don’t reach those sperm
thresholds and others do. And we haven’t had the numbers of people in these studies
yet to study them, but the first approach to that would be to look at genome similarities
that are more concentrated in the less responsive individuals than those who do
respond. So that will be exciting in the future.

00:26:11
Dr. Kaylee Byers: So genomics can help us develop contraceptive targets and
understand why some hormonal contraception works differently in different people. And
there’s also a larger piece to this whole conversation; because as much as we’ve been
talking about not having babies, the fields of contraception and fertility go hand-in-hand.

00:26:32
Dr. Stephanie Page: The intersection between contraception and infertility can’t really
be overemphasized, and there has been a lot more work on male infertility in the last 15
years than there ever has been before. And so as we learn more about the genetic
causes of male infertility, those actually can be targets for the development of new
contraceptive approaches. So I think there is a really exciting time coming in male
reproduction where the genomic data is really helping us inform these therapeutic
approaches.

00:27:02
Dr. Kaylee Byers: But even if we are learning more about male infertility, this is actually
a space that’s been left behind.

00:27:08

Dr. Premal Patel: I think from a society perspective, it’s always though of that, well, if
there’s a fertility issue, it largely falls on the female partner.

00:27:15
Dr. Kaylee Byers: Here’s Dr. Patel again.

00:27:17
Dr. Premal Patel: Which is unfair, but also a lot of it is untrue. So up to 50% can be a
male factor, and in a lot of cases, it could be a male only factor. So the issue is IVF, or
in vitro fertilization, has been fantastic for a number of patients who’ve been unable to
conceive. But when they started introducing IVF and all these options, it took away from
the research towards the male infertility field because it was saying, “Well, we can just
bypass that and do IVF,” as opposed to, “What can we do to optimize fertility naturally?”
It’s only been in the last several years where now there’s a lot more research being
done in the male fertility side, but it’s just significantly behind.

00:27:58
Dr. Kaylee Byers: Yeah. I find it really interesting as a woman who has previously on
the show complained about how women are often not studied in research to now be
like, “We need more research on men’s health.” It’s really unfortunate, though, that this
is an area that hasn’t received enough attention. So it’s nice to be on the other side of
things, crying out for equity for men. So thank you for giving me an opportunity to do
that in the health space.

00:28:26
Dr. Premal Patel: Hey, 100%. Listen, 100%. I agree.

00:28:28
Dr. Kaylee Byers: I know.

00:28:28
Dr. Premal Patel: But even going back to what I was saying, even just the female
fertility about how do we optimize natural conception? IVF is very hard on women. I see
a number of couples every day who, as much as I’m like, okay, IVF is an option, it’s
going through a lot. It’s going through a lot of injections, needles, all the risks and side
effects and so forth. So it’s not just that male fertility has not kept up, female fertility of
natural conception has also not been optimized as well. So both areas definitely need
support.

00:28:58

Dr. Kaylee Byers: Yeah, maybe, and this is classic of medical systems in general, and
I understand why, and it’s something that we complain about a lot, is that we’re really
reactive. So we find a technological solution that works and we focus on that instead of
addressing the upstream determinants ( upstream, hilarious) of why we have those
issues in the first place.

00:29:17
Dr. Premal Patel: Yeah, 100%, you’re totally right. It’s always at the dire straits that we
start thinking about different ways.

00:29:24
Dr. Kaylee Byers: Yeah. Dire straits is probably also a pun in there somewhere. We
should think more about that. We should think more about that. So finally, the million-
dollar question: when can we actually get our hands on one of these things? Where do
you think we’re at in terms of getting close to having something available on the market?

00:29:45
Dr. Stephanie Page: Yes. Well, I have been doing this for a while now and we have
been giving the same answer for a while, which has been, oh, I think 10 years. I actually
do think that we are at the precipice now, which if it goes very well, could take us about
five years. And I really think that once we have one novel method on the market, novel
reversible method, that will show that there is a market. You can do all the market
research in the world, but until you actually have a product, it’s very difficult to know.
And I think everyone in the field really feels like once there is something out there, we
will see that men are very interested in reproductive agency, and that men also in many
places really want to participate and share the burden of contraception with their
partners. So I think if we can get something out there, even if it’s not the best or the only
for a long time, it will really pave the way for the rest of the field. And I think we’re really
close to being there.

00:30:51
Dr. Kaylee Byers: And maybe on that note, what do you think these will mean for
society broadly in terms of having these contraceptive options and then also how we
think about responsibility and reproductive equity?

00:31:02
Dr. Stephanie Page: So I wouldn’t have been doing this for 25 years if I didn’t think it
would make a difference. The reality is that globally, 45% of pregnancies are
unplanned, and that number has gone down maybe a few percentage points in the last
20 years. So we still have an epidemic of unplanned pregnancy, and that’s not limited to

low and middle income countries. So unplanned pregnancy is a global problem, and
that’s despite the fact that we have many, many different female contraceptives on the
market. Female contraceptive access is still a big issue in many places, and people are
importantly working on that. But nonetheless, it’s my feeling that we need really some
kind of game changer, and it’s my hope that introduction of reversible male methods will
be part of that. The reality is that contraception is for having planned pregnancies.
That’s what it’s for. It’s really about ensuring reproductive agency and planning of
pregnancies, for when they can be done in a healthy, safe environment.

00:32:09
Dr. Kaylee Byers: It’s having options, right? Giving yourself options. Well, Dr. Page,
thank you so much for this. I really appreciated you taking the time and learning from
you today. This was great. My pleasure. So safe to say we’ve come a long way from
animal intestine condoms and beaver testicle cocktails. With new approaches and new
insights from genomics, we’re getting closer to a future where some people have more
options to take control of their reproductive lives, because when it comes to
contraception, fertility, and reproductive choice, it’s time we shared the load.
Our guests for today were urologist and assistant professor at the University of
Manitoba, Dr. Premal Patel, and endocrinologist and division head of metabolism,
endocrinology and nutrition at the University of Washington, Dr. Stephanie Page. You’ve
been listening to Nice Genes! A podcast brought to you by Genome British Columbia.
If you liked this episode, go check out some of our previous ones wherever you listen
from. Share us with your friends and leave us a review. You can also DM the show on
social media by going to @GenomeBC. Be sure to tune in next time when we get into
the latest in gene editing and how scientists are rewriting our DNA to treat diseases like
never before.

00:33:25
Ty Sperle: The first though in my mind was like, “I’m cured.” That was my first focus,
but it didn’t really clock to me that it was the first in the world.

00:33:34
Dr. Kaylee Byers: Thanks so much for listening. Catch you on the flippity flop.