If you’ve been following the news lately, it feels like we’ve been "five years away" from a male contraceptive for about three decades. It’s a bit of a running joke in the medical community. But honestly, we’re finally seeing some real movement in clinical trials. The big question—the one that makes most guys (and their partners) hesitate—is what happens once you actually start taking it. Everyone wants to talk about male birth control pill side effects, and for good reason.
Women have been carrying the hormonal load since the 60s. We know the drill there: mood swings, weight gain, blood clot risks. But men are a different biological puzzle. You can't just "shut off" an egg once a month. Men make millions of sperm every single day. Stopping that factory without breaking the machinery is a tall order.
The big testosterone problem
The primary hurdle in developing these drugs is how they handle testosterone. Most male pills in development, like DMAU (dimethandrolone undecanoate) or 11β-MNTDC, work by suppressing the hormones that tell the testes to make sperm.
But there’s a catch.
When you suppress those signals, your natural testosterone levels drop off a cliff. That’s bad news. Low T isn't just about "feeling manly"; it's about bone density, muscle mass, and even how your brain processes joy. Researchers have to find a way to kill the sperm production while keeping the "manly" side effects of testosterone intact.
The current crop of pills tries to solve this by using "progestogenic androgens." Basically, these are compounds that trick the body into stopping sperm production but act like testosterone in the rest of the body. In a 2018 study led by Dr. Stephanie Page at the University of Washington, men taking DMAU for a month didn't report the massive "crash" you'd expect from low testosterone, which was a huge win.
Acne and the "Second Puberty"
One of the most common male birth control pill side effects reported in early trials is acne. It makes sense. If you're messing with androgen levels, your skin is going to react. During a Phase 1 study of 11β-MNTDC (another oral candidate), several participants noted increased breakouts on their back and face. It's usually mild, but for a 30-year-old man, dealing with cystic acne again feels like a cruel joke.
The weight gain reality
Let's talk about the scale. In almost every major trial, weight gain pops up. We aren't talking 50 pounds, but usually a "modest" increase of 2 to 5 pounds over a month or two.
Is it fat? Water? Muscle?
Usually, it’s a mix. Androgens are anabolic. They make you hold onto weight. In the DMAU trials, researchers noted that while weight went up slightly, it wasn't necessarily "bad" weight, though most guys aren't exactly thrilled to see the numbers climb regardless of the cause.
Libido: The double-edged sword
This is the one that keeps guys up at night. If you take a pill to prevent pregnancy, but it kills your desire to actually have sex, the pill is effectively working too well.
The data here is actually kind of surprising.
While some men in trials for the NES/T gel (a topical cousin to the pill) reported a dip in libido, others actually reported an increase. Hormones are weird like that. Some guys feel more "driven" when their hormone levels are stabilized by a daily dose, while others feel a bit flat. There was a 2016 study (the famous WHO study) that was actually halted because of side effects. While that was an injection and not a pill, the fallout was massive. People mocked the men for complaining about things women have endured for years, but the reality was more complex. The study saw a significant spike in depression and mood disorders, which led an independent safety committee to pull the plug.
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What about "the mood"?
We have to be honest about the mental health aspect. Men are generally less likely to report mood changes than women, but in the context of hormonal birth control, it's a primary concern.
Irritability.
Fatigue.
A general sense of "grayness."
These aren't just anecdotes. They are documented responses to shifting androgen levels. Dr. Christina Wang at the Lundquist Institute has been a leading voice here, noting that while most men tolerate these pills incredibly well, a small percentage—usually under 5%—experience mood shifts that make them want to quit the trial.
Will it make you infertile forever?
This is the "myth" that won't die. People assume if you shut down the sperm factory, it might never restart.
So far, the data says otherwise.
In every major clinical trial for hormonal male contraceptives, sperm counts returned to normal levels within a few months of stopping the medication. It’s not a vasectomy. It’s a pause button. But, and this is a big "but," we don't have ten-year data yet. We have "three-month" and "six-month" data. The long-term impact on the "plumbing" is still something researchers are watching like hawks.
Liver health and the "First Pass"
Taking a pill is different than a gel or a shot. When you swallow a drug, it goes through your liver first. This is called "first-pass metabolism." Traditionally, oral testosterone was terrible for the liver—it could cause serious damage over time.
The new generation of pills like DMAU are "long-chain fatty acid esters." They are designed to be absorbed through the lymphatic system, skipping that initial liver hit. This is a massive technological leap. It means the male birth control pill side effects likely won't include liver failure, which was a dealbreaker in the 70s and 80s.
Why is it taking so long?
It feels unfair. Women have had options for decades. Why are we still waiting?
Biology is the first reason. A woman drops one egg. A man produces 1,000 sperm per heartbeat. You have to be 99.9% effective to actually be a reliable contraceptive.
The second reason is the "Risk-Benefit Profile." In the eyes of the FDA, pregnancy is a health risk for women. Therefore, the side effects of the pill are "acceptable" because they prevent a riskier condition (pregnancy). For men, pregnancy isn't a physical health risk. So, the FDA has a much lower tolerance for side effects in men. A pill that causes even moderate depression or high cholesterol in men is often seen as "too risky" because there is no direct health benefit to the man taking it.
The non-hormonal hope
If you’re reading this and thinking, "Forget the hormones," you aren't alone. There is a whole other side of research focusing on non-hormonal options.
One of the most exciting is a compound called YCT-529. This targets a vitamin A receptor (RAR-alpha) that is crucial for sperm production. Since it doesn't touch testosterone, it theoretically avoids almost all the side effects mentioned above. No acne. No mood swings. No "man boobs." In mouse studies, it was 99% effective. Human trials started recently, and the world is watching.
Then there's the "Slingshot" approach—a protein inhibitor that stops sperm from swimming. If the sperm can't wag their tails, they can't reach the egg. It's like a temporary, chemical blockade.
Making an informed choice (Eventually)
When these pills finally hit the shelves—and they will—you'll have to weigh the pros and cons just like women do. You’ll be looking at:
- Skin changes: Are you okay with a few more pimples?
- Weight: Can you manage a slight increase in appetite?
- The "Vibe": Will you stay mindful of your mood?
- The Routine: Can you remember a pill every single day at the same time?
Real-world data points
- 80-90%: The number of men in recent surveys who say they would be willing to try a male pill.
- 3 months: The average time it takes for sperm counts to drop to "contraceptive levels" after starting.
- 2027-2030: The realistic window for when we might see the first FDA-approved male oral contraceptive.
How to prepare for the future of male contraception
If you’re a guy who wants to be proactive, or a partner hoping to share the load, the best thing you can do is stay educated on the specific compounds being tested.
Track your baseline. If you’re planning on joining a trial or being an early adopter, know your body now. What is your current weight? How is your skin? What is your "normal" mood? You can't know if a pill is changing you if you don't know where you started.
Watch the "YCT" and "DMAU" keywords. These are the frontrunners. Follow the work of the Male Contraceptive Initiative (MCI). They are the gold standard for unbiased updates on where these drugs are in the pipeline.
Talk to your partner. Contraception is a team sport. Even with the side effects, many men find the idea of having direct control over their own fertility incredibly empowering.
The "side effects" conversation shouldn't be a scare tactic. It’s a transparency tool. We are moving toward a world where the burden of family planning is shared, and that requires knowing exactly what we’re signing up for.
Next Steps for You:
- Bookmark the Male Contraceptive Initiative website to track ongoing Phase 2 and Phase 3 clinical trial results.
- If you are interested in participating in a study, check clinicaltrials.gov for "male hormonal contraceptive" recruiting in your city.
- Consult a urologist if you have concerns about how your current testosterone levels might interact with future hormonal treatments.