Also important to note that permanent infertility is quite a strong side effect
> Eight participants had not recovered to meet the criteria of return to fertility after 52 weeks in recovery phase, the last visit according to the study protocol. These participants were followed on a case by case basis until they regained normal sperm counts (n 5, up to 74 wk of recovery) or declined further follow-up (n 2). One volunteer did not recover within 4 years since his last injections.
> One volunteer did not recover within 4 years since his last injections.
That's a really STEEP Price to Pay for an "experiment". Anyone know how much the participants were compensated for taking part in the study? No amount of money would make me do something like this. But that's just me.
To answer you question, I do not know what they were compensated. But I suppose if you already had the amount of children you wanted and were considering the ole snip snip, this might have been a considerable option. Maybe it's what they wanted? I do agree though that if this were a young man, I sincerely hope they made some frozen samples before committing to this study.
There's also the risk that the drug is not as efficient as expected, and you end up with an unwanted pregnancy, so participating in this trial is never a no-brainer.
I looked up the study, and it seems that participants were not allowed to use a second method of birth control:
"Couples enrolled in the efficacy phase were asked to rely only on these injections for contraception."
And there were four pregnancies during the study (from the abstract of the study):
During the efficacy phase of up to 56 weeks, 4 pregnancies occurred
among the partners of the 266 male participants, with the rate of 1.57 per 100 continuing users
(95% CI, 0.59 – 4.14)
I don't think they were measuring the efficacy on the basis of whether or not the participants conceived - that measure is affected by too many variables. Sperm count is the more reliable metric with reasonable granularity for measuring the effect.
If this was a side effect their pool was almost certainly vasectomy candidates, and rather than there being compensation, they probably didn't need to pay for their treatment.
> One volunteer did not recover within 4 years since his last injections.
It didn't say his sperm count was actually zero.
Generally IVF is still possible when the male is classified as "infertile" by traditional measures (i.e. extremely low sperm count or dysfunctional sperm).
As someone who did Phrama testing in college to help pay my way through school, compensation would be determined by how long the study went on, which the article failed to say:
"It was a pretty big study; they gave shots to 320 men every eight weeks, in different countries around the world."
Every eight weeks, but for how long?
In my experience, it would probably be in the neighborhood of a few thousand dollars, but not much more. For the participants, even that much money to take some pills over the course of say a few months would probably be seen as easy money.
But then again, there's those pesky side effects.
FYI: All the drugs I tested were already FDA approved and were not considered in a "trial" phase.
It's almost always a factor in such trials, AFAIK. Since it's live people that have their own lives and bodies, it could be that it happened for unrelated reasons. However, there are standards of risk and I guess "possibly makes males permanently infertile" was not an acceptable risk.
> Also important to note that permanent infertility is quite a strong side effect
I know many who would see that as a blessing though: License to have as much unprotected sex as they want without the unfortunate side-effect of an unwanted pregnancy. And they get paid for the experiment in the first place too? Win-win, they would argue.
Right, but I suspect the parent implied that this could be a feature that many would seek out - basically the chemical equivalent of a vasectomy that can't be undone.
Some people, like me, really don't want kids. Taking control of it so that you're not relying on your partner is important as trust (that they haven't forgotten to use contraception or worse - deliberately not take it) isn't a rock-solid security policy. It's also not fair on females to be the only ones in charge of contraception for bare-skin sex.
Another thing I've learned is that far too many parents take the statement "I don't want kids" as a personal challenge to moralize and condescend to people without children.
Na, I think it has more to do with either projecting ones own wishes onto somebody else or maybe even talk somebody down so that you can feel better if you don't are completely happy with the current situation.
I find it much more interesting to ask why somebody wants no kids. That gives much more insight into the person's mind than when you try to persuade them with your own experiences and produces much better followup talk opportunities.
Anyway, I'm curious what you think it might be evolutionary advantageous. On the face of it, if others have less kids, that would seem advantageous to your own kids.
What, aside from never making any decisions (which is a itself a kind of decision), can you do other than trying to make the best decision you can right now?
The honest to goodness answer here is that you can let other people make decisions for you, and it is the desire to make decisions for other people that prompts this argument.
Why? Having the means to do so is very very different from forcing it upon someone. Means to kill someone else are readily available to everyone -- kitchen knives, over the counter drugs -- but simply their availability isn't that scary.
What were they giving to the patients? Was the existence of what they were giving to those patients a scary thing just for existing - coz that's the question here.
You haven't responded to any of my points, just ignored them.
What you're really trying to do is make out that somehow sterilisation is a special case of something with a potential negative use case, where if they can easily be used, they will be, without arguing why it's different from all the other things that meet that criteria.
Not at all. It's similar to Google and the "right to be forgotten". In the old days something might be public knowledge but would say require visiting a records office to uncover. People could move on from things they regretted. Now it's just a search away. Aha, people say, but the knowledge was ALWAYS public. In practice the ease of doing it makes it completely different.
Which, again, is an argument about it being very easy to do.
That does not address jamesrcole's argument. He's not saying "it was always possible, therefore being easier is no different".
He's pointing out that there are worse bad things that are just as easy to do, yet they aren't considered scary.
You can't make an argument that the ease matters, because he's asking about things that are equally easy if not easier. Why is easy availability of such a drug different from easy availability of the knife/car/etc.?
It's a value judgement of course. As a society we accept that n deaths/year are worth it for the benefits that cars and butter knives bring to the wider population. In very recent history, sterilisation techniques have been massively abused by governments in an organised way. There was never a large-scale, systematic programme of running people over as policy. Forced sterilisation is still a thing in India...
Not really, tens of millions would line up for it; it'd be vastly better than surgery and plenty of pills can kill people now but we deal with that just fine and death is much scarier than sterilization. What you're doing there... it's called fear mongering. If you're really scared of something like that, you probably have some issues you need to resolve because that's a silly thing to be afraid of.
> The many people you know that would love to be permanently infertile can get what they want in a matter of minutes, in a proven/well-known way.
Are you sure about that? As far as I know nearly all urologists in the US will refuse to perform a vasectomy on a childless man, especially if they're in their 20s and/or unmarried.
Not from the US and I did the procedure in my thirties, married, with two kids.
But the doctor didn't ask about any of this (he obviously knew my age). I just had to sign that I was lectured about the potential risks and consequences - similar to the preparations for any medical operation really.
And I had to agree on the price, since this (obviously?) isn't covered by basic health care here.. ;)
So.. No idea. My doctor didn't know about my marriage or kids though.
Weird. The one comment suggesting that some participants probably see this as a feature is heavily downvoted, but the comments saying that this is shocking and awful are upvoted. I had no idea HN was so pro-birth.
Is it somehow hard to understand the difference between temporarily avoiding pregnancy and becoming permanently unable to have kids? You don't have to be "pro-birth", whatever that is, to understand how upset someone would be if they signed up for one and got the other.
Obviously these men signed up for an experimental protocol and presumably were made well aware of the risks. Nonetheless dismissing this as possibly "win-win" is spectacularly tone-deaf at best.
> understand how upset someone would be if they signed up for one and got the other.
Is it somehow hard to understand the statement that some men (not all men) would be OK with the outcome? I for one am never going to have biological children, so I don't particularly care whether I'm sterile or not.
It's not hard to understand, it's just totally irrelevant. Let's say one percent of the people taking a temporary contraceptive (rather than just having a vasectomy) happen to also not care if they are made permanently infertile. Meanwhile, another one percent get this side effect. These aren't going to be the same one percent.
The fact that there may be men in the first group is totally irrelevant to the experience of the second group.
Well, let's say you're going to have sex. _At that moment_, do you care whether you're sterile or not? Because these people probably are, but it's not certain.
Dad here, I'd downvote that too if I could. In my 20s children were the last thing on my mind; in my mid 30s, however, that changed completely.
Regardless of what one feels about children, I'm kind of shocked anyone could see accidental sterilisation as a benefit of any kind.
If permanent inability to produce offspring is what you want, there's always the snip. Of course, you'd still be subject to the risk of STDs if frequent change of partners is what you desire.
That it was accidental is always bad, but the point is that for men that were already looking into taking the snip, this was actually less invasive and possibly safer.
> Regardless of what one feels about children, I'm kind of shocked anyone could see accidental sterilisation as a benefit of any kind.
I know plenty of heterosexual men who would see this as a license to have unprotected sex with as many women as possible and never be burdened by the responsibility of a child.
I'm not saying I agree with this attitude (furthest from it, actually), but "you'll never have kids" probably won't come to them as a negative.
There are already simple, safe surgeries men can undergo that cause permanent infertility. I also can't see why someone would suggest this side effect is a benefit.
That is the most ridiculous FUD I've read in a while here.
It takes 20 minutes and you walk out. You'll feel not a thing (you might feel the injections of anesthetics). You 'recover' over a week of mostly nothing. I was riding my bike the day after the procedure.
You don't see a change, you don't feel a change and it is completely painless. Ignoring myself I've talked to a good number of friends who've done the same thing, said the same thing. I haven't heard of one single person that had a vasectomy and complained about pain in any way or form.
Honestly, I wonder why people would even wish for a 'chemical castration' all over this thread. Maybe your first line is something widely 'well known' and often repeated?
> I was riding my bike the day after the procedure.
Please do not spread terrible medical advice which you were surely told not to do. That's great you turned out fine but it is not ethical to promote such behavior.
Think of it as someone saying their children turned out fine without immunizations. Your words can become incredibly dangerous once you begin questioning doctors if you are not trained or have added knowledge in the area of specialty.
I asked my doctor if there's _anything_ I shouldn't do and he said 'No'. He told me an anecdote about a patient of his that HAD a bit of pain after flying for most of a day directly after the procedure (being cramped being probably a reason for that), but he explicitly said that there is no reason to hold back. "Be reasonable, be sensible".
But I honestly don't even know what drove you to comment here. I never said 'Ride a bike on the next day' nor am I a doctor or even TRIED to give out medical advice. Instead I explicitly called out (and tried to dispell) the 'OMG it is so painful' FUD.
Your comment is a) irrelevant (I don't give medical advice) and b) assuming things that are completely unrooted in reality and wrong.
I answered the sibling: I explicitly asked the doctor about restrictions and was - again, explicitly - told there are none, as long as I feel okay and am reasonable.
Running a marathon or karate competitions are probably out. I rode my bike with a dad with his daughter - we drove about 20km total, relaxed, with a nice spot to buy food and a beer. It wasn't "sport", it was "getting outside".
Honestly though? I totally didn't plan for that. I planned the trip, planned the operation. The operation's date was changed by my doctor, I didn't cancel the trip and just .. went along, because I felt fine.
Again: My doctor didn't list any limitations, even when I explicitly asked about it. But I certainly don't claim that people should jump on a saddle as soon as they've left the room. I merely pointed out what I happened to do on the next day to mock the 'the pain is unbearable' FUD.
Feel free to rest for a week. As far as I'm concerned and as far as I'm aware after talking to people that decided to take this step: There's no need to. There's no pain. A feeling ob numbness maybe (think strained ankle, but a week later) and obviously you have cuts that you don't want to strain.
But I had a lot of accidents with a razor or a kitchen knife (mind you, we're talking "face" and "fingers" now, right?) that were far worse than the vasectomy.
I know somebody who had that done, he never mentioned any pain. Indeed I thought he said it was a day procedure.
Along the same lines, I know several people who have had knee replacement surgery and they all said it was the most painful thing ever. All of them though, are very happy reaping the benefits of that years later. It was only a few months after saying that if he knew it would hurt that much that he wouldn't have had it done that an 80yr old friend of mine was proudly showing me how he could jump down some steps!
Not sure what "debilitatingly painful" is based on. Personal experience? Reports from others? Guessing?
My vasectomy was not painful at all. You do get a needle into your scrotum to inject the anaesthetic, and that is not a nice feeling at all. But it's over in two seconds. You don't feel the rest, because, you know, modern medicine.
What part do you think is painful?
For me the only major downside was the cost. If I ever decide I want children, I guess I'll have to adopt.
It's not the procedure itself that is sometimes painful, it's the recovery. When I had it done more than 20 years ago, I was fine with both, but the doctor proscribed me heavy duty painkillers in case the pain got bad.
He said he didn't use to, but then he had a vasectomy himself.
I have had one. Yes it hurts. Not debilitatingly though. And it's only for a minute or so per ball. It's bruised and sensitive for a week or so, but nothing major.
Depends what this study was about. If you were recruiting people as "try this contraceptive method", then permanent infertility is one of the most horrible side-effects possible. If, on the other hand, the focus of the study was "here are some pills that might make you permanently, or maybe just temporarily infertile", then it's fine. But then you wouldn't call it "contraceptive" or "birth control", I guess...
It's a stupid comment. An injection that has a small chance of making your infertile for an unknown amount of time, possibly forever, is useless. It's certainty that those participants need.
With that as a side effect, surely an elastic band would be a safer and more tried method. Obviously surgery would be better yet, but what they've come up with is literally worse than what we do to sheep.
So can dental fillings, breast implants, and artificial sweeteners.
Like female birth control though, most people agree that the risk for developing cancer associated with the activity is well worth the benefits. Saying "boo fucking hoo" about someone who can never reproduce again is pretty cold-hearted, in my opinion.
I did a quick Google and it appeared to me that most of the adverse events were measured at rates in the 10's per 10,000 ... Though that is absolutely from a very high level.
This study was presenting at around 20% (IIRC, I was reading the outrage version of this stuff a few days ago)
It is also important to note that this is by no means the end of the drug. The people involved consider this to be a very promising study and are going to continue working on it.
It wasn't stopped early "as a failure" to be shelved and never looked at again. It was stopped early because they knew enough about the upside and didn't have to continue on the down.
The next rounds of trials will likely try to alleviate the side effects while preserving the MOA (mechanism of action)
I wonder why they didn't mention vaselgel [1]. When I first heard about it a couple years ago it was pitched as an injection of $0.10 of chemicals into the vas deferens that would block sperm from traveling through it. They were hoping it would last 10 years, be reversible with another small injection, and be available in the U.S. in half a decade. A non-profit is funding the research and their goal is for it to be affordable even in developing countries.
I keep wondering when a reputable source is going to finally cover this and somehow burst the bubble. It sounds too good to be true, yet, somehow, nobody outside their own mailing list seems to acknowledge it. What gives? Is this known quackery? I am weary to get excited, lest I get my dreams crushed yet again :/
One theory for why it isn't acknowledged could be that the creators and trial participants are outside of the Western cultural establishment.
The material was discovered and synthesized in India at IIT by a Indian person. The largest clinical trial on Vasalgel - also in India.
Media coverage doesn't happen organically. In almost all cases it is a two way street, with networks and personal contacts creating the bridge. The researchers in India and the cultural epicenters of the Western media establishment are about as distant as two nodes can be. Discovery and contact between the two parties is probably very hard.
On the other hand if they tied it to a pre-dominant narrative in Western media about India - increasing sexual freedoms or a pathway to population management - and worked with the non-profit institutions that connect back to the nodes of cultural influence in the Western world, they would probably get a decent of amount of earned media coverage.
If they can't patent it, and it's known to be cheap, it's a race to the bottom in terms of profits. A pill would be far more profitable. I don't think pharmaceuticals would be eager for anyone to find out about it if they can't control the money.
You still have to pay for clinical trials in the US. If the drug can't be patented then no pharma group will pay for the trials if a generic can come along once trials complete and make just as much money.
It's not, but it's far from proven technology. Additionally, it's the exact opposite of most medical research - fairly inexpensive to develop (a few millions USD total), but also with very little profit upside on the other end.
I wonder how many other potential medical treatments fall into this category. If a treatment was found that cured a large percentage of cancers, but was 'too cheap' to develop, would the same thing happen?
Valerie Tarico has written about it, and she has her head screwed on straight (which I think means she’s reputable)! She's an excellent writer. However, maybe BuzzFeed needs to do a listicle on Vasalgel, or Cosmo needs to put it in SnapChat, before awareness goes mainstream… that's a sobering thought!
>I wonder why they didn't mention vaselgel [1]. When I first heard about it a couple years ago it was pitched as an injection of $0.10 of chemicals into the vas deferens that would block sperm from traveling through it.
Because how are pharmaceutical companies going to make billions from selling $0.10 of chemicals?
They can't patent it very easily if someone else invented it. Otherwise you'd see people trying to patent 'formulations' of their competitors' drugs all the time.
Even if they could patent a formulation, someone else can always jump in with a slightly different formulation at half the price.
I doubt this would work very well in this case, given that it's supposed to be a once-in-10-years procedure... Most pharma companies are increasingly focusing in drugs for long-term management of chronic conditions (e.g. cancer) - keep people alive and consuming your highly expensive drug covered by their insurance is incredibly lucrative.
>Because how are pharmaceutical companies going to make billions from selling $0.10 of chemicals?
How much do you think the raw inputs for Cialis are?
Gross margins at the aggregate level are around 80% for this stuff. If they are practicing value based costing they could simply just undercut surgical vasectomies slightly- I'm sure every man out there would choose an outpatient injection that is reversible vs a surgical operation.
I'm eagerly awaiting it getting to the market but don't buy that as an explanation
The rates of serious side effects were much higher than any female birth control currently on the market [1]:
> Nearly a quarter of participants experienced pain at the injection site, nearly half got acne, more than 20 percent had a mood disorder, 38 percent experienced an increased sexual drive, and 15 percent reported muscle pain. Other, rarer side effects included testicular pain, night sweats, and confusion. One study participant died by suicide, though the researchers determined it wasn’t related to the birth control. Twenty men dropped out of the study because of the side effects.
I think thats the point a lot of people miss. Yes, standards are far more stringent today and we take better care of individuals during clinical trials. That doesn't change the fact though the bulk of responsibility for birth control falls on women and the history of birth control is particularly nasty and cruel.
Personally, I think if there was a birth control option for men that was even remotely in the same ballpark as the pill in terms of effectiveness, reversibility and pre-plannability it would easily equal or surpass the pill's usage rate.
if they came out with a monthly pill or a 90 day shot in the arm for men, the birthrate in this country would plummet nearly overnight. Right now men really only have 3 non-permanent birth control options and all of them suck:
1) Bag over the dick - makes sex less enjoyable
2) Fully trust your partner to not "forget" to take her birthcontrol or lie about being on it in the first place.
3) Abstinence.
I'm not suggesting all women or even a significant percentage of women are evil liars. However, there have been many studies & surveys that have indicated nearly half of all women are willing to lie about contraception in order to get pregnant, regardless of their partners wishes, and fully half have said that if they became pregnant by another man but wanted to stay with their partner, they would lie about the baby’s real father.
I'd much rather know for sure by taking personal ownership of birth control myself.
But would you take a 90 day shot if it meant experiencing depression, serious cramps, and genital bleeding for long periods of time?
I don't know a single woman who has been happy on a single form of BC for a long time. My fiancee was on the implant until she started bleeding and didn't stop for five months.
In my case I went full bore and got a vasectomy. I literally let someone take a scalpel to by boys so yeah.. cramps? sure.
Genital bleeding is really a very gender specific thing. Women already bleed from their genitals the issue is that it is now prolonged. If a man started bleeding from the penis that'd probably be a fairly serious condition lol. I get your point though. That said discomfort is a perfectly reasonable trade to avoid 18+ years of responsibility and a financial cost currently estimated at $250K per child (not including opportunity cost mind you)
I know a few woman that are really happy with their birth control. They used to have heavy pain during their irregular periods, and birth control made their periods relatively painless and completely regular (useful e.g. for planning holidays). Of course, there might be other negative side-effects, but it seems that the positive effects prevailed.
Men have just as much interest in safe sex, as women do. In fact, one could realistically argue men have more interest in safe sex, because the decision on whether to continue the pregnancy is exclusive to the woman, however men are still legally and financially liable for the outcome.
You can get saddled with the cost of raising an unwanted child for 18 years.
I don't understand why women would want to keep a child on such an illegitimate basis (without the father's consent) but it does/can happen and is horrifying. Men have not right to choose, unlike women, which makes some sense, but can put you in a pretty nasty pickle.
Well, the death rate for births in the US right now is .9 per 10,000 which is thankfully pretty low compared to what it used to be and is about the same as driving to work for a year. A lot lower than the percentage of people in this study who got depression and committed suicide, for example (though who knows if that was causal).
Of course in terms of discomfort, trauma, having your life turned upsidedown, etc you certainly can't compare paying alimony to having to give birth to a child.
That’s why I didn’t really commit to that argument, leaving it as hypothetical.
For one thing, not all women would even consider abortion of pregnancy as an option, due to personal beliefs. There’s also emotional impact of such decision to consider.
The point was not to put absolute values on the risk of unprotected sex for either gender. I’ve only tried to illustrate that men have, just as women, enough of an incentive to consider protection a very serious matter.
> That doesn't change the fact though the bulk of responsibility for birth control falls
Under modern paternal support laws, I would say the unfairness of biological burden of pregnancy has evened out. So it should be a non-complaint. Especially, since abortion decision is exclusive to the woman.
The financial burden may have evened out somewhat (note that motherhood decreases earnings, for instance, while fatherhood increases them).
The social burden hasn't (the stigma of unwed motherhood remains; there's no significant stigma to unwed fatherhood).
And you're completely ignoring the medical burden of pregnancy, which STILL includes risk of death. There's the physical pain of childbirth and major tearing of the flesh of one's genitals (and often added to that, a major abdominal surgery).
And pregnancy often brings major changes to the body that linger for the rest of the woman's life - from swollen feet to incontinence.
So men (those who don't discover that most states have a way for men to opt out of legal responsibility early in the pregnancy if they also relinquish all parental rights) now actually take on some responsibility for a pregnancy they participated in causing. Good. But don't think for a moment that the burden is now equal.
The woman should know those risks - if she follows through with an unwanted pregnancy despite those risks, the burden is 100% on her.
If Elon Musk gave me a free ride on a rocket ship, I know the risks and I can refuse - I don't have to complain about how life is so unfair because the rocket ride could kill me.
Birth control responsibility always falls on the partner who really cares about its effectiveness. Trusting your partner is a non-starter, statistically, overall.
But these are healthy men — they're not going to suffer any risks if they get somebody else pregnant.
I don't believe what I'm reading. Give up your life as you know it or live with the guilt of "not being there", + the social and financial stigma that comes with it?
Clinical trials typically have something called a Data and Safety Monitoring Board, which periodically reviews safety (and, occasionally efficacy) data to decide if the trial should be halted prematurely. The DSMB is supposed to consider the potential benefits to the individual subjects and the population from which they're drawn, and weigh that against possible risks from the drug and the trial (e.g., complications from biopsies).
Since the subjects here are otherwise healthy men, who have other options for avoiding pregnancy, the DSMB should be fairly risk adverse and willing to kill the trial (as happened here). If, on the other hand, the trial were testing a new kind of anti-cancer therapy on patients with terminal cancer, the Board might be willing to tolerate a few more adverse events because the pay-off s are much higher.
The article seems to be saying, in a ham-fisted way, that the DSMB would have tolerated slightly more risk to women because pregnancy also carries its own risks.
Plenty of men aren't there and don't feel guilty about it. And stigma? Only if you live in a very small, close-knit community. For men, unlike women, involvement is a choice. Not an easy choice, but still a choice.
Removing the comment since it was misleading - I was under the impression that testosterone supplements increased aggression, but apparently the study that I linked [1] had some flaws. See crimsonpowder's comment as it has more to date studies on this.
Since steroids are demonized, I had to make a throwaway account. Testosterone does not increase aggression, even when given in doses far above natural limits. [1] [2]
When I'm not programming, my hobby is bodybuilding. To make it as a bodybuilder, you have to use steroids. With a sample size of ~30 (fellow lifters and me), I can tell you that more testosterone makes you calmer, leaner, and bigger. My stress and anxiety on steroid cycles vanishes and all that's left is confidence, even with powerful steroids like trenbolone.
This study was designed by some of the most incompetent people around. Athletes inject long esters every 3-5 days and these guys were doing a shot every 8 weeks. Athletes take additional drugs to control the conversion of testosterone into estrogen (the hormone behind acne and mood swings). If I had designed this protocol, it would've looked like standard Testosterone Replacement Therapy (TRT) plus an injection of nandrolone decanoate every week (which is great because it heals your joints). Of course, good luck selling bi-weekly injections.
For decades we shouted about reefer madness from the rooftops, arrested millions of people and threw them in jail, and expanded corrupt government agencies because marijuana was "dangerous". It seems like we're learning our lesson on that front and I hope we get our act together when it comes to hormones.
> To make it as a bodybuilder, you have to use steroids.
What does it even mean to "make it" in something you do as a hobby? If you're willing to risk your health to play competitive games, go ahead, but to say you "have to" sounds like you're rationalizing a bit.
There are divisions that are tested--monthly polygraphs and urine/blood. You've never heard of them. When people think about bodybuilding, they imagine freaks, which is not a natural state.
In software, we say: good, fast, cheap; pick two. In bodybuilding: big, lean, natural; pick two.
You can have a lot of mass and if you carry extra fat, or you can be shredded to the bone and carry a lot less lean mass. Naturally, the lower fat reserves run, the higher the chance that catabolic hormones break down lean mass. If you want to be big, lean, and win shows, you need to take the growth and steroid hormones to flip some bits on the config files in your muscular/adipose tissue to allow it.
Your DNA is the software for your body. Hormones bind to receptors on cells, get transported into the cell, bind to internal receptors, and then this complete structure moves into the nucleus where it transcribes certain DNA sequences into RNA chains that will be fed through ribosomes to produce proteins (your hardware).
Steroids/hormones (everything from vitamin D to testosterone) is the body's mechanism of editing /etc/* and calling kill -HUP on select daemons. Steroids evolved as the process for doing this because it's biologically impractical to grow a nerve ending to every single cell in the body.
This comment is very misleading. These aren't injections of straight hormones. They are hormone esters that are injected into a muscle, where they are slowly released in the blood stream and slowly metabolized to active hormones so as to maintain a steady level of hormone in the serum over a long period of time.
You compare 0.35 mg norethisterone to 200 mg norethisterone enanthate used in the study. The normal dose for women of norethisterone enanthate injection is 200 mg every 8 weeks. The same is true of the testosterone undecanoate used in the study. One injection is released over weeks, not all at once. You mention hypogonadism. In an early study of testosterone decanoate for hypergonadism, they used (almost) exactly the same dose, 1000 mg every 6-9 weeks.
It does seem like the testosterone may have been too much, based on the side effects listed, but you shouldn't come on HN and start posting diatribes when you aren't sure what you're talking about. And if you were sure, well, that's another problem.
I've been reading about steroids and from what I understand different esters have different half life/release. Still every side effect described is usually associated with testosterone.
As for aggression, from what I've seen there is no direct relation in most cases but it can affect some (just like not everyone gets acne or hair loss, etc)
I have a lack of faith in the pharmaceutical industry if this is their best attempt at male birth control. Those side effects aren't from testosterone, they're from massive hormone fluctuations, which with 1000mg of testosterone every 8 weeks your gonna get. There's no ester that will increase the half-life by that much, most people get prescribed testosterone cypionate, which is considered a long ester, and it's half-life is only 8 days.
The 1000mg every 8 weeks is pretty much for marketing and sales, because having to get an injection every 2 months is already a turn off for their consumer base let alone get an injection more frequent than that.
"There is evidence that testosterone levels are higher in individuals with aggressive behavior, such as prisoners who have committed violent crimes."[1]
There are a lot of confounding variables when you're looking at a prison population.
I'm still not sure if you're serious with your comment about decreasing women's rights or if this is possibly the greatest troll comment in history.
Compare to "RISUG" (Reversible Inhibition of Sperm Under Guidance). Which appears to be completely safe and 100% effective. Requires a single, out-patient procedure (two injections, not counting anesthetic). And is easily-reversible.
Meanwhile social networks are all atwitter with women relentlessly mocking the study because the side-effects sound familiar to women, because the articles vaguely phrase it as "sexual side-effects, emotional changes, cramps" and the like, not
"one of the participants comitted suicide and another is infertile".
And side effects of birth control options for women commonly include severe depression (yanno, the kind that induces suicide) and more rarely complications that can cause permanent infertility (septic infections due to punctured uterus).
That post was 137 days ago was... June 19, 2016. I had verified on about May 15, 2016 that I was azoospermic, and stopped the aggressive heat treatments on that date. I had used a variety of testicle-heating interventions for about 4 months. My sperm were completely gone for 2 months, then slowly started to return.
I intend to get a professional sperm analysis at the six month mark (November 15th), then redo the heat protocol, collecting more data this time... I suppose I need some better slides.
Can we agree that birth control of all kinds has a long way to go? Both men & women should have the option to be in control of their reproductive rights. Neither men nor women deserve to experience serious side effects from the exercise of those rights.
Some lucky folks can take hormones with very little effects. I (F) have had very negative experiences with hormonal birth control, I'd be bummed for anyone else to go through it.
> Some lucky folks can take hormones with very little effects.
There aren't any actual 'hormones' in birth control. These drugs are supposedly hormone-analogues, but they are only partial replacements for genuine ("bio-identical") hormones.
A big missing point in this story: acceptance criteria for medicine in general is stricter now than when hormonal birth control for women was approved for use.
The side effects experienced by the men in this study are not to be taken lightly. They're scary and dangerous.
They're also no worse than the side effects (from depression severe enough to cause suicide to life-threatening complications and yes, permanent infertility) that women on various forms of birth control have put up with for the past several decades. And continue to endure.
And even in studies not about birth control, women's medical complaints and concerns about side effects have been shown to be taken less seriously by medical professionals than men's similar concerns.
Your sister, girlfriend, date. That woman you saw on line at Starbucks. They may not all be experiencing those side effects (neither did all the men in the study). But they're all risking a LOT to avoid pregnancy. Today. Right this moment.
Ask yourself why those side effects and risks are OK for them to bear but not for you. Ask where the research is on female birth control without those risks.
I'm not saying this study should necessarily have continued. Just that there's very good reason for the bitterness.
If you want to understand the female perspective on this news, try the below opinion piece:
These are fair points about the general lack of male birth control availability.
Keep in mind, only 20 of 320 dropped out of this study. That means almost 94% of the participants complete it. The percentage who dropped out due to mood swings appears to be somewhere between 2%-4% (this wasn't entirely clear from the write up, but either way, it's a small percentage). And according to the study, over 75% of the participants said that they would be interested in continuing to take this drug as birth control. Lastly, it sounds like the research study was somewhat successful. This is an initial trial, and it appears to be effective. It probably makes sense to halt the trial at this point, refine, try to increase effectiveness, try to decrease side effects, and try another round.
It's a drug trial. This is a good thing. While I can understand the bitterness you've described, I really don't think this study, or the men who participated in it, are even remotely appropriate targets for it.
To answer your question, "Ask yourself why those side effects and risks are OK for them to bear but not for you"? From what I've read, it sounds like the majority of men who participated in this study absolutely are willing to tolerate the side effects and take those risks!
Lastly, you mentioned those women we see in line at starbucks "are all risking a LOT to avoid pregnancy". I don't mean to take your statement too literally, but do women never quit their birth control due to side effects, or in such low numbers that they are essential zero? Keep in mind, it was only 2-4% of men who quit due to mood swings, and 6.25% overall, and this was for an experimental trial.
I found the media reaction to this study to be pretty cringe worthy. That story I just describe was converted into some variant of "birth control study terminated because men can't handle the side effects".
In general women endure the side effects because the penalty for not remaining on birth control is higher. And because we're told those symptoms are "normal" and "to be expected". And because we're expected to accept more responsibility for birth control than men are, in general. The guy carries condoms in his wallet, but in a relationship it's the woman's problem.
But yes, women do quit or change methods because they can't stand the symptoms. I quit the pill because of depression, weight gain, and loss of libido. A friend had a non-hormonal IUD removed because it escalated her monthly menstruation to the level of hemorrhage. I know one who avoids the pill because of blood pressure and cancer risks. I know others who simply endure mood swings, weight gain, etc because they don't want to get pregnant and their boyfriends or husbands loathe condoms.
There's a lot to be fixed on both sides. I think some cultural change is in order. I hope we're able to develop a version of male birth control that doesn't have severe side effects. And I wish someone would invest in research into birth control for women that is safer than what we now have too.
This is nonsense. Many women even benefit from the contraception (I mean, beside the obvious benefit of contraception). I know of women who had horrific pain during that time every month, and with contraceptives, they regained control over their body and the pain during their days subsided (so, they'd take it even if they weren't sexually active). Risks of modern and popular female contraceptives are incredibly low. Besides, nobody forces women to take these contraceptives (which are currently the only ones that work well beside physical contraceptives).
They're also no worse than the side effects (from depression severe enough to cause suicide to life-threatening complications and yes, permanent infertility) that women on various forms of birth control have put up with for the past several decades. And continue to endure.
Not true at all, literally completely false.
I'm not saying this study should necessarily have continued. Just that there's very good reason for the bitterness.
If you want to understand the female perspective on this news, try the below opinion piece:
There is no good reason for the bitterness, frankly. It's just people complaining, instead of actually solving any problems. A classic trait of modern third wave feminism. These pills give women huge control over their bodies and they think men want to poison them or force it on them or something...
Female depressives attempt suicide at a higher rate than men. Men achieve suicide at a higher rate than women because they on average use more violent and irreversible means (such as firearms vs pills). The higher success rate doesn't mean the symptoms are worse.
Either way, assuming the same amount of men end up on this form of birth control as women are on hormonal birth control, there'd be severe consequences. Around 10 million women take the pill regularly, and the male equivalent would result in 50,000 more successful male suicides annually. That would more than DOUBLE the annual suicide total, on just 10 million men taking this pill.
I understand that female birth control is not without side effects - even relatively severe ones. But the current narrative that men are being wimps about this is insulting. These side effects would end up in tens of thousands of people dying.
Yes, and those people dying is not an ok result. Which is why the research has stopped. I'm just asking why, if we're not ok with those side effects, we're not also putting more research into safer birth control for women too.
Also, if the researchers wanted people to take the announcement seriously without women whining about what we put up with for birth control, they should have left stuff like acne and mood swings out of the explanation for stopping the research, FFS.
It's not valid to take the frequency of occurrence in a small sample size (320), and multiply it up to a large population (10 million). I still agree it's not worth the risk, but it's also not likely to be an additional 31,250 suicide attempts among men.
(Which is how my math worked out - I'm not sure where your 50,000 number of successful suicides came from. The study had 320 participants with one suicide attempt. But, again, this sort of multiplication from small sample sizes to large sample sizes is not actually predictive, so it's kinda moot.)
Agreed. But one attempted suicide and one successful suicide in a sample of 320 is not insignificant. This could be an anomaly, sure, but given that the average rate of suicide is 12.93 per 100,000 people [1], and it on average takes 25 attempts to produce a single death, this study should've expected no attempts at all. The fact that there was not only an attempt, but another successful attempt is not insignificant. The researchers were not mistaken when they decided to cut the study short, lest they be responsible for more deaths.
I agree on the potential significance and caution, but the study had only one attempted suicide. None of the participants killed themselves. There was a separate incidence of severe depression.
To get the 50,000, I mistakenly, based off another comment, used 200 as the sample size. Your number, 31,250, would be correct (assuming the extrapolation holds) for the actual sample size.
> "An attempted suicide is not really an attempt at suicide in about 95 percent of cases. It is a different phenomenon. It's most often an effort to bring someone's attention, dramatically, to a problem that the individual feels needs to be solved. Suicide contains a solution in itself," he says.
> In attempted suicide, both men and women tend to use methods that allow for second thoughts or rescue. Murphy says that when people intend to survive, they choose a slowly effective, or ineffective, means such as an overdose of sleeping pills. That contrasts to the all-or-nothing means like gunshots or hanging used by actual suicides.
Men truly want to kill themselves far more than women, and your rationalizing is sexist nonsense.
> Ask where the research is on female birth control without those risks.
As far as I know scientists and researchers are free to research whatever topics they want. And similarly, there are physical means of birth control for which women do not need to take the pill. It's a choice.
And regarding the permanent infertility effect specifically, I seriously doubt the rate is anywhere approaching 1 in 320 at four years of 1 in 40 (8/320) after one year.
Jesus christ, how about if women dont like it, they can stop taking it? There are plenty of alternatives, none perfect as Im sure you are eager to point out.
> Birth control can have non-contraceptive benefits as well, so plenty of people use it regardless of their level of sexual activity or pregnancy risk. For example, my dermatologist prescribed birth control pills when I was a teenager to help clear up my torturous pizza face – the pregnancy prevention part was a total bonus when I became sexually active later.
Other methods, like the hormonal IUD, can reduce and sometimes even stop menstrual bleeding and/or cramps, a side effect that lots of folks appreciate.
> that women on various forms of birth control have put up with for the past several decades. And continue to endure.
I keep seeing this kind of thing spouted and it's ridiculous. No woman has to take birth control. They do it because they want sex without any risks. If a women gets depression from it then she should stop taking it.
Seeing this and other stories like this posted on other forms of social media are frustrating since many females were voicing opinions that males are "weak/afraid/not able to deal with" birth control like they can.
>There's been a lot of eye rolling on the Internet about these side effects, because women have been experiencing things like mood swings and weight gain for decades with hormonal birth control.
Short version: The study is interesting but the early termination is largely ethics review working as intended and does not mean that all research into this method is terminated or that the results weren't promising.
lol the headline doesn't clickbait hard enough. Some participants became sterile... that's a bit more serious than simply quitting because of some "side effects".
My wife was on birth control the first nine years of our marriage (excluding the gaps when our kids were born) and I've been responsible for the birth control for the last twenty years. That seems like a pretty fair distribution of the responsibility to me.
I'm assuming his wife was on hormonal birth control while they were starting their family and once they were done he had a vasectomy.
Someone sane pointed out that the problem isn't the men in the study being wimps. Or that frankly there isn't any good drug target for male hormonal birth control. But that vasectomy rates are much lower than they should be. Because if you want something cheap, extremely safe and reliable, and you don't mind it being permanent, vasectomies are what you want.
I purposely left the "means" ambiguous but you're 100% correct. It was also my intention to point out that BC is a concern of a couple ... If you're talking about avoiding pregnancy during anonymous sex then the only logical stance is that both should be on BC since they can't really trust the motivations and diligence of their partners.
What bothers me about this far as I understand the drug doing the 'work' has bad side effects when given to men. Not as in some percentage of men, but 100% of the men will have unacceptable side effects.
So they're also adding other drugs to try and compensate for those. And of course that doesn't work very well.
Which part? Letrozole, anastrozole, and exemestane (the three biggest AIs) are all incredibly effective at keeping estrogen levels within range given a knowledgable doctor providing supervision.
The biggest problem is that there is a lot of taboo with testosterone treatments and finding a doctor that keeps up to date with the research is incredibly difficult depending on where you are located.
This headline is horribly editorialized. Can we have it changed to "Male Birth Control Study terminated due to safety concerns"?
Of note, 75% of the trial participants reported that they would have continued with this treatment if it were available, even after being informed that it was being terminated due to safety concerns, and the (male) study participants reported being more satisfied with the treatment than their (female) partners did.
Conversely, the adverse events extremely high rates of changed (mostly increased) libido, mood disorders, and pain (both at the injection site and elsewhere); and out of 320 trial participants there were two attempted suicides (one successful -- which the researchers attributed to academic pressure, but suicides rarely have a just a single cause). If the female birth control pill had the same safety profile, it would be the leading cause of death in 20-45 year old women.
(along with the helpful sub-tag, "Welcome to the club, dudes. Also: WOMAN UP.", along with a weepy picture from Dawson's Creek).
Welcome to the club, dudes. Also: WOMAN UP.
"From the study: "Of these 20, 6 men discontinued only for changes in mood and 6 men discontinued for the following single reasons: acne, pain or panic at first injections, palpitations, hypertension, and erectile dysfunction." The other eight men dropped out because of mood changes. "
I can't quite tell from this if it's 6, 8, or 14 men who dropped out due to mood changes. Overall, 20/320 dropped out of the study, 6.25%. I did a bit of research and found that median attrition rate for drug studies is 7%, but median isn't especially helpful since effects can vary.
The percentage who dropped out due to mood changes are (it's hard to tell from this well written article) 6/320, 8/320, or 14/320, so somewhere between 1.8%-4.3%.
This becomes the headline "Men Quit Birth Control Study". That's one of the charitable headlines, honestly. The fact that it morphed into this headline, to me, kind of is the story here.
I do think there's clearly a problem with suicide, especially among men, and I do think this is because, to some extent, men are particularly concerned about appearing weak and failing to get help. So a round of mockery about this is also painful to see.
I know this is going to sound snarky, but I really am genuinely asking: why? They have a history of very blatantly pushing their political agenda, most people seem to acknowledge that NPR is pretty left leaning. This doesn't seem out of place for them at all.
People have been playing a lot of political football with this story. I saw a Facebook post making the rounds saying that this cancellation proves once again that women tolerate pain better than men. And these women sharing the story and having a laugh were medical professionals. Yes, really! It's pretty absurd that our society still can't have honest, open, and adult discussions regarding reproduction and sex, even among the supposedly educated.
If the pill had any sort of side effects like what these drugs had, they'd be the leading cause of death for women 20-45. But no, it's "weak willed men". meh.
And even after the study was cancelled due to safety, 75% of the men wanted to continue taking it. I guess its worth personal safety and health versus the risk of having a pregnancy with a woman when you don't want one.
That was the title I saw as well since I had NPR in my news feed. I removed it now. There is just so much of this SJW post realism disregard for facts that I can take just because they decided to push some Alt Left agenda.
It's a pity because some years ago NPR used to be a balanced and excellent source of news.
Good grief NPR. Does the bizarre interpretation in TFA reflect something institutional? Should we suspect similar editorializing on every report in which men's and women's interests might be somehow be misunderstood to oppose each other?
If it's based on the one suicide and extrapolating to a death rate of 0.3%, I'd call it a bit of a stretch. Yes that would make it the leading cause of death if it did continue, but given the tiny sample size and single occurence (which may or may not be related), I don't think you can draw any conclusion.
Given that uncertainty concluding the study to work on the drug before trialling it again makes a lot of sense.
Extrapolating from one death + one failed suicide attempt + a large number of mood disorders. ezzaf is quite right that you shouldn't extrapolate from the one death alone, since that might have simply been a statistical fluke (although even one suicide is outside of the 95% range for this population and duration of study), but it becomes far more statistically powerful when supported by other side effects which are known to strongly correlate with suicides.
> If the female birth control pill had the same safety profile, it would be the leading cause of death in 20-45 year old women.
Out of curiosity, is this taking into account that the base rate for male suicide in the US is normally ~3.5x higher than for female suicide? Seems like you'd want to calculate a relative risk delta, rather than comparing the male delta to the female base rate.
Not leading cause of suicide; leading cause of death. He's saying if this thing killed those two men, that's 1/320, which is (wayyy) more than poison (top 1 currently for 25-34, ~1/10000). You'd need to adjust for how many women actually take the pill; after a cursory glance a conservative estimate seems to be 10%, but please don't quote me on that.
I think my comment still applies. It's not reasonable to imagine that women would be subject to a male death/suicide rate by taking this drug. Gender has a larger effect on those rates than the drug likely does.
Women are actually more likely to attempt suicide. Men are more likely to succeed because they tend to use more violent methods (e.g. firearms vs pills).
But yes, depression is a common side effect of female hormonal birth control too. Women who start the pill are twice as likely to subsequently start taking antidepressants as those who aren't on the pill.
No, I didn't take that into account. You're right that the suicide rate might be inflated in part because men are more prone to suicide to begin with; but even if you adjust for that, you'd be looking at a drug which would be as dangerous as smoking.
Depending on where the demographics you would expect as high as 1 successful suicide per 5,000 men per year. So, randomly having a successful subside in a 320 person study is not that unlikely. Unsuccessful suicides are more common. So, there is not really enough data to suggest a strong link.
Most likely the other side effects where the issue.
But if the treatment appears to cause severe mood swings in some cases, would that not suggest there's a good chance that it was a factor in the two suicide attempts (one successful)? Or is it counterintuitive?
There is a good chance, yes. And it's probably a good reason to stop this trial if that was completely unexpected. But I don't think that that's the last we will hear of this treatment if there is a market for it, which there seems to be.
For example, Isotretinoin https://en.wikipedia.org/wiki/Isotretinoin (known as Accutane/Roaccutane and by other names) is also associated with depression and suicidal behavior. It's still a popular drug used to treat acne, even though that is not a particulary dangerous disease.
I don't know anything about how the pharma industry works, but I'd guess they'll restart the trial, taking depression into account and watching for signs among the participants. And maybe with a lower dosage?
Yes, I strongly suspect that isotretinoin is responsible for my very soon after developing a chronic pain disorder and mood swings. After talking to others afflicted by chronic pain it turns out to be a rather common factor :( there's even a pretty plausible mechanism of action (to do with inflammation, which if you've ever been subject to the stuff, I suspect won't surprise you in the least...)
Had I known about any of this (to be clear, I just mean the risk - not my actual outcomes. No predictions of the future necessary) prior to taking it, I'd never have considered it.
> Eight participants had not recovered to meet the criteria of return to fertility after 52 weeks in recovery phase, the last visit according to the study protocol. These participants were followed on a case by case basis until they regained normal sperm counts (n 5, up to 74 wk of recovery) or declined further follow-up (n 2). One volunteer did not recover within 4 years since his last injections.
http://press.endocrine.org/doi/pdf/10.1210/jc.2016-2141