The Male Pill: A Biography of a Technology in the Making (review)

Nelly Oudshoorn traces the history of efforts to develop a male counterpart to the Pill, the G. D. Searle corporation's synthetic progesterone antiovulent that was approved for general use by the Food and Drug Administration in 1960. She divides her story into two parts—"Overcoming Resistance: Constructing Alternative Sociotechnical Networks" and "Configuring the User: Articulating and Performing Masculinities"—and seeks an understanding of why there is no male equivalent of the hormonal contraceptive pill for women.

In the first half of the book Oudshoorn focuses on advocates of male contraceptive drugs, the efforts of international public-sector agencies to include males in the contraceptive agenda, research and development of male contraceptives outside of the drug industry, synthesis of hormonal contraceptive compounds, infrastructure for clinical testing, and the effect of risk on testing. The second part, which examines integration of male contraceptives into the culture of birth control, includes chapters on family-planning policies, infrastructures for clinical trials, journalistic accounts, and the role of pharmaceutical companies.

Oudshoorn begins by declaring that male reproductive bodies are making headlines "for the first time in history," due to the immense popularity of the erectile-dysfunction drug Viagra. Other timely, albeit far-less-newsworthy topics include research on the decline in male fertility due to pollution, testosterone therapy for aging men, and the thirty-year quest for a male hormonal contraceptive. Historians generally avoid absolutes. Certainly Viagra garnered headlines, but is Oudshoorn trying to say that overt discussion of erectile dysfunction has a connection to interest in developing a male contraceptive pill? If so, she must mean a spike in interest, since the male pill is by no means a novel concept. China's Chou En-lai promoted the male pill during the late 1960s. This led to research on gossypol, a polyphenol derived from the cottonseed plant, with a known contraceptive effect in males. After China opened up in 1979, Western scientists learned that fourteen thousand males were participating in a clinical trial of gossypol. Gossypol's 99.89-percent effectiveness prompted Upjohn to begin animal tests. The Chinese experiments ended abruptly in 1980, when it was revealed that gossypol had toxic side effects including diarrhea, circulatory problems, heart failure, and permanent sterility. Interestingly, this did not prevent the World Health Organization (WHO) from collaborating with China on both gossypol and vasectomies. The former was terminated in 1990 when researchers decided against clinical testing of synthesized gossypol analogs.

Oudshoorn argues that the WHO, despite its failure in China, did manage to support development of long-acting androgen injections during the early 1980s. This research took place outside of channels normally controlled by pharmaceutical companies. As a result, the WHO was unable to attract the backing of companies necessary to undertake large-scale clinical testing of the new contraceptive.

Clinical testing of steroids for male contraception actually dates to the late 1950s when testosterone and progesterone preparations were administered to twenty prisoners at the Oregon State Penitentiary. Though not specifically designed to test contraceptive effect, data from the experiment prompted researchers to note that all subjects lost their sexual desire as well as their ability to have an erection and to produce semen. Libido and potency concerns dogged continued clinical testing throughout the 1970s and 1980s. Testing scaled up to large groups during the 1990s and gravitated toward the use of combined hormonal compounds as a way to resolve the problem of interference with sexual function. Perhaps the most significant understanding that emerged from these tests was that the goal of azoospermia (zero sperm count) was unattainable. Indeed, further tests of subjects with low sperm concentrations (oligospermia) demonstrated that hormonal contraceptives were statistically less reliable than condoms.

Another strike against the male pill is that—unlike its counterpart—the dose cannot be administered orally but instead requires an injection, implant, or patch used in combination with pills. Trials during the 1990s involved injection. Oudshoorn points out that Westerners are less receptive...