Men's sexual and reproductive health has been largely neglected in medical research and public health policy, despite men being central to issues like unplanned pregnancy and sexually transmitted infections (STIs). Every single unplanned pregnancy involves a man, yet contraceptive options concentrate almost exclusively on women. With only two male-focused methods available, vasectomy and male condoms, less than a quarter of men use any form of birth control. No new male contraceptive methods have entered the market in more than 100 years .

The gap extends beyond contraception. Men made up over 80% of the 39,000 newly diagnosed HIV cases in the United States in 2023, with two-thirds of these cases attributed to male-to-male sexual contact. For other STIs, the disparities are equally striking. Men who have sex with men (MSM), despite representing around 5% of the U.S. population, accounted for over 30% of syphilis cases in 2023 and approximately 40% of all gonorrhea cases in 2022 .

Why Is Male Sexual Health Research Underfunded?

The lack of investment in male contraceptive research stems largely from insufficient financial backing. Doctors have understood how hormonal male contraception could work for 85 years and have been conducting research since the 1970s, yet progress has been slow. These contraceptive methods work by mimicking the body's natural feedback loops to reduce sperm production. When the hormone regimen is stopped, the body's functions return to normal and sperm counts increase again .

The consequences of this research gap are significant. Every new contraceptive method introduced historically correlates with a 12% increase in overall contraceptive use. Without new male options, reproductive health choices remain limited for men, and unplanned pregnancies persist. In the past year alone, half of the 250 million pregnancies across the world were unplanned .

What Breakthroughs Are Currently in Development?

Medical science is making progress despite funding constraints. Several promising male contraceptive options are now in late testing stages. NES/T is a gel combining progestin and testosterone that is applied daily and has shown no serious side effects in trials. Synthetic testosterone derivatives that can be taken orally are also undergoing clinical trials. With sufficient testing, a viable hormonal male birth control could reach the market before 2030 .

For HIV prevention, the landscape has shifted dramatically. The Food and Drug Administration approved biannual injections of Lenacapavir for pre-exposure prophylaxis (PrEP) in July of last year, joining cabotegravir, which is already available as a PrEP injection every two months. Research is underway to make yearly injections or monthly pills available as PrEP options. These advances address a key challenge: even in developed nations, it can be difficult for some people to adhere to daily medication regimens due to cost and complexity of appointments and prescriptions .

How to Address the STI Crisis in Men?

• Vaccine Development: Scientists are working on vaccines for multiple STIs, including gonorrhea, syphilis, chlamydia, and herpes simplex type 2. One approach to creating a gonorrhea vaccine involves adopting the meningococcal serogroup B (MenB) vaccine, which has already been approved in many countries and shows promise based on the bacteria's genetic similarities.
• Targeted Education and Screening: Young men often come into clinics unaware of STI risks, not knowing that most STIs are asymptomatic or that many are readily treatable and easily diagnosed. Increased awareness campaigns targeting high-risk populations, particularly MSM, are essential for early detection and treatment.
• Rapid Response Infrastructure: The mpox outbreak demonstrated how effective investment and quick action can control disease spread. When Fenway Health in Boston began educational programs and preventative vaccines for MSM after the first cases were reported, they administered more than 6,000 doses of the Jynneos vaccine in less than five months, helping protect the Boston-area community.

"Every single unplanned pregnancy involves a man, but contraceptive options concentrate on women. With essentially just two male-focused methods available, vasectomy and male condoms, less than a quarter of men use any kind of birth control," stated a medical research director and professor of medicine at Harvard Medical School.

Medical Research Director and Professor of Medicine, Harvard Medical School

The challenge of STI prevention is compounded by antibiotic resistance. Antibiotic-resistant strains of gonorrhea continue to emerge, raising concerns about untreatable superbugs. While heterosexual men and women contract gonorrhea at similar rates, the disproportionate burden on MSM requires targeted prevention strategies .

Sexual and gender minority people face additional barriers to care. They may delay seeking screening and treatment because of concerns about mistreatment by health care providers. One person may not be particularly sexually active, but if their partners are, they are at higher risk. To stop STIs effectively, solutions must address all populations and account for these systemic barriers .

The current funding environment presents a significant threat to progress. Government budgets for research and public health programs are being cut rather than expanded. The proposed slashing of budgets for the National Institutes of Health, which is the major funder for new research, and the dismantling of programs that supported sexual and reproductive health globally, represent a crucial loss at a critical moment .

Experts emphasize that improving men's sexual health is not about redirecting funding from women's health. Sexual and reproductive health is interconnected between men and women, between heterosexual and homosexual communities, and across different countries. Addressing the research gap in male sexual health ultimately benefits everyone by reducing unplanned pregnancies, controlling STI transmission, and improving overall reproductive health outcomes.