MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. For millions of women, the birth control pill is a fact of life. They make appointments, talk to doctors, fill prescriptions and planning for pregnancy is a part of their everyday routine. But for men, birth control options are limited and guarding against unplanned pregnancy is something that often comes up only in the moments before sex rather than a reality that must be faced every day.

MR. KOJO NNAMDIMore contraceptive options could allow men to take greater control over their fertility, but there are many questions to be answered. What alternatives are being researched? Would men want to take them? Would women want men to take them? Joining us to explore where this research is going and why the sociology of male birth control is just as complicated as the biology is Diana Blithe. She is program director for Contraceptive Development at the National Institute of Child Health and Human Development. Diana Blithe, thank you for joining us.

MS. DIANA BLITHEThank you for having me.

NNAMDIDiana joins us in studio. Joining us from studios at KQED in San Francisco is Elaine Lissner, director of the Male Contraception Information Project, a non-profit advocating research and promoting awareness about male contraception. Elaine Lissner, thank you for joining us.

MS. ELAINE LISSNERMy pleasure.

NNAMDIJoining us by telephone is William Bremner. He leads the center for research and reproduction and contraception at the University of Washington where he's the Robert G. Petersdorf professor and chair in the department of medicine. William Bremner, thank you for joining us.

MR. WILLIAM BREMNERThank you.

NNAMDIFor those of you who would like to join the conversation on the air, you can call us at 800-433-8850. Men, would you take a birth control pill? Women, how would you feel about your partner taking birth control, 800-433-8850? Go to our website, kojoshow.org, join the conversation there. There is a joke in the medical community that for the past 40 years, a clinically approved alternative to condoms or vasectomies has always been five to ten years away. While the last four decades have seen a flourishing of the female birth control industry, innovations on the male side have lagged. What's the hold up, Diana Blithe?

BLITHEWell, actually the innovations have continued throughout that period of time as compared to the female methods where, actually, innovations haven't really happened very much. The methods that women have been using for the last 40 years have been tweaked a bit, but generally speaking, there haven't been any really new products out there, where the research on the male contraception has taken two approaches.

BLITHEOne is the hormonal approach where we have very good clinical evidence that we can suppress spermatogenesis, that is the production of sperm, and also a non-hormonal approach where we think we can either inhibit the production of sperm or the function of sperm as they're normally going toward the egg and how they would get there.

NNAMDIElaine, can you tell us, why do we need new methods of contraception?

LISSNERWell, we see two main groups of men who are looking for new options. We have over 6,000 men who've signed a survey and petition at malecontraceptives.org and they pretty much break down into two groups. The first group is men who want to help their partners and see their partners suffering with current female methods, whether that's the pill and side effects or IUDs with cramping.

LISSNERFor some women, these methods work out great, but there are a lot of others who have problems. And those men want to see their partner not suffer and maybe, in some cases, get her libido back. I mean, there are some direct reasons, as well. And the other group is men who want to have some control over their own fertility, which, if you think about it, is a fairly basic human right. And we do have condoms which are very important in new relationships, short-term relationships.

LISSNERBut people eventually do get tired of them when you've been, you know, with your husband or your fiancé or boyfriend for four years, six years, whatever. I would say -- so those are the two main groups. And I would say, as we begin to talk about methods, there are three factors we should keep in mind. When people think about these methods and would I want to use one or not, they think about quote/unquote "Male pill." Now, these methods aren't all pills.

LISSNERSome of them are long term methods. Like, we'll talk later about one that lasts ten or more years and it's reversible. So think about, is it a pill that you have to remember to take or is it a long term method because that changes the trust equation. Is it a long term relationship where maybe you don't have the STD issues or is it a new relationship? And is it hormonal versus non-hormonal? Because those are going to have very different side effect profiles.

NNAMDISpeaking of hormonal and non-hormonal, William Bremner, those are the two main streams of research into male contraception. Can you outline the basic differences between these two birth control options?

BREMNERYeah, sure. The -- first, the importance of having some sort of male contraceptive is worth re-stressing. It's something like half of all pregnancies around the world are unintended and something in the range of a quarter are unwanted. And so for couples, it's really important to have some additional choices and ability to control their own fertility. And, as was mentioned a moment ago, it's important for men to have a method that they can have under their own control for a whole variety of reasons that perhaps we can come back to.

BREMNERBut specifically to your question, the hormonal methods in men were much analogist to the way the methods work in females by turning off the production of sperm, but maintaining testosterone levels normal in the man so that there aren't adverse affects in the man from either too low or too high of testosterone level. And then sperm counts are suppressed to the range of infertility and then they're fully reversible. These have been shown now in thousands of men in studies over quite a few years to be fully reversible.

BREMNERAnd the methods of administering them are what's being worked and the specific combinations of agents to make them most acceptable. There are a whole variety of non-hormonal approaches that are being used in main and experimental animals. Very few have made it into studies in human beings. And many of them are quite promising, as Dr. Blithe was just touching on.

NNAMDIDiane Blithe, hormonal male contraceptives are often referred to the Male Pill. But as we've already heard in this broadcast, a hormonal birth control for men would not necessarily be available in pill form. Can you explain and tell us what the current research looks like?

BLITHEWell, the reason it's not available in a male pill is because it's a two step process. The first could be done by a pill, but would probably be better done by a long acting method, as Elaine mentioned. That would take the burden of having to remember to take the medication that actually suppresses the sperm away from the man and make it so that you don't have to think about it, which we know improves birth control advocacy for both men and women, if they don't have to think about the suppressive pill.

BLITHESo if they took that, then what would happen is that their testosterone would go so low that they would have some side effects. And that's the part we can't replace in a pill, at the moment. There are some, hopefully, methods in development. We know we have gels that work to get testosterone levels back. There are injections, but those are problematic because you get such highs and lows with a long term injection.

BLITHESo we're very excited about some new developments in delivery methods that would give a level of testosterone that would retain -- would cause all of the normal functions to occur, but would not restart spermatogenesis. And that would be the, sort of, male pill. If that could be done in a oral way, then there would be a pill that men could take on a daily basis and if they didn't take it, they would start to feel side effects that they didn't like so they would have incentive to remember to take it. And all would be well under those circumstances.

NNAMDII was about to ask about a study by Columbia University that revisited the possibility of a male version of the pill. Is that what you just described for us?

BLITHENo, the Columbia University study is a non-hormonal method that involves a different pathway in sperm production. And it's a very exciting one. And there's also a similar study being done at the University of Washington using that same pathway. Sperm are really interesting cells because they have such a terrific complexity between being a normal cell and then getting recruited by the millions to be developed into a very unusual type of cell with functions, a head and a tail.

BLITHEAnd you remember the Wood Allen movie where they were all waiting to be ejaculated and then they go forth and have to find the egg, which is quite a distance. So there are a lot of places where we could intervene and in a very specific way and -- so this pathway at Columbia and University of Washington, is being examined because these are both drugs that have oral availability and they stop sperm production.

BLITHEAnd what we're trying to do with them is to develop them so that they're so specific so that they only attack something that happens in the testes and do not affect anything else, anywhere else in the body.

NNAMDIIf you'd like to join this conversation on male contraception, do you think there's a need for more male birth control options or what are your concerns about alternative male birth control options? You can call us at 800-433-8850. Send us a Tweet @kojoshow or e-mail to kojo@wamu.org. Elaine Lissner, the majority of past research and funding has been focused on hormonal approaches to male contraception, but where do non-hormonal methods stand and why non-hormonal?

LISSNERWell, the non-hormonal methods are quite exciting at this point. The issue with the hormonal approach, although it's quite interesting scientifically, is that hormones are not one size fits all. And what they're basically doing with the hormonal methods is suppressing testosterone and then giving it back, but in a way that doesn't get to the testes to allow for sperm production. But that's kind of like, say you took away everybody's shoes and said, well, 10 is a pretty average men's shoe size. Here are size 10 shoes for everybody.

LISSNERIt's not going to fit and work so well for everybody. There are going to be some people who are quite happy, but there are people on the extremes who are not going to be happy. So for hormonal, your testosterone can end up too low or too high. And I don't think we have a medical system, at this point, that is set up for that -- for individualized medicine. The non-hormonal methods, there's some quite interesting ones.

LISSNERJust three very quickly that are probably close -- the first two are closest to actually being to market. And we can talk some more later about what the hold up's been. But one is an Indonesian pill that based on a plant in Indonesia that interferes with sperm production. And they're saying they're going to have it on the Indonesian market within a couple years. They've done tests in men already and it seems to be going fine.

LISSNERThat won't be to the U.S. anytime soon. So if you know someone in Indonesia, you're in luck. But it would need much more extensive studies to come to the U.S. The second one is one called Vasalgel, also known as RISUG that was developed in India. And it's been a very slow process in India. But now it's coming to the U.S. and there's a parallel process that's moving quite quickly. It is a gel that goes in the Vas deferens, which is the tube that sperm swim through on their way from the testes to where they exit. So it's the same tube that would be cut in a vasectomy, but here there's no cutting.

LISSNERThere's an injection which, yeah, that's kind of scary to think about an injection down there, but it's over in a few minutes. And it's just local anesthesia and you'd get up and walk away. I've seen it done twice. It lasts for 10 or more years and is reversible with another injection to just flush it out if the guy wants to have a child in that time. That's been animals so we need to see that reversibility study in people.

LISSNERIt's been done in a couple of people, but not officially yet. So when you can get very targeted like that, you get away from the side effects of hormones when you just block the sperm where they are -- block them and kill any that get passed.

NNAMDIGot to take a short break. When we come back, we will continue this conversation on male contraception. If you have already called, stay on the line, we will get to your call. If you have not called yet, we still have a few lines open, 800-433-8850. How do you think the birth control methods that are currently available shape male attitudes about sex? 800-433-8850 or go to our website, kojoshow.org. Join the conversation there. Send us a tweet @kojoshow or e-mail to kojo@wamu.org. I'm Kojo Nnamdi.

NNAMDIWelcome back to our conversation on male contraception. We're talking with Elaine Lissner. She joins us from the studios KQED in San Francisco. She is the director of the Male Contraception Information Project, which advocates research and promotes awareness about male contraception. It's a nonprofit. Joining us in our Washington studio is Diana Blithe, program director for contraceptive development at the National Institute of Child Health and Human Development of the National Institutes for Health.

NNAMDIAnd joining us by telephone is William Bremner who leads the Center for Research and Reproduction and Contraception at the University of Washington, where he's a professor and chair in the Department of Medicine. Bill Bremner, it's my understanding that John Amory, one of the doctors researching male contraception at your university, recently began studying a drug used for worm infections. What's this research about and what hopes do you have for it?

BREMNERDr. Amory is doing several studies related to male contraception. One of which is developing an oral administration of testosterone that was touched on a few minutes ago. The other is using an agent that's been used for -- variation of an agent that's been used for decades for a variety of other purposes, but new advance of the molecule can act within the testes in a non-hormonal way to block sperm production. And that's been shown in animals by Dr. Amory and also by Dr. Wolgemuth at Columbia that was touched on earlier.

BREMNERSo he's going ahead to develop agents that will specific to the testes and not have adverse effects on other part of the body. And that's work that's ongoing in Seattle. One other thing to touch on quickly would be that it's often asked whether men will accept any form of contraception and it's always a surprise for listeners to note that about 30 percent of contraception in the United States now is done by male methods with about 15 percent condoms and about 15 percent vasectomy.

BREMNERSo despite the problems of both of those agents, that is irreversibility for vasectomy and the difficulties that was touched on for use of condoms. Still, they're very acceptable to large numbers of the population. So I think men will use new agents if they become available, along the line that we've been discussing.

NNAMDIHere's Devin (sp?) in Bethesda, Md. Devin, you're on the air. Go ahead, please.

DEVINThank you very much for taking my call. Just along the lines that you just touched on. The recent Obama administration order to allow female oral contraceptives to be covered by co-pays, do you think -- what will be the social acceptance, given that some organizations, some groups, be it political, religious, are opposed to contraception? How do you think it will differ in the sense that it's a male contraception?

NNAMDICare to address that, Elaine Lissner?

LISSNERYeah. The nice thing about male contraception is it's about as far away from the egg as you can possibly get, especially something like the research at Columbia or University of Washington that interferes with sperm function or the method developed in India, RISUG, that's being called Vasalgel in the U.S., that actually blocks the sperm and kills any that get passed, still in the man. So if it's an abortion issue, then this gets around that because there's just no contact with the egg.

LISSNERNow, if someone has a problem with contraception because they think sex is only for reproduction and they have 10 children because they are practicing what they preach, okay, they can have a problem with male contraception. But if it's just about abortion, this is a really nice way to get around that debate and get back to the goal of eliminating those half of pregnancies in the U.S. that are unplanned.

NNAMDIThank you very much for your call, Devin. You, too, can call us at 800-433-8850. What are your concerns about an alternative male birth control option? 800-433-8850 or you can send e-mail to kojo@wamu.org. Diana Blithe, we got this e-mail from Don. "As a former personal trainer, I am very aware of the roles of testosterone and estrogen in the building and sustenance of muscle tissue. I would be very concerned for men, especially those who are over 40 who have the hormonal regulation of male contraception as muscle production decreases as we age." Care to comment on this effect?

BLITHEWell, this is the reason that the method might be a health benefit for men, because as you're eliminating the local production of testosterone from the testes, you're replacing it with a level that is certainly adequate to maintain muscle mass and libido and ejaculation and all the other functions. Because the level of testosterone that's necessary for that is much lower than the amount that's needed in the testes to maintain spermatogenesis.

BLITHESo, in fact, you could replace at a level that would be high enough to maintain muscle mass and overcome some of the low testosterone issues that are already occurring in older men. And also, we're trying to develop other androgens that would have a prostate sparing effect but still maintain muscle mass and all the other good things that testosterone can do.

NNAMDISince we're on that subject, I'll go to Sean (sp?) in Berryville, Va. Sean, your turn. Go ahead, please.

SEANHi, thanks for taking my call. I have two questions. First of all, I'm curious in these conversations. It always seems as if the people who are promoting, say, the use of estrogen, progestin and so on or, in this case, testosterone, they always seem to avoid the side effects, breast cancer in women, cervical cancer, liver cancer. When the pill came out, one in 24 women got breast cancer, one in eight get it now. So I'm curious why that's not part of the conversation.

SEANSecond of all, I would remind everyone that if we're talking about giving, you know, teenage boys testosterone, the moment they get arrested for that and they go on trial for taking steroids. So I'm wondering how they're planning on maybe getting around that.

NNAMDIWilliam Bremner, care to address that question?

BREMNERYes. First of all, the female pill, they're -- it has, of course, been given to hundreds of thousands of women who have taken it for decades and it's been studied extensively. And it's one of the safest drugs there is and, in fact, have some positive health benefits, ovarian cancer and other endpoint. So, it's -- and it's certainly much safer than getting pregnant and the risk of child birth and delivery. So, you know, I think society and hundreds of thousands of women have decided that it's in their best interest.

BREMNERWith regard to testosterone administration to men, the -- if they, of course, were prescribed, it's perfectly -- we use it clinically all the time for a whole variety of indications, not contraception and there's, you know, nobody getting arrested for taking their medication. So it certainly can be done clinically as well once we've given it to large enough numbers of men they can be fully convinced of its safety.

BREMNERThe things that Dr. Blithe was touching on a second ago are important to re-stress. There are positive health benefits of potentially of androgen administration on men, including the muscle mass issue that was brought up. And we can now block the conversion of testosterone through the agent that particularly affects the prostate, ahead of testosterone and in fact, it also affects the skin so that it's possible to decrease the likelihood of both baldness and adverse prostate conditions in men. So there are many potential positive health benefits as well.

LISSNERLet me just ask something.

NNAMDIIt's Elaine Lissner, Sean.

LISSNERIn terms of the legality issue, the amounts that people are taking for body building and for cosmetic purposes are way, way higher. So despite what I said earlier about testosterone not being one size fits all, these are normal amounts that are being replaced for men, not extreme amounts that you would see, you know, people turning into Rambo. And also, just to add also on the side effects for the female pill, the pill is not much fun for a lot of people.

LISSNERSome people it's great, but a lot of people have trouble with it. But it has turned out to be a lot safer than people feared. Now the levels were very high in the early studies and it was not a pretty thing, the levels that were given to women at that point. But it's really come out with a pretty clear bill of health in terms of safety.

NNAMDISean, thank you very much for your call. You, too, can call us at 800-433-8850. Do you think there is a need for male birth control options? What could be the option that you'd prefer having listened to this discussion so far? 800-433-8850. Send us a tweet @kojoshow or go to our website, kojoshow.org. Join the conversation there. Diana Blithe, where does product cost factor into your research? How important is affordability in developing new contraceptives?

BLITHEWell, it's very important that the method be affordable, because if it's not, then it won't be utilized. So it either has to be very inexpensive if it's going to be something that people can get over-the-counter or it has to be covered by insurance, if it's going to be a prescription product. And we expect that these products will be very affordable in the long term. And of course, the prevention of unplanned pregnancy provides a lot of relief of social burden from people who are trying not to get pregnant and don't want to have that social burden as well.

BLITHEAnd one of the things that was mentioned is that about 50 percent of the pregnancies that normally occur are unplanned, but the other thing that was not mentioned is that 50 percent of those unplanned pregnancies usually are a result of a contraceptive failure. So that's one of the reasons why we need more methods. We need more effective methods. We need methods that word for everybody that will cut down on discontinuation rate and also forgetfulness or user compliance issues.

NNAMDIOn to Kelly in Falls Church, Va. Kelly, you are on the air. Go ahead, please.

KELLYHi, thanks for taking my call. I'm calling about a method that my husband and I use called the Billings method and it involves basically conversation. We've been using for many years and what happens is I write -- there's a couple different parts to it, recognizing the cervical mucus changes, that's my role, and then communicating it. Almost every day, my husband and I have a conversation about my current state of fertility.

KELLYThat allows him to actually take ownership in the fertility need to feel valuable and that it's not a disease that I'm fertile. When I was on the pills, subconsciously I felt like I was taking the pills for this disease of fertility. The problems I've ran into it with it are, of course, when I go to the doctor or whatever and I say I'm on natural birth control, they automatically assume I'm pregnant or the social acceptance of that is it's not going to work.

KELLYBut the benefits far outweigh the complexes and I realize it would only work in some circumstances, like my husband who accepts this method and chooses to participate in discussions about cervical mucus every day. But I wanted to ask a couple of questions, do you think men would be less likely to have subconscious affects from the pill they'd be taking than women and also why is it that we can't socially work into our lives this natural type of plan?

NNAMDIElaine Lissner?

LISSNERYeah, fertility awareness methods I find very interesting and really valuable thing for people like you who are very conscientious. And one kind of neat element of them is that it can be used in conjunction with condoms. I was in India recently and it turns out a lot of the young couples there use condoms during their fertile period, which they figure out by fertility awareness and they even have iPhone apps to help them keep track of their fertile days.

LISSNERSo there are a lot of different ways you can track you fertility. But on the other hand, I also have a dance teacher who has a child because she was using fertility awareness. So it's a really good method when people are really careful. And it's free too, which is nice.

BLITHECan I make a comment?

LISSNERYeah.

NNAMDIPlease do, Diana Blithe.

BLITHEThe problem with fertility awareness is that not everyone can be as aware of their fertility as this individual is able to do successfully. And that is one of the reasons why the failure rate is about 20 percent or higher. And women's cycles are not as regular as they would like them to be. And on any given cycle, a woman might think she's not in her fertile period, but she is. And that can result in a failure.

NNAMDIThank you very much for your call, Kelly. William Bremner, earlier, we talked about some of the studies that were going on at your university. I omitted to ask and I should have at the time, how are subjects chosen for clinical trials when it comes to contraceptive?

BREMNERWe advertise in the local radio and newspaper for men who are willing to participate and really it's simply a matter of their being normal consenting volunteers. So, they choose themselves really. And among the reasons they state for participation, probably the biggest single reason is that their female partners have problems with one or more of the methods available to them. And we know from studies that between 30 and 60 percent will stop using any particular form of contraception within a year for a variety of reasons.

BREMNERAnd so that's an important reason and some of them also show an interest in developing new agents for them, for the use of men in general. And some of them is actually the sort of spacing method between periods of fertility and we've had asked quite a few volunteers who have had children or and then wanted to not have them for a period of time and go on one of the techniques and then come off and have children again.

NNAMDIWell, we seem to have opposing points of view here. This e-mail we got from Carly (sp?) in Tacoma Park, "Whoever finally comes up with a solid male method here is going to have one hell of a customer base in Washington, D.C. You don't think some of those politicians on Capitol Hill aren't going to be interested in avoiding getting people pregnant? They're probably not going to call in on this show, but I can guarantee you that they must be interested." And then there is Diane in Gaithersburg, Md. Diane, your turn.

DIANEHello, Kojo. I just would like to make a brief statement and see what you guys will take into effect with it. Unfortunately, for me, at 52, I was on the dark side recipient of the pill. I was so highly sensitive, I couldn't take it. And so we tried other birth control methods and I got pregnant and I had an abortion. And the gentleman that kind of made me feel I had no choice but to do that, because he wouldn't support it.

DIANELong story short, seen him 30 years later and he's very glad to be married to his Catholic wife whose religion he's used, and his children, to try to make me feel guilty or transfer all the guilt onto me for his part in it. And it's ruined my life. I've tried to kill myself several times. And eventually, I'll probably succeed. But I'd like to know how men are in this world, and how women are -- and how women are persecuted for having abortions by the religious and the people who are involved, because men won't take responsibility for their unborn children. How do you think they're gonna take responsibility now by taking something?

NNAMDIWell, two things about that, Diane. If you are suffering from clinical depression, you should be consulting with a professional about that. Have you, or will you?

DIANEI have over the years.

NNAMDIOkay.

DIANEIt doesn't help. It doesn't go away.

NNAMDIOkay. But I think it's something that you should continue to do, because we don't want you doing anything to yourself. The other part of it that you raised, I asked the question earlier, how do you think the birth control methods that are currently available shape male attitudes about sex. And what Diane seems to be saying, Elaine Lissner, is that we have -- that what's available now gives men a certain latitude to be irresponsible. How do you -- what do you say?

LISSNERWell, I'm not sure I agree with that. We have pills for women. We have all the female methods, and we have condoms and vasectomy for men. And vasectomy isn't reliably -- you can't count on it being reversible. So that's not an option for a man like in her situation, where he wanted to maybe have children some day in the future. Condoms, people make mistakes.

LISSNERI think that there are a lot of men who would like to not be in the situation that her man was in terms of getting someone pregnant without meaning to. And it sounds like he had some not so -- not-so-nice ways of justifying it in his mind, and it had some pretty serious impacts on the caller. But what we're trying to do is get some really effective long-term methods. Methods that you don't have to remember to take every day, that will avoid these kind of situations.

LISSNERAnd I hear stories like her story all the time in terms of people who've had abortions because nobody told them that antibiotics and the pill don't mix. Or people who had varicose veins starting in their teens because of the pill -- high early doses of the pill. So we're trying to get towards a method where men have some options and some control to not put themselves and other people in those kind of situations.

LISSNERLike this ten-year method where you know you're just good to go and you can reverse it if you need to. But these days it sounds like this situation was a while ago. These days there are some pretty serious financial repercussions for men too, and changing their entire life if they get someone pregnant in college or whenever. So we're trying to get people options that work really well to avoid this kind of really sad story.

NNAMDIDiane, thank you very much for your call. Dr. Blithe, turning away from the men for a moment, listening to our last caller, Diane, many women are dissatisfied with the methods of birth control available to them. The side effects are undesirable or intolerable for some women. Are there better alternative methods of female birth control in the research pipeline?

BLITHEThere are. And some of the methods that have been developed, the IUD is certainly one that is not hormonal and has been shown to be the most cost effective, because even though there's some up-front cost, over the ten-year period that it's effective, it's quite -- or it's very reversible, it becomes much less expensive. But we are trying to develop in our institute some other methods for women that might be non-hormonal, with the same approach that we used to stimulate non-hormonal approaches for male contraception by going to researchers and saying, you're already working on these really fascinating reproductive biology questions.

BLITHEHow would you be able to take that research and think about how you might be able to get a contraceptive product out of it. So that would -- that stimulates the field to think about the research in a somewhat more applied way than normally happens in grant research.

NNAMDIGotta take another short break. When we come back, we will continue this conversation. If you have called, stay on the line. We'll try to get to your call. If the lines are busy, go to our website, kojoshow.org, and join the conversation there. I'm Kojo Nnamdi.

NNAMDIWe're talking about male contraception with William Bremner. He leads the Center for Research in Reproduction and Contraception at the University of Washington where he's a professor and chair in the department of medicine. Elaine Lissner is director of the Male Contraception Information Project, a non-profit advocating research and promoting awareness about male contraception.

NNAMDIAnd Diane Blithe is program director for contraceptive development at the National Institute of Child Health and Human Development. Diane Blithe, the pharmaceutical industry seems to have been reluctant to sponsor innovations in male birth control. Why do you think big pharmaceutical companies might be holding off on marketing alternative male contraception?

BLITHEWell, we've had a speculation for a number of years about why that might be. They were originally involved in contraceptive development and then they merged with larger companies and abandoned that in favor of other methods of pursuit. But I think that one of the reasons they considered it not to be a suitable pursuit is because they also have a very large female contraceptive portfolio, and they might have felt that it was sort of a zero sum game that if they developed a male contraceptive they might lose market share on their female methods.

BLITHEHowever, I thought that it was very interesting that the New York Times article that recently talked about male contraception generated a lot of comments from men who were saying that they would like to use the product if it were available, and women who sometimes said they wouldn't trust their husband to bring home a quart of milk, let alone take a birth control pill, which would indicate that they would continue to take their method.

BLITHESo it's possible that a pharmaceutical company might see this as something that would increase market share because the women would continue to take something that they felt would protect them, and the men might choose to take something that would protect them as well.

NNAMDIWilliam Bremner, one of the main questions to be answered before the pharmaceutical industry promotes the cause of male birth control is how do we market this? Which consumers are we targeting?

BREMNERWell, there have been a variety of surveys done both by pharmaceutical companies and others that suggest that something in the range of 50 to 80 percent of men from a wide range of cultures and geographies and religions would be willing to take a method if it were effective and reversible, and without significant side effects, and reasonable cost effective.

BREMNERSo there's a huge potential market out there, and it's both men who are married or in other stable relationships as well as men who are not in a long-lasting relationship but would like to be certain that they're not capable of causing a pregnancy, and acquiring the attendant responsibilities and risks that go along with that. So there's a lot of people who would be interested in taking such methods, and we certainly don't have trouble getting volunteers for our studies partly for that reason.

BREMNERThe other thing about whether women would trust them has also been surveyed, and there was one study that was done both in Europe and in Africa -- South Africa, and Hong Kong, which showed that over -- that approximately 98 percent of women in all those cultures would trust their married partner. Of course, would not be particularly trusting necessarily of somebody they're not in a long-term monogamous relationship with. But if they were, they were -- stated their willingness to trust the man to take the method.

NNAMDIElaine, listener -- I think you may have mentioned this earlier, but not specifically. One of the most talked about new fronts in the male contraceptive movement is a technique known as reversible inhibition of sperm under guidance, or RISUG or RISUG. Which is it, what is it, and how does it work?

LISSNERSo it's a terrible name, but this is the method I was talking about that was developed in India. It's a high-tech polymer gel that is injected into vas deferens which is the tube sperms swim through, and it mostly blocks the sperm, but it also kills any that get past. It's very interesting. It makes a structure almost like a sponge inside, and it filters out the sperm, and it can be reversed by an injection that dissolves it and flushes it out if a man doesn't want the full ten-plus years.

LISSNERNow, this is the method that is probably the second one that will make it to market in terms of timeline. Probably the Indonesian pill will be first in Indonesia. But as far as new methods in the U.S., I don't see the hormonal methods coming in the next five years, even though people are always saying five to ten years. But RISUG, which will be called Vasalgel in the U.S., is being developed by a non-profit company that's part of a foundation.

LISSNERSo nobody's looking to make a killing, but the people who invest can potentially get their money back if it goes well, and I think this is what you need in order to get some of these non-hormonal methods to the market. A different scale of funding is needed now, and that's what's been holding things up, is we've done lots of nice $100,000 here, $100,000 there studies, you know. Some rats here, some mice there.

LISSNERBut once you actually want to get something to the market, you need millions of dollars. You need minimum four or $5 million to take something through the FDA process, and that's if you're being efficient. So luckily we now have the Gates Foundation getting involved in this field, the Bill and Melinda Gates Foundation. And if people want to see these methods available more readily, what they can do to help is go to our website and fill out the survey and the petition.

LISSNERI think some major funders are not entirely convinced that men are a high priority in this area, and certainly the NICHD is different. They've been working on this for a long time, and really hanging in there. But we need a different scale of funding to finish the job, and I think this is a place where a non-profit pharmaceutical company can get something to market sustainably, keep the company alive, but without expecting to make a killing.

NNAMDII think we have one caller on the line who approves of its availability, in his case, if somewhat belatedly. Here is Scott in Silver Spring, Md. Scott, you're on the air. Go ahead, please.

SCOTTHi, Kojo. Long-time listener, first-time caller.

NNAMDIThank you.

SCOTTI recently, what is it, six, eight months ago, underwent a vasectomy myself. I'm in a relationship with my wife and concerned about the long-term effects of taking birth control and so underwent this vasectomy. It was fairly easy, but boy would I have loved just an injection instead that lasts ten years. I'm 38, not planning any kids from here on out. But I could see a huge market for something you do once, lasts ten years. You don't have to worry about it again.

SCOTTI think pharmaceutical companies are probably a little concerned about something like this because in like a case like ours, a guy undergoes this treatment, and then that's years of birth control pills that the wife is not going to be taking. So ten years of profits that this pharmaceutical company would see from getting a monthly set of pills is just gone.

NNAMDIYeah. I think that's all we call all say, Scott, is yeah. I think you're right. Thank you very much for your call, Scott. Diana, what -- we heard about the Gates Foundation. What role to the National Institutes of Health play in male contraceptive research?

BLITHEWell, as I said, we've developed a program where we asked investigators to look into their research and see if they could find a method that would be applied where we could develop product and we try to help them, because it's a really important area that women's groups have identified as something that they think is incredibly important to their well being. And so if pharmaceutical companies aren't doing it, it behooves the government to try to do some research in this area.

BLITHEWe're also in a very exciting period of time where we can take molecules that work more broadly and make them more specific, because we're learned how to do that so that something that might have worked systemically, for instance the pill that John Amory is working on, has an effect in the liver as well as in the testes. But because the receptors in those two tissues are very different, if we can just modify that molecule as chemical modifications are becoming easier to do, we can perhaps take away the liver reaction and only have the testicular reaction which would make it a very specific, very safe method that men could that.

NNAMDIWilliam Bremner, like female birth control, male birth control would not protect against sexually transmitted diseases. Condoms are still necessary for safe sex. Do you foresee the male birth control pill having an effect on the use of condoms, and consequently, the prevalence of sexually transmitted disease?

BREMNERThe -- what you said at the beginning is true. That is that none of these methods that are under development for male contraception would -- are planned to also target sexually transmitted disease. So that's a theoretic concern in young people who would otherwise be at risk of sexually transmitted disease. But there are two different conditions, and people -- the vast majority of people who are involved in long-term relationships and -- of a monogamous nature, don't feel themselves to be at risk of sexually transmitted disease, but are certainly at risk of pregnancy. So it's a huge part of the population who this would be applicable to.

NNAMDIAnd I'm afraid we're just about out of time. William Bremner leads the Center for Research and Reproduction and Contraception at the University of Washington where he's also the Robert G. Petersdorf professor and chair in the department of medicine. Thank you for joining us.

BREMNERThank you for asking me.

NNAMDIElaine Lissner is the director of the Male Contraception Information Project, a non-profit advocating research and promoting awareness about male contraception. Elaine Lissner, thank you for joining us.

LISSNERMy pleasure. Thank you very much.

NNAMDIDiana Blithe is program director for contraceptive development at the National Institute of Child Health and Human Development. Diana Blithe, thank you for dropping in studio.

BLITHEThanks very much.

NNAMDI"The Kojo Nnamdi Show" is produced by Brendan Sweeney, Michael Martinez, Ingalisa Schrobsdorff, and Taylor Burnie. The managing producer is Diane Vogel. Our engineer today, Andrew Chadwick. A.C. Valdez is on the phones. Podcasts of all shows, audio archives, CDs, and free transcripts are available at our website kojoshow.org. Thank you all for listening. I'm Kojo Nnamdi.