The Male Pill: Where Men's Contraception Really Stands

For more than sixty years, the pill has been something women take. Men have had two options: condoms, or a vasectomy. One is easy to get wrong, the other is meant to be permanent.

That may finally be changing. A gel that men rub on their shoulders each morning has suppressed sperm in large trials. A hormone-free pill has passed its first safety tests in men. And the science behind both says something useful about testosterone, because the same hormone that builds muscle and drives libido turns out to be one of the most effective ways to switch sperm production off.

Here is where male contraception really stands, what is still missing, and why the question matters to any man thinking about testosterone.

Why male contraception is so hard

Female hormonal contraception has a simple target: stop one egg being released each month. Men produce millions of sperm every day, continuously, from puberty onwards. Any method has to stop almost all of them, reliably, without affecting libido, mood or erections, and then let production come back fully when the man stops.

For a long time the barrier was not biology but money and confidence. Drug companies doubted men would take a contraceptive, and worried about liability for side effects in healthy people. Most of the progress in the last twenty years has come from publicly funded research, notably the US National Institutes of Health and the World Health Organization.

How hormonal male contraception works

Sperm production depends on two pituitary hormones, LH and FSH. LH tells the testes to make testosterone, and FSH, together with very high levels of testosterone inside the testes, drives sperm production.

Give a man extra testosterone, and the brain senses that levels are high. It switches off LH and FSH. Testosterone in the blood stays normal or high, because of what you are giving him, but testosterone inside the testes falls sharply, and sperm production slows or stops.

That is exactly why testosterone therapy tends to make men temporarily infertile. See will TRT make you infertile? Hormonal male contraception simply uses the same effect on purpose, usually adding a progestogen to switch LH and FSH off more completely, while the added testosterone keeps libido, energy and muscle normal.

The trials that came before

The idea is not new. In 1990, a World Health Organization study gave healthy men weekly testosterone injections. About two in three had no sperm at all within six months, and pregnancies in their partners were rare while their counts stayed suppressed.

The problem was practicality. Weekly injections are not something most men want for years.

In 2016, a WHO-supported trial published by Hermann Behre and colleagues tested an injection of a progestogen with long-acting testosterone every eight weeks in 320 men. It suppressed sperm in most of them and was about 96% effective at preventing pregnancy among couples who continued. But recruitment was stopped early because of side effects, mainly mood changes, acne and changes in libido. Even so, more than three-quarters of the men said they would be willing to use the method.

The early stop was widely reported as "men can't handle the side effects women put up with". The reality was more cautious: the trial's sponsors stopped it on the advice of an independent safety committee, which was applying the strict standards used for healthy volunteers. The trial showed the principle worked, and pointed to the need for a gentler, more convenient method.

The gel: NES/T

That method may now exist. NES/T is a gel combining segesterone acetate, a progestogen also known as Nestorone, with testosterone. Men apply it once a day to their shoulder blades.

In a large international phase 2b trial led by the US National Institutes of Health, results presented at the Endocrine Society meeting in 2024 showed that among 222 men who used it for at least three weeks, 86% reached the contraceptive threshold of one million sperm per millilitre or fewer by week 15. The median time to get there was under eight weeks, faster than previous injectable methods.

The phase 2b trial, which also measured pregnancies, side effects, acceptability and recovery of fertility, finished in 2024, and full pregnancy results are still awaited. The company Contraline now holds the rights and plans a phase 3 trial from 2027. It is the most advanced hormonal male contraceptive in development, but it is not yet available, and approval is likely to be some years away.

Is it safe for your testosterone?

Because the gel contains testosterone, blood levels stay in the normal range, which is what protects libido, erections and muscle. What changes is testosterone inside the testes, which is the point. In the earlier trials of hormonal methods, sperm production usually recovered after stopping: an analysis of 30 studies and more than 1,500 men estimated that about two-thirds were back to normal within six months, and almost all within two years.

The hormone-free pill: YCT-529

The other approach avoids hormones altogether. YCT-529 is a daily pill that blocks a protein called retinoic acid receptor alpha. Vitamin A, through its breakdown product retinoic acid, is essential for sperm production, and blocking this receptor interrupts the process without touching testosterone.

In animal studies, it stopped sperm production and fertility returned after stopping. In 2025, its developer, YourChoice Therapeutics, working with the University of Minnesota, published the first results in men in the journal Communications Medicine. In a small safety study of 16 men, 12 took the drug and four a placebo. It was well tolerated, and testosterone, mood and sexual function were unaffected.

This was a safety study in men who had already had vasectomies, not a test of whether it prevents pregnancy. A 28-day study has since shown changes in sperm counts, and a longer 90-day trial looking at sperm suppression is now under way. If it works in people as it did in animals, it would be the first contraceptive pill for men that does not involve hormones at all.

Other methods in development

• Oral hormonal pills such as DMAU and 11-beta-MNTDC, which combine testosterone-like and progestogen activity in a single molecule, have completed early safety studies.
• Gels injected into the vas deferens, the tubes that carry sperm, are being trialled as a long-acting, possibly reversible alternative to vasectomy. One version, known as RISUG, has been studied for decades in India.

None of these is yet approved in the UK.

What men can use today

For now, the options remain:

• Condoms. According to the NHS, they are 98% effective when used correctly every time, but less in real life because they are often used imperfectly. They are also the only method that protects against sexually transmitted infections.
• Vasectomy. More than 99% effective and intended to be permanent, though reversal is sometimes possible. It does not affect testosterone. See does a vasectomy lower testosterone?

Why this matters even if you never use it

The research into male contraception has produced some of the clearest evidence about what testosterone does to fertility. It shows that:

• Taking testosterone switches off sperm production in most men, which is why men on TRT, or using anabolic steroids, often become infertile. See anabolic steroid side effects.
• The effect usually reverses, but it can take months to two years.
• Testosterone in the blood and testosterone in the testes are not the same thing. A man can have normal or high blood levels and almost no sperm.

If you are thinking about testosterone therapy and might want children, that is the single most important thing to understand. See TRT in your 20s and 30s.

Testosterone is not a contraceptive on its own

One warning. Because testosterone suppresses sperm, some men on TRT or steroids assume they cannot get a partner pregnant. That is a mistake. Suppression is not guaranteed, it varies between men, and it can take months to develop. Without regular semen tests showing very low counts, testosterone should never be relied on as contraception.

The bottom line

Male contraception is closer than it has ever been. A testosterone-based gel has shown strong sperm suppression in large trials, and a hormone-free pill has passed its first safety tests. Neither is available yet, and both still have to prove they prevent pregnancy reliably in everyday use.

In the meantime, the research carries a lesson for every man: testosterone and fertility pull in different directions. Taking testosterone lowers sperm, often to zero, and it is usually, but not always quickly, reversible.

Common questions

Is there a male contraceptive pill yet?

Not one that is approved. A hormone-free pill called YCT-529 has passed an early safety study in men, and longer trials of its effect on sperm are under way. A hormonal gel called NES/T is further ahead in testing.

How does the male birth control gel work?

It combines a progestogen with testosterone. Together they switch off the hormones that drive sperm production, while the testosterone keeps blood levels normal so libido and energy are maintained.

Will male contraception lower my testosterone?

Hormonal methods keep blood testosterone in the normal range because they contain it. The hormone-free pill YCT-529 did not change testosterone in its first study.

Can TRT be used as contraception?

No. Testosterone usually lowers sperm counts, but not reliably enough or quickly enough to depend on without regular semen testing.

Is fertility restored after stopping hormonal male contraception?

In the trials so far, almost always. About two-thirds of men recovered normal sperm counts within six months, and nearly all within two years.

Sources: World Health Organization Task Force on Methods for the Regulation of Male Fertility, Contraceptive efficacy of testosterone-induced azoospermia in normal men, Lancet 1990;336(8721):955-9 · Behre HM et al., Efficacy and safety of an injectable combination hormonal contraceptive for men, J Clin Endocrinol Metab 2016;101(12):4779-88 · Blithe D et al., Nestorone/testosterone gel phase 2b sperm suppression results, ENDO 2024, Endocrine Society press release, 2 June 2024 · YCT-529 first-in-human study, Communications Medicine 2025, University of Minnesota College of Pharmacy · Liu PY et al., Rate, extent, and modifiers of spermatogenic recovery after hormonal male contraception, Lancet 2006;367(9520):1412-20 · NHS, Male condoms and vasectomy · Educational only, not medical advice.

Keep reading: Will TRT make you infertile? · Does a vasectomy lower testosterone? · Sperm count: what lowers it · TRT in your 20s and 30s · Testosterone recovery after steroids · Peptides explained