A study released at the end of August found that the number of vasectomies performed in the United States rose 26% between 2014 and 2021, and experts believe that post-Dobbs this number will continue to go up. Even though the trend started before Roe was overturned, I see men’s increasing interest in birth control as part acknowledgement of the plight of women in a country with dwindling abortion access and part self-preservation in a county with dwindling abortion access. Regardless of motive, I appreciate it. I also appreciate that male-controlled options are limited to vasectomies (which are permanent) and condoms (which are excellent but much maligned).
Like many, I’d love for Team Testicles to have more ways to prevent pregnancy because the Uterus Union has been doing it for centuries and we’re a little tired. I remain skeptical, however, about whether we’ll see any new options within this decade or the next. In the almost three years of this newsletter and the ten or so years before that, I’ve written about many male birth control methods that might-maybe-possibly-could be here soon.
Some of them sound promising, like the pill that blocks a protein vital in sperm motility and was found to immobilize rodent sperm for at least a few hours. Many of them seem less than user-friendly, like the ultrasonic testicle bath or the gel that gets injected into the scrotum to block the vas deferens but requires a second injection to unblock the vas deferens. (As an aside: I first wrote about the injectable gel in 2014 in an article on masturbating baboons and noted at the time how unfair it was that I couldn’t use the phrase spanking the monkey. Have I mentioned recently how much I enjoy writing Sex On Wednesday and appreciate that you’ve come to expect my cheap, crude jokes? I feel almost obligated to make them at this point. Keep reading.)
Then there’s the method that injects nanoparticles covered in citric acid into the bloodstream and uses magnets to guide them to the testicles where they are heated to 104 degrees Fahrenheit to stop sperm production. It worked temporarily in mice—they became unable to impregnate a female for 30-60 days—but it shrunk their testicles and would have to be repeated regularly. The researchers thought this was promising, but these are the same researchers who started the study by trying to put hot magnets directly into the testicles before realizing that the procedure was too painful and apt to burn sensitive skin.
The newest method which I share in the story below is not new at all. Apparently, it was first proposed in the late 1950s. It is essentially a kinder, gentler way to heat the testicles, and it seems to be quietly trickling through Europe. It doesn’t earn a “that’s not how it f**king works” badge because the hot-testicles-don’t-make-sperm theory is sound. It does, however, have me shaking my head in a super-judgey “Okay, but why?” kind of way. I try not to yuck other people’s yum, but shoving your testicles back up into your body for 15 hours a day sounds pretty yucky.
Tuck Them in Tight: The DIY Heated Testicle Method
The reason our balls hang low and wobble to and fro is because our internal body temperature—98.6 degrees Fahrenheit or 37 degrees Celsius—is a bit too warm for sperm production. So, testicles sit inside the scrotum, and the scrotum hangs outside the body where its cooler. The cremaster muscles wrap around the scrotum and pull the balls in closer to the body when it’s really cold outside or when a perceived threat triggers the fight-or-flight reaction. It’s a pretty sophisticated set of hydraulics, and for decades researchers have suggested that interrupting it and warming the testicles could be a relatively natural way to prevent pregnancy.
Early attempts at this apparently exposed the testicles to too much heat for too long and used what some researchers called impractical heat sources. (I don’t know what they were, but in my head I’m seeing a zippo lighter waved back and forth under a ballsack.) A 1967 paper suggested that an increase in temperature of just one or two degrees Celsius would be sufficient and argued that holding the testicles inside the body for much of the day would be enough to achieve this kind of globall warming. (Would globe-al warming have been better?)
In 1994, researchers in Toulouse, France put this method to the test in a very small study of just nine couples having penis-in-vagina sex. The researchers gave the men special tight underwear with a strategically placed hole and a rubber ring in it. The men in study pushed their testicles into their pelvic cavity, put on the underwear, and then pulled their penis and empty scrotum through the ring and then the hole. (Go ahead, take a second to picture it: the balls are stuffed back into the body, the underwear is on like normal except the penis and unoccupied scrotes are dangling outside it.) The men wore these extra-tighty-whities during all of their waking hours (at least 15 hours a day).
All of the men had normal sperm functioning at the start of the study. After over a year, only one man had caused a pregnancy. It turns out that he stopped wearing his special underwear after seven months (raise your hand if you’re surprised). That there were over 150 menstrual cycles with no pregnancies and no observed side effects—researchers said the men’s libido and sexual functioning were normal—does seem like enough for tentative proof of concept. It’s also encouraging that many of the men in the group went on to father children. But eight men who didn’t knock up their wives, plus one who did, does not a randomized controlled trial make.
That study was almost 30 years ago, and the method has not gotten very much attention since. A 2018 study, also in France, found that neither new health care providers nor new fathers had ever heard of this ball-heating contraceptive concept. While a decent proportion of health care providers (40%) were intrigued and said they wanted to learn more, the men themselves were not all that excited (raise your hand if you’re surprised). Only 29% of new fathers said they might be willing to try it.
When asked about the pros and cons, 52% of new fathers liked that it was “natural,” 38% liked that it was “without side effects,” and 36% liked that it was “non-hormonal.” There were a lot of things the fathers didn’t like, however, including “lengthy wear time” (56%), “daily undergarment wear” (43%), and “concern about possible discomfort” (39%). That “apprehension about shoving my balls into my body/please don’t make me do it” wasn’t in the top three potential drawbacks suggests only that it wasn’t one of the multiple-choice options.
Despite the underwhelming enthusiasm, there is apparently a market for thermal male contraception contraptions, at least in Europe. There was a rumor a few years ago that the authors of the 1994 study were doing clinical trials on a device they were calling the Toulouse Ball Lifter (really guys?), but nothing has come out yet. There is a French startup that sells a product called SpermaPause (seriously?) which has not been evaluated or approved by the European Medicines Agency or the FDA. Rather than holding the testicles in the body, SpermaPause has a built-in heating pad. Another start-up called Andro-Switch was selling silicone rings for this purpose online before being shut down for not complying with European medical standards.
Other entrepreneurial male contraceptive advocates have started hosting workshops in which men make their own ball machines. Paul Labourie, a Belgium-based writer for Vice, wrote about a workshop he attended in Brussels (apparently these are held weekly in various location in France and Belgium). Participants were first shown “around 30 colourful rings of different sizes and invited us to try them on, the bookshop’s toilets and the back of the store serving as impromptu changing rooms.” Then came the DIY portion of the day which involved “silicon, machines, moulds, clamps, syringes, coloured dyes, and glitter.” The workshop’s leader apparently noted, “You have to wear it all day, it might as well make it look nice.” (Anyone make one of these at day camp?)
Laubourie says he was pleasantly surprised by the results of his craft project and felt privileged to be able to share the burden of contraception with his girlfriend, but he added that only time will tell if it works well for him and his partner. Of course, time might tell them it didn’t work by offering up a positive pregnancy test. This method is based on a decent theory but is barely tested and not approved by any scientific or public health body.
So, let me be my highly opinionated, yum-yucking, judgey self and say this: If you want to walk around in super tight underwear that hold your testicles in your body all day, go for it. They’re your balls. If/when, however, you pull your penis back through the hole in your underwear and/or the silicon ring and let your balls drop back into your scrotum so that you can get it up and get busy, please wear a condom. Condoms are 98% effective against pregnancy, but we don’t yet know just how effective glittery napkin rings are.