For millions of American romantic partners who aren’t currently in the midst of actively trying to conceive a child together, or countless Americans who are single, the entire category of “birth control” has a tendency to become a female responsibility almost by societal default. Since the federal approval of the first birth control pills for women in 1960, the birth control field’s almost total focus on women has subsequently become a double-edged sword: Access to readily available birth control finally allowed many women to take an active role in choosing not to get pregnant, but it simultaneously allowed men to culturally remove themselves from the conversation much of the time. That suited many men just fine, resulting in a subsequent seven decades where America culturally attuned itself to the unspoken new normal where preventing pregnancy was a responsibility falling on women far more often than men.
On some level this is understandable, given that pregnancy can simply be a dire state in America for women regardless, particularly in the wake of the Supreme Court removing the federal right to abortion via Dobbs in 2022. At the very least, it makes perfect cultural sense for American women to continue demanding unfettered, easy access to reliable birth control, for their own interests and health. But at the same time, where is the scientific progress toward the elusive, problem-free male birth control that has so long been seen as a necessary but missing tool of gender equality? Why should men be able to skate on by without taking more active roles in preventing pregnancy, save by using condoms or receiving a vasectomy, when women engage in such a wide array of labor for this purpose, often with painful side effects? Shouldn’t there be a male method of birth control not invented hundreds of years ago that is widely in use today? You’re telling me we haven’t improved in this field in the last 200 years?
These are some of the questions mulled over and illustrated by the new feature documentary Give It a Shot from director Vaishali Sinha, with a title both imploring men to get involved in this conversation and educate themselves, and also describing a pioneering method of male birth control … that has been in active development since 1979 without ever getting wide approval and commercial release, despite numerous seemingly positive tests of its effectiveness over the course of decades. Sinha’s film is as fascinating as it is deeply frustrating, an illustrated road map of the pitfalls and potholes present in an academic’s quest to simply address a problem he saw in society, only to find that powerful forces out there don’t necessarily want to see the same problem solved. After all, there’s no real money to be had in a single shot men can get to act as effective birth control for 10 years … that is also easily reversible at any time. Not when you can sell women a pill that needs to be taken every day like clockwork for decades, or an incredibly painful device to be inserted in a traumatic doctor’s visit!
Our central figure in Give It a Shot is the now 83-year-old, indomitable Dr. Sujoy Guha, who back in the mid-1970s first mulled over an idea for male birth control that he would end up dedicating his life to for the next half century. That technique, he called RISUG, an acronym for “Reversible Inhibition of Sperm Under Guidance.” It’s a simple enough mechanic: Dr. Guha reasoned that because sperm naturally have a net negative surface charge, if they were made to pass through a positive charge it would render them unviable. This is achieved by a single injection of a polymeric hydrogel into the man’s vas deferens, the tube through which sperm pass. When a man ejaculates, sperm are either blocked by the hydrogel or rendered non-viable. There are few if any other side effects, and RISUG apparently has no noticeable affect on erection, the sex act itself, or male pleasure. If the man desires to reverse the process, it’s as simple as flushing out the hydrogel to restore fertility. The technique has been tested by hundreds of men in India, including phase 3 clinical trials that were already underway in 1999. And yet it’s still just now maybe approaching the finish line of being commercially available there.
The obvious question, of course, is why, and one of the biggest reasons seems to boil down to a lack of well-heeled financial support for Dr. Guha’s team. No major pharmaceuticals company has ever taken an interest in “something injected once and goodbye,” as Guha puts it. And the wider scientific community also seemingly ignored RISUG for years, until a World Health Organization site visit in 2002 that acknowledged the treatment’s effectiveness while simultaneously voicing concern over issues such as facility quality control, with implied overtones of racial derision. RISUG was likewise derailed in India in the early 2000s when sweeping revisions to the laws for the country’s drug development essentially sent the team back to the drawing board to start all over again with the earliest phases of clinical trials.
Simultaneously, however, Dr. Guha licensed his technology and technique to other researchers, which has led to the development of parallel, American-fronted versions of similar treatments … that have also run into many of the same problems and struggled to make it across the finish line to commercial availability. Give It a Shot expands its purview here to follow the travails of others who have pursued the dream of a more effective and simple male birth control, including the team of Elaine Lissner/L.R. Fox that developed Vasalgel–now known as “Plan A”–after branching off from Dr. Guha’s original design. Their idealistic aims at promoting equality between the sexes and giving couples more options to choose who is handling the primary burden of birth control is counterbalanced by the more entrepreneurial approach the documentary likewise centers from startup leader Kevin Eisenfrats, the creator of the company Contraline, which is simultaneously developing a RISUG-like injectable method for male birth control called ADAM, and an entirely separate, hormonal male birth control in the form of a topical gel applied to the shoulders and arms.
All of them are equally likely to walk around conventions for this sort of thing, spouting off unintentionally amusing lines like “You’ll still have adequate ejaculate volume.” As the documentary delves past anxious concerns of male sexual performance, it likewise acknowledges that true male birth control is rather more complicated by default: Instead of trying to stop a single egg or two, it involves controlling the production or viability of millions upon millions of sperm. It’s a big biological ask.
Novel scientific thinking has brought us to the point where such simple, long-term treatments are possible, but at the end of the day … yeah, the fate of this line of research still so often comes down to people who are clinging to rigid gender roles and sexism. As one of the Indian men being presumably being interviewed by Sinha puts it: “This is a patriarchal society. Men will always push the women forward.” To millions of men worldwide, that is the extent of the conversation: Women are expected to fully commit to their partner forever, while men are perpetually keeping their options open. Any form of “male birth control” that is created for them needs to not only be easy and convenient, but perfect and free from any downside. Just look at what happened to the most promising hormonal male birth control, which was effectively shut down in 2016 after large scale clinical trials resulted in reports of mild side effects. That was too much to expect from the male consumer. Side effects are for women, didn’t you know?
That’s how we got to the year 2026, at a time when there are at least 15 birth control options available to women, and a grand total of two for men: Condoms and vasectomies. Sorry, make that three–some people unironically list “the pull out method” as one additional option here. Need I go on about that method’s historic effectiveness? I think we can do a little better.
Give It a Shot opens in Los Angeles theaters on Friday, Sept. 18.
