This story is jointly published by nonprofits Amplify Utah and The Salt Lake Tribune, in collaboration with Salt Lake Community College, to elevate diverse perspectives in local media through student journalism.
Kaylee Gates suffered months on end, waiting for her body to adapt to her hormonal birth control implant.
Weight gain, mood swings and acne began to wreak havoc on her body and mind. The longer she waited, the more her hope faded.
“The challenges I faced were really awful,” she said. “[It got] to a point where it wasn’t even worth it any more.”
Two years in, Gates decided that she had enough when extreme nausea, irritability and period pains incapacitated her for a full week. She discussed the risks with her doctor, and with the implant removed, she hoped the worst of it would now come to an end.
“I am two years off of it, and I am still having those issues,” said Gates, 22. “It’s still causing me issues with my mood, like being irritable, and it caused me a lot of weight gain and made my periods heavier.”
Gates and her new husband, 22-year-old Azhurel Mendes, got married in March and are considering their future as parents. They aren’t ready now, they said, but because birth control made Gates so miserable, having other options – like a new prescription contraceptive for men – could have helped them better manage their own family planning.
The University of Utah’s ASCENT Center for Reproductive Health and seven other sites across the nation, contracted by the National Institute of Health, now are studying a potential beacon of hope for couples like Gates and Mendes.
A new possibility
Nestorone-testosterone, otherwise known as NES/T, is a gel applied to a sperm-producing man’s shoulder. NES/T consists of two main compounds: Nestorone and a testosterone replacement.
“This is a combination gel,” said Dr. David Turok, director of the U.’s ASCENT Center and lead investigator of the Utah site. “Nestorone is basically a synthetic version of progesterone, [which] is used in an FDA-approved vaginal ring.”
Progesterone blocks the hormones that allow for ovulation in many female-born patients. With NES/T, Turok said a similar hormone-blocking effect can be created in men. Contraception methods that utilize progesterone now are only available to female-born patients.
“[The gel] does basically the same thing, but the end result, the target, is in the testes,” Turok said. “It does two things there: It stops sperm production and [negatively] impacts testosterone production. That’s why you need the second drug in it, [the synthetic] testosterone.”
A man using the gel daily, Turok said, may need to wait one to six months for his sperm count to drop to a level deemed reliable to prevent pregnancy.
Responsibility shift
The U’s study of NES/T consists of 20 heterosexual couples. For Turok, this new method has shown potential for a shift in responsibility of hormonal birth control, which typically has fallen on women.
“The most common theme is that the female member of the couple is saying, ‘I’ve tried all these things and they don’t work, and now it’s his turn,’” Turok said.
Turok said he believes that sentiment exists among many couples who don’t want children or aren’t ready for pregnancy.
“The way our society tries to shame and blame women around [unplanned or undesired] pregnancy and then, amazingly, not pursue or acknowledge the man’s role in it is really phenomenal,” Turok said. “From what we’ve seen from the participants in this trial, men [are] acknowledging, ‘I have a role in this, and I want to step up.’”
After watching his wife suffer the side effects of her birth control for so many years, Mendes said he’s interested in learning more about the male version of such contraceptives.
“If it’s not any worse than birth control for women, I think it is only fair that men could take the brunt of it, for once,” he said.
The second phase of the study is still going on. According to Turok, if the gel is to receive approval from the U.S. Food and Drug Administration, it still will need to go through a third phase of study, which would likely enroll more than 1,000 couples and follow them for a year — then the data would be analyzed and submitted to the FDA.
As researchers continue their work, both Mendes and Gates expressed concern over the gel’s side effects, and wondered if they could be similar or worse than current birth control methods available to women.
“If we did a lot of [personal] research into it … and there were a lot of other people who had tried it, I think I would be willing for you to try it,” Gates said, motioning to her husband. Mendes first heard about the study when it was announced in January 2022 and wanted to learn more about it then.
Lingering questions
Four years earlier, the Male Contraceptive Initiative found that a lot of other men shared Mendes’s interest. Out of 1,500 men from the United States, ages 18-44, 80% either believed that they had a sole or shared responsibility to prevent pregnancy. Of those men, 70% said they’d be willing to try new contraceptive methods.
While there is evidence that men want to share the birth control burden with their partners, Turok said NEST/T could lead to trust issues, as women might have a difficult time trusting their partners to consistently and correctly use birth control.
“One of the main questions that researchers have put out there is, ‘Is this acceptable for female partners?’ We are collecting some data on that,” he said. “If a man says, ‘I’m using this,’ will their female partner accept [and trust] them?”
While adoption of modern female birth control options, such as the IUD, has become more common at the turn of the century, the development of male birth control has conversely been met with several obstacles. Turok said he’s eager for the gel’s results to be published, but, “I have no idea when that will be,” he added.
Whenever the gel ultimately goes on the market, Turok said, “it’s [likely not] going to be the most popular choice right off the bat, but I do think it is an important step forward.”
Ethan Udy wrote this story as a journalism student at Salt Lake Community College. It is published as part of a collaborative including nonprofits Amplify Utah and The Salt Lake Tribune.