The Male Pill: a biography of a technology in the making (review)

Nelly Oudshoorn. The Male Pill: A Biography of a Technology in the Making. Durham: Duke Univ. Press, 2003. Pp. 306. $21.95.

The Male Pill traces the kaleidoscopic history of hormonal methods of contraception for men, exploring why such methods have been so long in coming when those for women have been available for nearly 40 years. The common features of pituitary endocrine control, whereby gonadotropin withdrawal switches off the function of both gonads, could surely have led to the parallel development of such methods in both sexes, despite the widespread belief that millions of sperm daily were harder to suppress than a single egg ovulating each month. New male contraceptive methods could replace less effective male methods and would occupy niches, e.g., when delaying vasectomy, when female methods were not tolerated, and during the post-partum period. As an early investigator remarked, the much longer fertile life of men makes them a target population of great significance.

We now know that preparations of androgens, given either alone for the suppression of gonadotropin hormones or combined with progestins (derivatives of natural progesterone) or with gonadotropin-releasing-hormone antagonists, effectively and reversibly suppress spermatogenesis in men (Anderson and Baird 2002; Kamische and Nieschlag 2004). Licensing one or another of these regimens will depend on their contraceptive efficacy in clinical trials, such as those recently conducted by the World Health Organization (Waites 2003). Interestingly, while novel androgens from a WHO steroid synthesis program were being ignored by the pharmaceutical industry, Chinese pharmacologists formulated an injectable testosterone undecanoate, an out-of-patent drug originally designed for oral administration. A trial involving over 1,000 couples testing the contraceptive efficacy of monthly injections of this newly-formulated long-acting androgen is nearing completion in China. It is likely that this monthly injectable will be the first male contraceptive drug to achieve registration in a national family planning program (Handelsman 2003).

This represents the present scientific situation. The Male Pill also discusses the social and cultural revolutions needed to turn what the author, a social scientist, calls "the established sociotechnical networks" away from their exclusive focus on women and onto men. Nelly Oudshoorn, Professor of Gender and Technology at the University of Twente in the Netherlands, has had unprecedented access to the scientists and policy makers involved in the WHO's research and development program to develop male contraceptive methods. Her interviews reveal that the investigators themselves, building on earlier pioneering clinical studies, provided the commitment that has advanced the field so dramatically in the last two decades.

Oudshoorn identifies the formidable opposition faced by advocates for the development of male contraceptive drugs. She relates how WHO and other public-sector agencies were forced to develop an R&D network "to compensate for the pharmaceutical industry's reluctance" to be involved. This network established the infrastructure for laboratory and clinical research through the so-called WHO Male Task Force, whose considerable public health achievements are described elsewhere (Waites 2003).

Oudshoorn explains how the clinical investigators overcame the difficulties of recruiting men to participate in trials that risked pregnancy in their partners. This was undertaken in a medical climate rooted in the resistance of gynecologists and urologists and in a social climate influenced by media-driven distortions. The recently embedded view that fertility control was solely the woman's domain led to the pursuit of the development of the pill for women in the late 1950s, with the enthusiastic support of the pharmaceutical industry. By contrast, studies to develop contraceptive methods for men were left to academic scientists to pursue, with the support of public sector agencies only.

Unfortunately, Oudshoorn's arguments are sometimes obscured by terms...