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NEAL CONAN, Host:

This is TALK OF THE NATION. I'm Neal Conan in Washington.

For the most part, choices about birth control are used by women. Men can use condoms or get a vasectomy. But now, a new option is emerging. Doctors in China tested a testosterone-based injection that proved safe and 99 percent effective. It's still too early to know whether the monthly injections cause long-term side effects, but it appears that we are closer to hormonal methods of male contraception, which raises questions. What would this mean for couples? Who is responsible for birth control? And men, would you use an injection like this as a contraceptive if it were deemed safe and effective? Women, who do you think should be responsible?

G: In Search of Sex and Satisfaction." He joins us today from the studios of member station KPBS in San Diego, and nice to have you with us today.

M: In Search of Sex and Satisfaction.") Hi Neal, it's a pleasure to be here.

CONAN: And I know you've looked into the male contraceptives being developed, like that one in China that we mentioned. Can we assume that something like this is going to be available in what kind of a time span?

M: Well, they've been saying it's going to be available in five to seven years for the last 40 years.

CONAN: I see.

M: So - they started in the mid-'60s exploring the idea of using hormones to prevent sperm production. It hasn't quite worked out yet. This may be the one, but I wouldn't count my chickens just yet.

CONAN: And I wonder if you think that this is - obviously still being tested. And simply the method of delivery, it doesn't necessarily mean that it's - because it's an injection now it would have to remain an injection.

M: That's right. There are explorations going on with pills and even creams. So, it doesn't always have to be an injection. And I would think that a pharmaceutical company, for them, the ideal would be a pill. Because I think getting men to go their doctors every month to get a shot would be a hurdle they would rather not have to climb.

CONAN: And many men would rather not have to climb it, too.

M: That's right, yeah.

CONAN: And if this does come to pass, however - one of these times it's going to be true, one suspects - how would this change things, do you think?

M: Well, it will give another option. It will also, I think, create another conversation. And it's the view of the column that I write, "Sexploration," that conversation's good to have. I mean, people don't talk enough about sexuality when they're involved in a relationship, and especially birth control. Right now, there is a lot of assuming going on. You know, I'm assuming that she is taking the pill, or I'm assuming he will wear a condom. And assuming, as your little intro pointed out, can be dangerous.

CONAN: Assumptions can be extremely dangerous - or surprising, in any respect.

M: That's right.

CONAN: And nevertheless, we should also be careful to point out that methods of birth control other than the condom, as far as I know, none of them protect against sexually transmitted diseases.

M: That's right. This would do nothing, for example, for college students who are in kind of a hook-up culture, They are not going to be protected against STDs at all by a male contraceptive injection or pill or anything else.

CONAN: And you mentioned a hook-up culture. Obviously, this would affect different people differently. People who are married might react very differently to people who are single and dating.

M: Exactly right. I mean, I think if there are, you know, just say for the sake of argument, there are, you know, 150 million people of reproductive age in this country. You could easily have 150 million different opinions about a male birth control. I mean some men would embrace it enthusiastically. Other men would be very concerned about things like hair loss, for example, or weight gain, or just the idea of going to get a shot or even taking a pill.

Some men would be very relieved. I mean, there's always that concern that men have and that my readers talk to me about, about how can I be sure she is actually taking a pill and not sort of tricking me? You know, how often that happens doesn't really matter so much, as the fact that men believe it's going to happen. And so for some men, the ability to control their own fertility would be quite reassuring.

CONAN: And for some women, the question is, how can I believe he is getting this monthly shot? He tells me he is but maybe not.

M: Exactly right. I mean, that's the question that men face right now. She says she is on the pill, but how do I really know?

CONAN: It also raises the question - again largely, this has been a decision made by women who - obviously the consequences are greater for them, for the most part, than for men.

M: That's right. I think that's probably why we've looked toward women to control this since the creation of the pill about 50 years ago because women are the ones, obviously, that are going to carry a baby or not carry a baby.

CONAN: And be primarily responsible, should they give birth, for its care.

M: That's exactly right. I mean, you know - people don't expect, even now in our culture - they don't really expect men to sort of quit their jobs and stay home.

CONAN: For the most part.

M: For the most part.

CONAN: Again, there are always exceptions. Let's get some...

M: Yeah, absolutely.

CONAN: ...callers in on the conversation. What questions are raised for you by the development - potentially - of a male contraceptive, a hormone-based injection, cream, whatever, that would be used monthly? 800-989-8255. Email us: talk@npr.org. And Jim(ph) is on the line, with us from Spencer in Iowa.

JIM: Well, I think this is going to be very well accepted by the males that are in relationships. I think that has been very frustrating to use the idea - the prophylactics that are available, it's like novacaine. And I just think that if I had had this opportunity, that my life would be a lot different.

CONAN: Really? How?

JIM: Well, I wouldn't have been assured that there was nothing to worry about. I have three wonderful sons, but all three of them were surprises. And I would like to have had something to say about it.

(SOUNDBITE OF LAUGHTER)

JIM: Besides you can do it or do without.

CONAN: I see. And so, but this - you say you're in a relationship and obviously you've got three sons, so this is something that you could conceive of using - excuse me, you're going to - I hope that's the last time we run into the double entendres - but that you would consider using this on a monthly basis?

JIM: I would definitely do that, and I think that there are some people out there that are a little bit more careful about certain procedures - not, you know, one gender with other withstanding. That's not the point. But, you know, whoever has a responsibility, that's the person who would feel inclined to take care of that part of the agenda. And I think that hair loss and weight gain are just as well to be expected as anything else. So, whatever.

CONAN: And it's not as if women don't have side effects from - if they use the pill.

JIM: Well, I'm perfectly happy with the side effects because I know that, you know, when I'm comfortable in that position, it just goes that much further for me.

CONAN: Jim, thanks very much for the call. Appreciate it.

JIM: Okay.

CONAN: Let's turn now to Kay Hymowitz, as we often do in discussions like this. She joins us from our bureau in New York, where she is a senior fellow at the Manhattan Institute, author of "Marriage and Caste in America." Nice to have you back with us on the program, Kay.

KAY HYMOWITZ: Thanks, Neil.

CONAN: And how would this change thing - will women - well, who is responsible for birth control?

HYMOWITZ: Well, ultimately, I think it's always going to come back to women because they are the ones that get pregnant. I mean, this is not rocket science here. I think that the male birth control pill will be a very nice thing for some couples where - mostly, I would guess, married couples - that is, people with long-term, committed relationships where there is a lot of trust, because there is going to need to be trust. But in relationships that are less long term or less committed and less well defined, I think a women would be very, very foolish not to see herself as in charge of these things because she, after all, is the one who will be left holding the baby.

So I don't imagine that that's going to change very much. Like I said, I think this could be a very good thing for women, in particular who are having problems with the female pill - and many, many do. And hopefully, they're going to create a pill for men that won't cause some of the same side effects.

Aside from what your caller said earlier, I think a lot of people are not going to want to take a pill that troubles them in these ways. But like I said, I don't see a profound change in social relations and sexual relations that we saw with the female birth control pill.

CONAN: Because once that became available - it could have been a male pill at that time, but the fact was at that point, well, sex became - sex without consequences - or at least without the consequences of pregnancy - became quite possible.

M: That's right. And what followed from that was something that nobody foresaw, certainly that I was aware of, and that was not only the good stuff - that is, that women had more control over their reproductive lives, that they could put off child bearing 'til they chose to have a baby, and that they could enjoy sex more, without fear of getting pregnant.

But the downside was, at least some people believe, that it normalized recreational sex in a way that made men less responsible so that there is at least a - there are some, including Nobel Laureate George Akerlof, the economist - who argue that we saw the end of the shotgun marriage as a result of the birth-control pill, which now means that we have a 40 percent out-of- wedlock birth rate. So paradoxically, we got the female birth control pill, and we got a huge jump in out-of-wedlock pregnancy.

CONAN: I wonder, Brian Alexander, if - do you think that this will change the conversation?

M: I think it will create more conversation, which I think is always a good thing. I mean, I wouldn't be at all surprised if in the not-too- distant future, you had two young people, a man and a woman, who are both using birth control, some sort of hormonal birth control, because the guy wants some reassurance and the woman is going to want some reassurance - especially in casual encounters, as is becoming ever more popular.

CONAN: We got, in fact, an email exactly on that point from Kate in Arrington, Virginia. If this were available, my partner and I would definitely use it, and I would stay on my own birth control. There's nothing wrong with both a belt and suspenders.

S: Would you use an injection like this as a contraceptive if it were deemed safe and effective? Women: Who do you think should be responsible for birth control? Give us a call: 800-989-8255. Email us: talk@npr.org. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

(SOUNDBITE OF MUSIC)

CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington. We're talking about who's responsible for birth control. There's no version of the pill available for men, but several possibilities are in the pipeline - the latest, a monthly injection of testosterone.

JIM: talk@npr.org. You can also join the conversation on our Web site. That's at npr.org. Click on TALK OF THE NATION.

Our guests are Brian Alexander, the "Sexploration" columnist for MSNBC.com, where he also contributes health and medicine features; and Kay Hymowitz, a senior fellow at the Manhattan Institute and a contributing editor of City Journal. And let's see if we can get another caller on the line, and let's go to Katherine, Katherine with us from Tucson.

KATHERINE: Hi. I just think logistically, it's easier to control one egg than millions of sperm. And I look at, you know, kind of a war between the two and go, oh, one's always easier to control.

CONAN: That may be. I'm not sure, Kay Hymowitz, if that follows. Do hormones promise to control that well?

M: Well, I have no idea, not being a scientist. But, you know, in terms of the sort of Darwinian thinking about who's got the most invested in sex and in reproduction, it's the women because that egg may be only one egg, but it's a big one.

(SOUNDBITE OF LAUGHTER)

M: Neal, that has been the issue over these last 40 years of experimentation, is that your caller is right. You know, men make scads of sperm. And one of the things that they've had trouble doing is having zero sperm count with some of these formulations.

CONAN: And Katherine, would this change your relationship if it were safe and available?

KATHERINE: No. My husband's actually going for a vasectomy this week.

CONAN: This week?

(SOUNDBITE OF LAUGHTER)

KATHERINE: So we're going to not have to worry about birth control anymore.

CONAN: And if I was hearing correctly there in the background, this is after you've had at least one child.

KATHERINE: Yes. He's 2 and a half. Did it, done it, loved that I did it, but I don't want to, you know, keep on having kids. And I don't want to deal with birth control anymore.

CONAN: And you accept vasectomy as pretty much permanent?

KATHERINE: Yes, if you follow all the steps that, you know, you go back every couple, you know, months, get everything tested and do all that. Yes. And I also have an IUD, which will stay in for another three years.

CONAN: So you're really - you really want to make sure.

KATHERINE: Oh, yeah. Yeah. I'm not one for doing mistakes and oopses with children.

CONAN: I understand that. Katherine, good luck to you and to your son, and wish your husband well.

KATHERINE: Thank you very much.

CONAN: Bye-bye. Here's an email from Dana in Indianapolis: I'm a newly married woman. For me, it's not a question of responsibility in birth control, it is a question of trust. My husband forgets to brush his teeth when he's sleepy. I'm not quite ready to trust him with the possibility of a child.

(SOUNDBITE OF LAUGHTER)

M: Yeah, can I jump in there?

CONAN: Please go ahead.

M: You know, I think trust is really the major word that we're going to be repeating during this conversation. And I agree with Brian that with the appearance of a male birth-control pill, there will be more discussions, more conversations between couples. But I suspect there's also going to be more very suspicious negotiations as well, and that a lot of issues of trust will come up that haven't - that women haven't had to face before because it's simply been their issue, their issue to control.

M: And one of the things about men is that men typically don't like going to doctors. From the time a girl hits puberty, seeing a doctor regularly is just sort of part of her life. Men in general just don't do it. So if there was going to be some sort of an injection or a renewal of a prescription for a pill for men, they are going to have more contact with their doctors. And that's going to be a little bit of a cultural change for guys.

It could be a good thing, too, because, you know, men could stand to see a doctor a little more often.

CONAN: And sometimes those monthly checkups, or however often they happen, well, they can reveal other problems as well. You're absolutely right about that.

Let's see if we can get Greer(ph) on the line, Greer with us from Hastings in Michigan.

GREER: Hello, thank you.

CONAN: Go ahead.

GREER: I was - the thing that comes through my mind as I listen to this conversation is that I see this as a way to really level the playing field a little bit more as far as who has reproductive control. And as a woman who has gone through many different stages in my life - in college, you know, where you have the culture of hook-up going on, as you called it, I was very interested in not only protecting myself from pregnancy but also STDs. And so I was doubly protected there.

I am now married, two children, ended up with a tubal ligation, but this, I've got to say, really sort of puts the responsibility - in a committed relationship where trust is not an issue - on both partners. And I love that idea about it, and I love the idea of men having to kind of, you know, think about it and not it just be a female problem, so to speak, or the duty of the woman to participate in that aspect.

CONAN: And again, we can't emphasize enough, this doesn't cover STDs on either end of this equation. But - and that sort of evening the playing field, Kay Hymowitz, I think a lot of women might feel that way.

M: Well, again, I think that that can be true within marriages, within long-term, committed relationships. But I just don't see how it changes anything when it comes to the mating game - certainly not, as Brian mentioned before, not within the hook-up culture.

Women are still going to be the ones that are going to have to be taking charge because they simply, you know, there's too much at risk, and they would be foolish not to.

When it comes to marriages, of course, those issues should be negotiated, should be discussed just like who does the dishes and, you know, has to be worked out between couples. And I think that that's basically a good thing.

I don't think it's a profoundly important thing as - in terms of social change.

CONAN: Greer, thanks. Let's see if we can go next to - this is Carl, Carl with us from Willoughby, Ohio.

CARL: Hey, how are you doing? Thanks for taking my call.

CONAN: Go ahead, please.

CARL: I just - I remember saying as a male - I mean, it kind of makes me nervous to be taking these pills. I've been - actually before the show, I was looking up some things on the Internet. And a couple months ago, some people I knew were doing a project around this. And they studied the whole idea of the dry orgasm, and just a lot of the things that they were saying made me really nervous because it was messing with actual physiology of my body. And it's just questions of, you know, if I wanted to have a child farther down the road, would I be able to because of the messing of the physiology of my body, excuse me.

And so, yeah, just a whole bunch of, like, the unknowns make me nervous about this. You know, will I be able to produce sperm after I've been taking this birth control for several months? You know, will this affect how much sperm I produce, you know? Like the previous caller said, you have one egg, and we know that one egg will keep coming but, you know, will my sperm continue to be produced in the, you know, quantity that it needed to, you know, have a baby?

CONAN: Well, these questions would be presumably answered by scientific studies, and presumably this would not be released to the public if it were not safe. However, nothing is 100 percent effective, and nothing is 100 percent safe. And it could be pointed out, Carl, that women have been asked to take those kinds of risks for a long time.

CARL: Oh, absolutely, yeah. I guess the norm is what's kind of I'm afraid of going against just because, like, a lot of people are worried about trust and a lot of people are worried about will males take these. And I think that kind of having a male be in control of it puts another X factor in there.

You know, when you meet somebody new, there's always a question of are they safe? You know, is there a question of will I get this person pregnant? And I think by adding, you know, does this male now, is he taking this birth control, is he being serious about it, you know, as opposed to just the female, I think there's just a lot of X factors that rise up with this.

You know, you're introducing a new unknown into the equation, and so I think it might complicate things a little bit more.

CONAN: All right, Carl, thanks very much for the call. Appreciate it.

CARL: Yeah, no problem. Thanks for taking my call.

CONAN: Presumably, if - Brian Alexander - if Carl's medical questions are answered, well, satisfactorily, nevertheless, I think there's going to be a lot of men who react like him.

M: I think that's exactly right. I'm very happy that Carl called because one of the things that often doesn't get said is that, you know, if the FDA approves such a thing and they have a fistful of studies that says it's okay, I think that men are still going to be concerned about a few things.

One is, what's it going to do to my libido? Another one is, in addition to the hair loss and the weight gain, is men have a series of measurements that they use to define themselves sexually, their sexual prowess. And one of those things are things like volume, for example. And I get tons of emails from readers of the column saying, you know, I don't seem to be producing as much as I used to produce. What does that mean about me?

I think there are things involving male image that are going to be at play if there is such a thing as a male contraceptive, one of the things that's going to have to be overcome if men are going to accept this sort of thing.

CONAN: Let's see if we can get Jennifer on the line, Jennifer with us from Tallahassee.

JENNIFER: Hi. One thing that hasn't been discussed is the impact it will have on women who cannot take contraceptives. I'm in a long-term, committed relationship, and I have been spayed with a tubal ligation. But before that, I could not take contraceptives by doctor's orders because of a history of cancer in my family. And the same questions that men will have about this have been the things that women have been dealing with for years.

CONAN: And Kay Hymowitz, she certainly has a point there.

M: Oh, absolutely. And, you know, you do want more choices in medicine in general. And this will give couples, like Jennifer and her partner, more choices and more really safe choices, hopefully.

You know, I do want to mention that I think Brian is absolutely right that the male - or a male birth-control pill or injection or whatever it is will possibly have more psychological weight than a female birth-control pill because, after all, the release of an egg is not something that women are usually aware of. And if a pill is effective, that's what it's doing.

So I think he's right to - and the caller who raised this question was right to wonder whether it's not going to be more - a little more psychologically problematic for men.

Now, you know, as you say, women have had to deal with all sorts of physical issues related to the birth-control pill and some of them, hopefully, will be relieved of those burdens once there is a male birth-control pill.

But again, you know, I keep harping on this subject but, you know, I think it needs emphasizing. There has to be an awful lot of trust in order for that to be the sole method of birth control.

CONAN: Jennifer, thanks very much for the call.

Let's see if we can go next to Zach, and Zach, with us from Norman, Oklahoma.

ZACH: Hey, Neal.

CONAN: How you doing?

ZACH: I really don't see why guys can't be trusted to use condoms. I don't see what the big deal is with that. I agree with the caller earlier that said that guys won't necessarily remember to take the pill if there is a pill or an injection, but I don't really see what the problem is with using a condom. If a guy doesn't use a condom, you know, a woman's there to pressure the guy to use it, too. They know.

CONAN: Mm-hmm. Brian, there is resistance - well, we've even heard it on this show - of Ben saying, I don't like to use condoms.

M: Oh, sure. You know, shower with a raincoat, that whole sort of thing. But there's also the idea that, you know, people go to a bar, they party a little bit, lose a little bit of control, the next thing you know somebody's either got an STD or is pregnant. I mean, it's common.

So while we like to think that yes, men can be trusted to use a condom or a woman might insist on a condom, the fact is a lot of people go without it when perhaps they shouldn't go without it.

ZACH: I think that comes down to responsible sex, though.

M: Oh, sure. No doubt about it. Responsibility is a very good thing. But as the birth rate - unwed birth rate in this country shows, a lot of people make mistakes.

CONAN: And responsibility is something you can think about days or weeks in advance. In the flush of the moment, Kay Hymowitz, it often goes by the boards.

M: Well, that's right. You know, the advantage of condoms, of course, is that women can trust but verify. You can't with a pill.

CONAN: Zach, thanks very much.

ZACH: Thank you.

CONAN: We're talking about the effects of a possible male contraceptive; you're listening to TALK OF THE NATION from NPR News.

HYMOWITZ: I'm a college-aged man and am in a committed relationship. I think a male hormonal contraceptive pill would be hugely beneficial because it encourages symmetry, and the relationship suddenly becomes we need to take birth control, not simply you need to take birth control. And I am all for it.

Let's see if we can go next to Matt, Matt with us from Honolulu.

MATT: Hi. Thanks for taking my call.

CONAN: Go ahead.

MATT: I'm not sure I'll add anything very new to the conversation, but I do think it's a great opportunity for men to take more responsibility in a relationship.

I have to agree with some of the earlier callers. I'm a married man, and I think in our committed relationship, if the opportunity arises for me to take more responsibility, then I think I probably should do that.

But one of the guys you have there talking about this, he said that there might side effects of being overweight or going bald or something.

CONAN: That's a well-known, recognized side effect of testosterone, yes.

MATT: Oh, I was going to say that might provide its own form of birth control right there. I don't know.

(SOUNDBITE OF LAUGHTER)

CONAN: All right, Matt. You did have something new to add. We appreciate that.

Let's see if we can go next to Coral(ph), Coral with us from Boise.

CORAL: Hi.

CONAN: Go ahead, please.

CORAL: Well, I just wanted to say that I've been on birth control for about a year now in a committed relationship. And my boyfriend reminds me to take my pill every night because it is both of our responsibility, because he's not a bad man and wouldn't leave me on my own were we to have an unexpected pregnancy.

CONAN: Every night he reminds you.

CORAL: Every night, yeah.

CONAN: Well that...

CORAL: If I forget, which I occasionally, you know, a bottle of wine in the evening may do.

CONAN: Do you think that he would be trustable to take his pill reliably should that become an option?

CORAL: Absolutely. If it were upon him to ensure that we didn't become pregnant before we were ready, then absolutely.

CONAN: And would you remind him?

CORAL: I certainly hope so.

(SOUNDBITE OF LAUGHTER)

CONAN: All right, Coral. Thanks very much for the call. Appreciate it.

CORAL: Thank you. Bye.

CONAN: Here's an email from Jeannie in Elrod(ph) - no, Jenny Elrod. Excuse me. I'll learn to read soon.

In my experience, women most often are ultimately the responsible member for providing, paying for and using birth control in the relationship. Many times, in my own experience and friends of mine, men could be very wishy-washy about using it and buying it.

I wonder if some of this lack of responsibility on their part was generated during the teen years by parents who maybe didn't stress their responsibility. Parents might be more worried about a young daughter becoming pregnant, but may worry less about educating their sons.

Kay Hymowitz, any evidence of that?

M: Yeah. You know, I think the emailer is right that parents don't tend to talk as much to their sons about being careful as they do to their daughters.

But there is a biological reason for that, that we just can't - we don't seem to be able to socially surmount, culturally surmount ever, and that is that the women are the ones who get pregnant.

I, you know, it seems like such an obvious fact, but people keep coming back to its unfairness, its basic - the fact that the women are the ones responsible. Well, yeah.

But if - until we can make it that men are the ones having babies - and maybe someday that will happen, too - I just don't see how you can ever expect for this to be an absolutely equal undertaking.

I think in good, close relationships, yes, we will see more responsibility taken by men, and that's a good thing. But when it comes to the grayer areas of the relations between the sexes, I don't think much will change. Women are still the ones holding the baby.

CONAN: Brian Alexander, I don't think that male pregnancy is going to be possible even in the next five to seven years.

(SOUNDBITE OF LAUGHTER)

M: Probably not.

(SOUNDBITE OF LAUGHTER)

CONAN: We thank you for your time today, Brian. Brian Alexander is the "Sexploration" columnist for MSNBC, where he also contributes on health and medicine features, author of "America Unzipped: The Search for Sex and Satisfaction," with us from KPBS in San Diego.

Kay Hymowitz, with us from our bureau in New York, where she's contributing editor of City Journal and the author of "Marriage and Caste in America." Thank you for your time today.

M: Thank you.

CONAN: And when we come back, we're going to be talking about a trip: "Six Months in the Sudan."

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