So close, yet so far: Why “the pill” for men isn’t right around the corner

Author: Ashley Melnick
Editors: Stephanie Hamilton, Christina Vallianatos

Family planning is an important component in many relationships; this includes preparing for planned pregnancies and navigating ways to prevent unplanned pregnancies. Since prescription-based birth control hit the market, women have mainly been responsible for taking “the pill” and utilizing other methods of pregnancy prevention, such as cycle monitoring, rings, and patches. In December 2018, the CDC released data indicating the pill was the most commonly used form of birth control (12.6%) after sterilization (18.6%), with long-acting reversible contraceptives (LARCs) like intrauterine devices (IUDs) trailing closely behind (10.3%), followed by male condoms (8.7%). With new advances in reproductive health research, a similar breadth of contraceptives is becoming available for men, which will soon give men more family-planning options. Western societies have recently pushed men to take larger roles in raising a family, ranging from paternity leave to being stay-at-home dads, and others beyond and in between. Developing additional options for male contraceptives will give men and women, both in relationships and as singles, more options when it comes to planning for children or preventing pregnancies.

There are a few commonly used contraceptive options designed to manage male fertility. One option is an invasive surgery called a vasectomy. In a vasectomy, the vas deferens, the tube that carries sperm to the ejaculatory duct, is cut, stopping sperm from entering the semen. Reversal of this procedure is tricky, having a success rate of 40-70%. A second, and reversible, option is condoms which are 98% effective when used correctly, but that number drops to 85% with typical use. Improved options for male contraceptives would alleviate these issues of convenience, invasiveness, and reversibility.

“Many men say they would prefer a daily pill as a reversible contraceptive,” says Dr. Stephanie Paige, a lead researcher at the University of Washington. She is part of a team developing a new pill being tested to regulate testosterone levels in men. Testosterone is an important hormone involved in the sperm production process. Dimethandrolone undecanoate, or DMAU for short, is a modified version of testosterone. When introduced to the body in certain dosages, it lowers the level of a hormone essential for testosterone production and consequently lowers sperm production in men. This trial pill is a remarkable step in the field of male contraceptives, not just because it seems to be effective and in a convenient form, but because it is also easily reversible.

DMAU sounds like a promising option for a male contraceptive, so why haven’t we seen it at our local pharmacies yet?

 

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From mouse models, gene editing, and drug development, research on male contraceptives is challenging. Illustration by Catherine Redmond.

First, the small study size of 83 men does not provide enough data to draw strong conclusions about DMAU’s effectiveness in men of different ages or ethnicities. It also does not allow researchers to confirm what dosages of the drug are the most safe and effective. A larger study is being planned by the same research team. Other male contraceptives in development include a hormone-based shot and a hormone-based gel, but, like many drugs, they come with their own side effects.

Along with reversibility, safety and effectiveness are additional aspects to consider when developing a contraceptive. Researchers need the pill to have as few effects as possible, given how widely it could be used. Men reported slight weight gain from DMAU, but this isn’t life threatening, and women commonly experience this side effect from female contraceptives. Men must be mindful that side effects are to be expected when taking any drug that interferes with the normal processing of hormones.

Another factor to consider is whether the male version of “the pill” will affect the sperm formation process long-term. By targeting sperm cells early in their development, sperm may not be produced correctly or at all. This may lead to a reduction in testes size, a physical effect generally unappealing to men. If the pill affects sperm cells later in development, it could target a critical function during fertilization- the sperm’s ability to swim. This means sperm would be produced but be unable to propel themselves to fertilize an egg. As of now, researchers do not know how DMAU impacts sperm formation, an answer that may affect short-term and long-term fertility.

To learn more about sperm development, researchers in Dr. Chen Chen’s lab at Michigan State University are working on a genetic approach to look at sperm production. To do this they use a gene knockout model in male mice. Think of “knockouts” like taking apart a car and then putting the car back together, except for one piece. Would your car function the same? Maybe the wheel would not turn anymore, or the engine would not start? Would a male mouse be fertile after the removal of an essential gene? Mouse genes are relatively similar to human genes, so mice make great models for infertility and human health studies in general. The Chen lab hopes to identify a target for a male contraceptive pill using these genetic models.

Although it may take some time researchers are getting closer to developing oral male contraceptives by taking careful steps in the right direction. Dr. Paige and Dr. Chen are just a few of the researchers advancing the field of male reproduction. Men hold equal importance and responsibility when it comes to fertility control and family planning, so it’s important to have a variety of safe options available for them. A better range of options can help distribute the accountability for outcomes related to reproduction.


MelnickAshleyAshley received her MS degree from Michigan State University studying spermatogenesis and male fertility. She is now a PhD student in the Molecular and Integrative Physiology Department at the University of Michigan, where she hopes to continue her passion for research in reproductive sciences. Outside of the lab, Ashley enjoys playing with her puppy, camping in Northern Michigan, trying out new restaurants, and watching Game of Thrones. Interested in connecting? Find her on Twitter and LinkedIn!

Benefits of Nutrition in Cancer Prevention and Survivorship

Author: Lei Wan
Content Editor: Zena Lapp, Kristina Lenn; Senior Editor: Sarah Kearns

Disclaimer: The opinions in this post belong to me. Patients should consult their own physicians about what will work best for their treatment and recovery plan.

When I volunteered in a cooking class for cancer patients and cancer survivors, I was often asked about nutrition and dietary supplement choice. For example, patients with colon cancer would ask if they should take omega-3 fatty acids; patients with prostate cancer were interested in taking lycopene and vitamin E. I pondered the same questions when my mom was diagnosed with breast cancer and when her cancer recurred—would she recover faster if she ate more cruciferous vegetables like broccoli and Brussels sprouts? These questions are also of interest to the public, given increasing evidence supporting the role of nutritional factors in cancer development. Continue reading “Benefits of Nutrition in Cancer Prevention and Survivorship”

To Complete or Not Complete (The Full Course of Antibiotics)

Author: Katie Wozniak

Editors: Tricia Garay, Charles Lu, and Shweta Ramdas

You may recall going to your doctor and being told to “complete the full course” of antibiotics that were prescribed to you. Over the last 70 years antibiotics have been used to treat bacterial infections. The CDC, FDA, and WHO have pointed out that some bacteria could remain in your system if you stop taking the prescribed antibiotics before completing the full course, even if you feel better. This remaining population consists of bacteria that could survive the antibiotics the best; this select group of resistant bacteria is then allowed to grow and re-infect you with a vengeance. However, a recently published article in one of the oldest medical journals questioned these age-old instructions and suggested alternatives. In the era of antibiotic overuse and resistant infections, should we still complete the full course of antibiotics?
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Ciencia y redes sociales: Como el “compartir de más” está ayudando al campo de la genética humana

Versión original en inglés escrita por Christina Vallianatos, traducida al español por Adrian Melo Carrillo y editado por Jean Carlos Rodriguez Diaz.

Vivimos en una época en la cual compartimos de más.  Desde tu mejor amigo compartiendo sus fotos artísticas de comida (#boozybrunch), hasta tu colega tuiteando en tiempo real su experiencia de parto (“¡Cesárea en 20 minutos!”), parece que constantemente nos enteramos de detalles íntimos de todo el mundo.

¿Qué pasaría si alguno de esos momentos en que compartimos demasiada información no fueran necesariamente “demasiada información”? ¿Y si estos momentos estuvieran de hecho ayudando a resolver una de los mayores dilemas en el campo de la genética humana: la identificación de genes causantes de enfermedades?

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Recent Advances in Cervical Cancer Research

Author: Veronica Varela

Editors: Whit Froehlich, John Charpentier, and Scott Barolo

Cervical cancer has been getting much more attention as of late, partly due to the HBO adaptation of Rebecca Skloot’s book The Immortal life of Henrietta Lacks. As a survivor of the same type of cancer that took Henrietta’s life and led to the development of the HeLa cell line, I found that Skloot’s book resonated deeply with me. My diagnosis compelled me to learn more about cervical cancer, which is one of the most preventable forms of cancer.

What Is Cervical Cancer?

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Figure 1. A diagram showing a stage IV cervical cancer (tumor is in blue)

Cervical cancer is an abnormal and uncontrolled growth of the cells lining the cervix, which acts like the doorway to the uterus. The cervix lining is mostly made up of two different cell types. Lining the outer cervix that faces the vagina are squamous cells, which are flat in shape, while the open passage of the cervix which leads into the uterus is lined by glandular cells, which are blockier in shape and produce mucus. Cancer can arise from either of these cell types; however, squamous cell cancers are the more frequent.

Most cervical cancers are caused by Human Papilloma Virus (HPV). HPV is commonly known as the virus that causes genital warts, but what many don’t realize is that there are over a dozen types of sexually transmitted HPVs, and only a few of them result in genital warts. The National Institutes of Health (NIH) highlight that persistent infection with certain HPV strains, especially types 16 and 18, is the major cause of most cervical cancer cases.

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What Does Smoking Do to Your DNA?

Authors: Shweta Ramdas

Editors: Irene Park and Kevin Boehnke

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Figure 1. Smoking is known to cause at least 14 different types of cancers, although it is not clear how or why.

 

We have known tobacco to be a cause of many cancers for decades now. It is associated with it least 14 types of cancers (see Figure 1). Less understood is how tobacco causes cancer. The short answer—it causes mutations. Tobacco smoke is a mixture of many chemicals, including at least 60 carcinogens (cancer-causing chemicals).

A trans-national team of researchers has begun unearthing the distinct types of mutations caused by tobacco smoke to better understand the biological pathways leading to tobacco-induced cancer. They found that tobacco causes specific types of DNA damage in organs directly exposed to smoke (like the lungs) and that smoking tobacco generally leads to higher rates of mutation in all tissues. Understanding how the chemicals in tobacco smoke cause mutations can help scientists identify new and emerging mutagens and design better treatment strategies.

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Training T Cell Assassins

Author: John Charpentier

Editors: Zena Lapp, Theresa Mau, and David Mertz

 

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Figure 1. An encounter between a CAR-T cell and a cancer cell

 

The assassins have a description of their targets, who are hiding in plain sight among the non-combatants. The targets are guerillas who’ve infiltrated the neighborhood, overwhelming the local authorities and fomenting chaos. After only minutes on patrol, the assassins go on the attack, quickly identifying and eliminating the enemy without harming a single bystander.

This scenario may sound like the plot of a Hollywood blockbuster, but it’s also a good metaphor to describe the activity of engineered immune cells against cancer cells. The assassins are called CAR-T (Chimeric Antigen Receptor-T) cells, and they receive their elite training at the hands of physicians and scientists, who teach them to recognize particular molecules on the surface of tumors.

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GMOs: Unjustified Fear or Actual Danger? (Part 1)

Author: Irene Park

Editors: Brittany Dixon, Theresa Mau, Alisha John, and Scott Barolo

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Figure 1: A “Non-GMO Project Verified” product label

It seems like “Non-GMO Project Verified” labels have been popping up on more and more food packages. GMOs (genetically modified organisms) are on the public’s mind, and food manufacturers, restaurants, and the government are reacting.

For example, the restaurant chain Chipotle recently promised to ban genetically modified ingredients, naming three main reasons: the long-term health effects of consuming GMOs are unknown; GMOs harm the environment; and GMOs do not meet the restaurant’s standard of “high-quality” food.

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How Your Electronic Health Records Could Help Biomedical Research

Author: Brooke Wolford

Editors: Jimmy Brancho, Shweta Ramdas, Bryan Moyers

Think back to the last time you visited your primary care physician. Was the health care provider using a laptop or tablet to take notes and update your health information? In many doctors’ offices across the country your health records have gone digital. In addition to their exciting potential to help doctors’ offices reduce human error and better serve patients, electronic health records (EHRs) also make available a new source of “big data” for researchers.

EHRs are patient-specific digital records your health care provider maintains. The information in your EHR helps your doctor efficiently track your health over time and helps researchers learn more about diseases, which ultimately improves the clinical care your doctor provides to you and other patients. Believe it or not, EHRs from patients like you and me have already helped researchers make discoveries that improve health care for everyone!

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Rabid: How to Beat a Gold-Medal Virus

Author: Shannon Wright

Editors: Ellyn Schinke, Jessica Cote, Alisha John

What is the most deadly virus in the world? The answer may surprise you. If we consider case fatality rate (the number of people infected who die from the virus if left untreated), it’s not Smallpox (20-60%), or even the Ebola virus (~50%), but rather, a common mammal-targeting virus you almost certainly have heard of: rabies. With no known cure, this infamous virus has a 100% fatality rate – certainly worthy of a gold-medal if we were giving out medals for how deadly viruses are.

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