Men’s Health: Why Ignoring Male Reproductive Needs Harms Everyone | STAT News

More than 1 million sexually transmitted infections (STIs) are acquired every day globally and roughly half of the 250 million pregnancies each year are unplanned. These figures, stark reminders of ongoing public health challenges, underscore a critical gap in medical research and policy: the relative neglect of men’s sexual and reproductive health. At the clinic where I work in Boston, we’re seeing a steady increase in infections, and it’s clear that addressing these issues requires a more inclusive approach.

The Uneven Landscape of Contraception

Every unplanned pregnancy involves a man, yet contraceptive development has historically focused almost exclusively on women. With only two widely available methods – vasectomy and male condoms – less than a quarter of men use any form of birth control. This isn’t due to lack of interest, but a lack of options. For over a century, there has been minimal innovation in male contraception, a consequence of chronic underfunding and a historical bias in research priorities.

This oversight isn’t just a matter of fairness; it directly impedes reproductive health for everyone. As a physician who has worked in HIV and STI prevention for four decades, I’ve witnessed firsthand how limited choices impact individuals and communities. Young men often present unaware of risks, lacking knowledge about asymptomatic infections and readily available treatments.

Men as Vectors and Vulnerable Populations

The focus on women in reproductive health often overlooks the role men play in STI transmission. Men tend to have more sexual partners than women, increasing their likelihood of acquiring and transmitting infections, even if asymptomatic. This is particularly relevant for men who have sex with men (MSM). Despite representing approximately 5% of the U.S. Population, MSM accounted for over 30% of syphilis cases in 2023.

Beyond transmission rates, sexual and gender minority individuals may face barriers to accessing care due to fears of discrimination or mistreatment. Even individuals with fewer partners can be at increased risk if their partners are sexually active with others. Effective STI prevention requires solutions tailored to all populations.

Progress on the Horizon: New Contraceptive Options

Fortunately, the landscape is beginning to shift. Medical science has understood the principles of hormonal male contraception for 85 years, with research dating back to the 1970s. These methods work by manipulating the body’s natural hormonal feedback loops to reduce sperm production, with the potential for reversibility when hormone treatment is stopped.

Several promising products are now in late-stage testing. NES/T, a gel combining progestin and testosterone applied daily, has shown encouraging results with no serious side effects reported to date. Oral synthetic testosterone derivatives are also undergoing clinical trials. With continued investment and rigorous testing, a viable hormonal male contraceptive could be available before 2030.

The introduction of new methods is likely to increase overall contraceptive use. Studies suggest that for every new method introduced, there is approximately a 12% increase in overall contraceptive prevalence. Expanding options for men will empower them to take greater control of their reproductive health and contribute to reducing unplanned pregnancies.

Beyond Contraception: STI Prevention and Treatment

Advances in STI prevention are equally crucial. The past decade has seen monumental progress in antiretroviral therapy (ART) for HIV, to the point where, medically, the disease is often manageable and transmission can be prevented. Although, new HIV cases persist, with men accounting for over 80% of the 39,000 new diagnoses in the U.S. In 2023, with two-thirds attributed to male-to-male sexual contact.

Adherence to daily ART regimens can be challenging, particularly due to cost and logistical complexities. Many individuals are unaware of their HIV status or do not utilize pre-exposure prophylaxis (PrEP). To address these challenges, researchers are developing longer-acting prevention options.

The FDA recently approved biannual injections of Lenacapavir for PrEP, joining cabotegravir, which is already available as a PrEP injection every two months. Research is underway to develop annual injections or monthly pills for PrEP, offering more convenient and accessible options.

However, the success of HIV prevention and treatment may inadvertently contribute to increased STI rates due to reduced condom use, reinforcing the need for solutions for other STIs. The emergence of antibiotic-resistant strains of gonorrhea is particularly concerning. While gonorrhea rates are similar between heterosexual men and women, MSM accounted for around 40% of all gonorrhea cases in the U.S. In 2022.

The Promise of Vaccines

Vaccines may offer a long-term solution. The bacteria causing meningitis shares genetic similarities with gonorrhea, leading researchers to explore adapting the meningococcal serogroup B (MenB) vaccine for gonorrhea prevention. While clinical trial results have been mixed, larger, definitive trials are underway.

Vaccine development is also progressing for syphilis, chlamydia, and herpes simplex virus type 2. The recent mpox outbreak demonstrated the effectiveness of rapid response and vaccination efforts, particularly within the MSM community. This success provides a blueprint for future investments in men’s health protection.

A Call for Reinvestment

The response to mpox, particularly at institutions like Fenway Health, highlights the power of swift action, leveraging existing research, identifying at-risk populations, and committing adequate funding. However, current trends are moving in the opposite direction. Proposed budget cuts to the National Institutes of Health and the dismantling of international aid programs supporting sexual and reproductive health threaten to reverse this progress.

Investing in men’s sexual and reproductive health is not about diverting resources from women; it’s about recognizing the interconnectedness of sexual health for all. Resurgent mpox outbreaks in Africa demonstrate the global implications of neglecting vulnerable populations. HIV continues to spread beyond MSM communities, and every unplanned pregnancy involves a man.

The path forward requires increased government investment in research and programs, expanding access to state-of-the-art medical approaches, and ensuring culturally competent care for all. Without prioritizing the often-overlooked health needs of men, we will fall short of achieving true reproductive health equity.