A Bitter Pill: Slow Progress Toward a Male Contraceptive

By Carrie Arnold | December 26, 2013 2:30 pm

contraceptive pill

Scientists have called the contraceptive pill one of the most important inventions of the twentieth century. Now, more than fifty years after the Pill was first released, contraception remains a woman’s world.

Sure, men can use condoms or have a vasectomy, but women have a much more dizzying array of options from which to choose. From pills to contraceptive vaginal rings to intrauterine devices and more, most scientists and pharmaceutical companies have focused their contraception efforts on women.

This isn’t necessarily a bad thing. Many reproductive health scientists say that we need more, not fewer, options for contraception. The problem is that virtually all contraception is being geared toward women. That’s largely because, historically, contraception was grouped in with the traditional female concerns of family and childbearing.

“There are a fair number of women who are dissatisfied with their current method of contraception,” said Michael O’Rand, a biologist and male contraception expert at the University of North Carolina at Chapel Hill.

In recent years, however, attitudes have been shifting. Men are expressing more and more willingness and even desire to take on some of the responsibilities of contraception. Cross-cultural surveys reveal that men are willing to take contraception and, at least in committed relationships, females would trust their partner to take the drug.

The problem is that they have no new options. Even as new breakthroughs in male contraception in animal models are being published to great fanfare—the latest came out earlier this month in the journal PNAS—they haven’t translated into products men can use to prevent pregnancy.

“The forces that should drive pharmaceutical research and development spending are somehow not working. They’re leaving promising opportunities untapped because they have an emotional bias that men won’t buy it. As far as we can tell, that’s just not true,” says David Bishai, a public health economist at the Johns Hopkins School of Public Health in Baltimore.

Contraceptive Checklist

The requirements of good birth control, whether for men or women, seem almost ridiculously simple on the surface. It needs to be very effective, have low levels of side effects, be easy to use, and also be reversible, so fertility can return after the contraception is stopped.

Neither condoms nor vasectomies meet these criteria. Although condoms are very effective at preventing the spread of sexually transmitted infections, they are less so at preventing pregnancy. The Centers for Disease Control estimates that condoms have an 18% failure rate. This means that 18 of 100 women who typically use condoms during intercourse will have an unintended pregnancy in the first year of use. Vasectomies are more than 99% effective, but they are not considered reversible.

When trying to create a male contraceptive that fulfills these four criteria, researchers have focused primarily on the testes. Just as hormonal contraception for women works partly by preventing ovulation, scientists have tried to design a hormonal contraceptive for men by preventing the creation or development of sperm.

Trying Testosterone

They first turned to testosterone. Ironically, high doses of the hormone most closely associated with male virility and fertility can render a man effectively sterile. The problems for researchers have been balancing potential side effects of the drug (which can include mood swings and acne) as well as finding a way to administer it. O’Rand said that pharmaceutical companies invested lots of time and money to develop a formulation of testosterone that would survive a swim in the acid bath of the stomach. They couldn’t do it.

Patches, gel, or injections could avoid the oral route, though injections are unlikely to be practical since most men would find them too inconvenient to have on a regular basis. Thus drug developers are down to a testosterone patch or gel should they elect to go the testosterone route.

Several testosterone-containing male contraceptives are currently in Phase II trials, but even harder trials may lie ahead for them. It’s currently not clear whether the side effects of these compounds will be tolerable over the long term. Clinical trials are better at detecting acute side effects than potential problems after years of use. Nor do scientists know if using these drugs for months or years could permanently alter a man’s future fertility.

“A number of these drugs may be okay if you give them in a low dose for a short time, but over the long term, they may be toxic. It’s a problem, and we just don’t know,” O’Rand said. Although this is true for any number of compounds, male contraceptives will be given to an otherwise healthy population and researchers expect that regulatory agencies and males alike will have a lower tolerance for potential harms that may arise.

An Untapped Market

Testosterone isn’t the only player in the male fertility market, although it is currently the best-researched idea. O’Rand and his colleagues at UNC have successfully tested ultrasound as a way to disrupt sperm development. His lab has also spent more than a decade developing a way to freeze sperm in their tracks.

The method relies on a protein known as Eppin. Eppin is found on the outside of sperm and acts as a brake by binding to another protein known as semenogelin. When Eppin and semenogelin are bound together, sperm can’t swim and thus can’t move up the female reproductive tract to fertilize the egg. But this brake is released after ejaculation, when semenogelin breaks down and the sperm start swimming. When O’Rand and colleagues immunized male monkeys against Eppin, he found that he could render the monkeys temporarily infertile.

The work has been slow going, in part due to a lack of good animal models to use. The reproductive systems of rats and mice are nothing like human ones, O’Rand says, which leaves only primates as potential animal models. This can get expensive quickly, and is one more barrier for investors and pharmaceutical companies to take a chance on a male contraceptive.

Still, though, the rewards are great. “Male contraception is a drug that you would have to take every day for years and years. This is what pharmaceutical companies love. This is the big prize in pharmaceutical research,” Bishai said.

The market, Bishai and O’Rand say, is there and waiting. The contraceptive market as a whole is estimated to be worth $16 billion and to reach $23.3 billion by 2018. In the past year, however, only 37 of the 13,500 studies on contraception focused on males.

Until Big Pharma and scientists alike can shift their thinking that contraception isn’t just for women, that market will remain untapped.

Image by Danil Nevsky / Shutterstock

CATEGORIZED UNDER: Health & Medicine, Top Posts
MORE ABOUT: sex & reproduction
  • Rus Archer

    totally into the idea of male contraception
    as a female running the risk of pregnancy
    do you really want to count on a dude saying,
    “it’s cool, i’m on the pill”
    or something similar
    with no way to verify?

    • Charity Diary

      Really? What guy would lie in order to get a woman pregnant? I’m fairly sure that’s not on any man’s agenda. Anyway, women should take the same precautionary stance that men have always taken when it comes to sex: just worry about yourself.

      Men have been wrapping their junk in what is essentially a trash bag for a while now, just in case the woman isn’t really on the pill. If you’re a woman and you’re worried about some guy playing you, it won’t hurt to remain on the same birth control you’re likely already on already. Men have never really had that option.

      I just really don’t appreciate it when people act like male birth control methods would just be abused by men. Men have been under the complete control of women in the realm of sexuality and reproduction for far too long. I welcome the change, even if some men will abuse it. After all, look at how many women have abused their reproductive power to get checks from some poor schmucks.

      • Rus Archer

        I didn’t mean that men would try to trick women to impregnate them
        but lie to them to have sex with them without contraception

        • dasasd

          I think it’s sexist to assume a man is more likely to lie about this than a woman.

      • Ethan Wayne Wood

        Women have ben in control of sexuality and reproduction? What fantasy realm have you been living in? I’m a man, and I think you’re completely wrong. In a world where women were in complete control, I think abortion would be a commonplace procedure. Why isn’t it? Because men are in control of reproduction rights. If women were in control, wouldn’t all employers and schools be required to provide contraception to women? But they’re not. Because men are in control of reproduction.

        Frankly, when members of the legislature are able to say some of the idiotic things they have said about reproduction, it shows that women are certainly not in control of the process.

        And, on what planet are men always responsible, always trying to do the right thing, always looking out for someone other than themselves? I don’t think women are always like that, and I certainly don’t think men are. You wonder why the laws favor women in reproduction? Why men have to pay child support and such? The reason is that, if a man gets a woman pregnant and then wants nothing to do with the pregnancy, that leaves the woman with two very hard choices the man doesn’t have to make: have an abortion, or have the kid. And either one can be very very detrimental to her life. The man doesn’t have those issues. So the laws balance the field. Men now have to pay child support, and can’t simply run away from their responsibilities. Now, are the laws perfect? Of course not, no law is. But they’re a lot better than nothing.

        And I’ve known several girls who have been in relationships with men who have wanted to settle down and have a family, but the woman isn’t ready for that. If one of those guys wasn’t that great of a guy, I can easily see him trying to get his girlfriend/fiance/wife pregnant, knowing that once it’s done, she has two very hard choices, and since she has a partner, she’s more likely to choose to have the kid. The male has a lot more leverage in that situation. So, women need to always be on birth control, unless they want a kid. And the same goes for men. I welcome the invention of these new preventative methods, and even plan to use them myself. However, I disagree with some things you said or intimated. Women are not in control of reproduction, men are. Go read scientific literature, you’ll see my claim backed up. Only in some primitive tribes are women truly in control of reproduction. Those societies do exist, in which women choose who to have sex with and whether they want a child out of it. But Western society is not like that. Also, men are sometimes in a position to want a child where their female partner is not. Men aren’t innocent of that. Also, I think the number of women that “trick” men into getting them pregnant is grossly exaggerated. The laws were meant to help women out of a difficult place, not give them some sort of huge power over men. If what you’re saying were the case, especially in a male dominated society, the laws wouldn’t have been passed in the first place, or would have been changed after they were.

        • Hibernia86

          Do you think men are the only ones allowed to vote? Pro-life laws pass because there are millions of women supporting them. I don’t support those laws, but I hate when people suggest that men are the only ones responsible for pro-life laws. One recent survey put the percentage of women who are pro-life at 46%.

          The difference between your scenarios is that if a man lies about birth control, the woman always has the option of an abortion, but if the woman lies about birth control, the man doesn’t have the option of abortion meaning that he is forced to have a child before he is ready. I think the best law would be one which said that first trimester pregnancies only legally continue with the consent of both partners.

          • Mabel

            Ah god, being Irish, I hate your username, and your forced abortion idea is ridiculous. You may even be a troll…

            Anyway, 46 per cent is less than half. And our conservative sexual norms were formed by a very sexist history, and ongoing sexist religious agenda. Liberal women are pro-contraceptive and, for the most part, pro-choice. The preacher telling those voters that every sperm is sacred is statistically not a woman.

            Also, being Irish, abortion is not “always” an option for me. And there are forces working pretty damn hard to remove that right from women in certain states in america as well.

            This reply particularly bothered me because it was added to one of the most level-headed posts here. There is no sign you’re interested in the truth but at least you get to keep on adding that crazy suggestion of yours to every post here!

          • Ethan Wayne Wood

            That’s a terrible idea. What if a woman wants to keep the baby, and a man doesn’t. Will you force her to have an abortion? If so, that’s an infringement on her civil liberties, and on her religious freedoms. That’s exactly what pro-choice advocates are fighting against. Forcing a woman to do something with her body she isn’t comfortable with.

            We don’t live in a country with national referendums and a popular vote on each issue. Lawmakers decide which laws get passed and which don’t, and lawmakers are currently and have always been predominantly male. Female legislators are more likely to vote for laws that favor women’s rights and women’s wellbeing, even female lawmakers who claim to be pro-life. Women understand women’s issues better than men, because they have to live them. It’s just a simple fact. Also, just because lawmakers are popularly elected doesn’t mean they speak for everyone they represent.

            I think the choice of what to do with a pregnancy is entirely up to a mother. She’s the one that has to carry the baby for 9 months and the one that has to provide the majority of care for it after it’s birth, so she’s the one who should decide whether she wants to keep it or not. I don’t think the man should have any say in it. His female partner should take his feelings into account, but when a man impregnates a woman, he gives up his right to have a say, and should trust his partner to respect his wishes.

      • LizinNC

        Are you really that uninformed? First, men do have reproductive choices, which currently are: 1) abstinence; 2) condoms; 3) vasectomy; 4) limiting sexual activities to those which do not result in pregnancy.

        Second, men lie to women all the time about their fertility and practice reproductive coercion; that is behaviors which force an unwanted pregnancy on a woman through violence, threats of violence, birth control sabotage, and restricting access to pharmaceutical or medical treatment. It is a form of domestic violence, used to maintain power, control, and domination in a relationship.

        • Hibernia86

          But the reproductive options that men have a much fewer and are worse overall (for example, vasectomies require surgery to reverse and are much more likely to result in permanent infertility than methods that women have)

          Women also sabotage birth control, but they have abortion, which men do not, meaning women have more control over their reproduction than men do. Society should not always assume that every problem is caused by men. Women cause their share of problems as well.

          • Mabel


        • Hibernia86

          Also, the vast majority of men are honest about birth control because the woman knows if he is wearing a condom and they know if they took birth control pills. Men are not lying “all the time” about their fertility. If a man lies about birth control the woman could have an abortion or leave and he’d be responsible for child support and will have few opportunities to see his own child. It is vastly more common to see men whose partners force them to have children before they are ready than women whose partners force them to have children before they are ready. The reason is that women have access to abortion and men do not.

          • Mabel

            I don’t.

    • Lynn

      That’s why they should both be protected.

      • Rus Archer

        and you’ll still have to use condoms
        unless you want a vd

  • http://www.mazepath.com/uncleal/qz4.htm Uncle Al

    By 21 December, an Oklahoma City Federal judge granted an injunction preventing enforcement of ObamaCare requiring religious groups provide healthcare insurance including the morning-after pill and contraceptives. Avoid unknown hazards, swallow halcyon ephemerides of MBA omniscience, embrace god swill Luddism, engage intellectual potlatch. Strength Through Sacrifice, then breed around it.

  • Kevin

    It’s the same risk men take believing women. The only difference is that the woman have laws that favor them. No guy is going to lie and say they are when they aren’t, especially if they know they have 18 years of baby daddy bills ahead of them. Women however will trap men with this lie AND then still reap the financial rewards.

    • Carl A. K. Sverdrup

      Maybe you shouldn’t sleep with someone you don’t trust enough to be sure that they actually are on the pill, or, you know, just wear a condom.

      • raudskeggr

        That doesn’t address the point he made about the inequality of contraception choices, does it?

        • Mabel

          You’re right. It isn’t equal. If I don’t want to get pregnant I still need to use birth control. Because it will happen to my body and unless I really trust my partner I still need to prevent it on my side.

          I don’t think men are trying to trick me into getting pregnant. Men who don’t like condoms say a lot of things to convince women at a point when logic is a difficult thing to bring into the conversation. Pregnancy does not happen with every single incident of unprotected sex and it’s a chance people take.

          I feel sorry for all the commenters here who talk like all women are just waiting to trap someone for the paycheck. I don’t know anyone like that personally (anecdotally yes) but everyone I know has more self respect.

          As for the breakthrough – it’s great that men have the option to control something like this, but I worry it encourages unprotected sex among singles. That’ll make the world a more dangerous place regarding STIs.

          • Hibernia86

            No one is saying that all women are trying to trap men with babies. Most women aren’t. But there are a few women who do, normally the type that think “If we have a baby together, he’ll marry me.” The difference is that men who try to force women to get pregnant can’t succeed because the woman has the option of an abortion, whereas women that try to force a man to have a child can succeed since men currently don’t have the option for abortion.

            That is why I think that during the first trimester, the pregnancy should legally not continue without the consent of both partners. it doesn’t matter if it was on purpose or accidental. Both partners should be able to opt out of a pregnancy if they want. No one should be forced to have a child before they are ready.

          • Mabel

            Great. Men have always had the option of using a condom. And hopefully soon they’ll have the pill. Maybe your radar should go off if a woman starts insisting on not using condoms. I never have, it’s a courtesy to a partner who I trust and has problems with them.

            Hmmm. I don’t think you’ll get far with that forced abortion idea. Why didn’t the man take responsibility at the time of conception? (barring accidents, but surely we’re not talking about golddiggers in that case)

          • Mabel

            I wanted to concede one point – of course it’s possible for a woman in a somewhat-steady relationship to come off the pill and set the trap you’re talking about. When I wrote my first comment there was an almost unanimous thread here that all women just sat around rubbing their hands together at the cash that could be earned with their uteruses(eses). The discussion needed some balance.

          • Chandra Oldfield-Clark

            Are you kidding?!?! Getting pregnant is a risk that both adults understand and accept. If they don’t understand this then they just shouldn’t be having sex. Simply put. As for a man haveing a say in the pregnancy for the first trimester, that is ridiculous. So if a woman gets pregnant, and the man doesn’t want to have children, then that man could say I want an abortion and POOF! No more baby. But there is a problem. There have been a number of cases that some women who go in to get an abortion can come out of the procedure room and are told that they can no longer have any more children because of complications during the abortion that was performed. Is that ok? Just because that man wasn’t ready to have a child and made the women get an abortion and now she can no longer have any children. You would be ok with that? Ruining a woman’s body simply because that man didn’t want to have kids. It’s barbaric. Senseless. Call me old fashioned, but a woman’s body is hers. Not yours. Unplanned pregnancies happen. If you don’t want to take a risk of possibly having a child, then don’t have sex. Use your hand.

          • Vanessa Hooper

            Amen! And who are these women anyway? I’m going to destroy my body, take a year off from my career and bring a life into the world to trap some man? Please!

            And to all these men that are afraid of being trapped by this imaginary woman, I’ve got a great solution for you. Keep it in your pants! I don’t think you’ll really have to worry about it though. With that type of misogyny, I don’t think any real woman would have you.

          • yeah, okay then

            Google this: “how can I secretly” and what is the first thing that pops up? its not paranoia its men using their 1st head instead of the head downstairs, btw a “real woman” is any who identifies as one. But of course you as a woman know for a fact that women never lie, only nasty men do that!

          • Vanessa Hooper

            Immaturity is prevalent in both sexes, that is unfortunately, a fact of life. However, because current biology dictates that women are the ones who’s lives are most affected by reproduction, trusting a man about birth control is not an option. You mentioned men using their 1st head instead of the one downstairs. Once again, biology prevents this from happening most of the time. This is why women should insist on condoms as their primary form of birth control, both to thwart STDs and to prevent pregnancy.

          • Pumpkin King

            Bwahahaha,,,You are too funny. Like Vanessa said.. Men more commonly as a majority using their first head??? Get real. I’m a man, but I’m not blind nor a liar.
            There are bad people of both sexes…But low life men are much more prominent then woman.

        • Carl A. K. Sverdrup

          No, but I didn’t comment on that part of it either.

      • Hibernia86

        Just because you trust someone doesn’t mean that they won’t ever betray you. You seem to think that if you trust someone that forces them to do the right thing. This is why I think that first trimester pregnancies should legally only continue with the consent of both parents.

        • Carl A. K. Sverdrup

          While you might not think that seems like a bad idea at first I’m sure you can agree with me that controlling someone else’s body isn’t exactly a scenario we’d want, now is it?

          Yes, people will betray you at some point in life, but then use a condom. It’s the only more or less sure way to avoid an unwanted pregnancy. Abstinence is the only way to be completely sure. Trust in other is a necessary part of life, unless you want to live alone and not interact with any other humans for the rest of your life.

          • TX51

            I’m sorry, but an 18% failure rate needs to be added to this equation. A condom is not a legal ground men can stand on.

          • Carl A. K. Sverdrup

            I’m not sure you understand what that actually means. Regardless, I never said condoms were perfect or that I was against new male contraceptives.

    • LizinNC

      Men lie about their fertility and need for birth control all the time, either due to their preference not to use condoms or in an attempt at reproductive coercion.

      It defies belief that men still believe any sane woman is willing to risk her health, sacrifice her career, social life, personal appearance, sleep, personal and financial freedom all for the dubious honor of single parenthood, grudging visitation…all for that sweet, sweet court-ordered child support (which often amounts to the price of a video game and a couple of cases beer). What a prize you must be.

      • Hibernia86

        So you think that men will resort to reproductive coercion, but somehow you find it unbelievable that women would?

        And you aren’t being honest about the woman’s motivation. Most of the time it is because either the couple is already married or because she hopes that pregnancy will convince her boyfriend to marry her. She believes that she will get far more than just child support because she will have a husband to help her raise the child. Now, often this doesn’t convince the boyfriend to marry her because men don’t like to be forced to have kids before they are ready, but that doesn’t change the fact that she is hoping for marriage.

        I find it sad that there are particularly politically motivated people who are so quick to assume that men would do something bad but don’t want to admit that women would.

  • http://blogs.discovermagazine.com Terry Simpson

    It’s the same risk men take believing women. The only difference is that men can just take off after impregnating a woman and leave her to deal with having a baby or having an abortion. A guy is just as likely as a woman to lie about it in order to entrap his/her partner, and NO financial rewards compensate for having an unwanted child or an unwanted abortion. Women have always paid the price of men’s uncommitted sex – and they probably always will.

    • Kevin

      Scenario one is man fakes contraceptive use, impregnates woman and then leaves wanting no responsibility. Woman seeeks legal action and gains a monthly check for 18 years. If dad doesn’t pay he gets jail time. Scenario two is woman traps man. Man doesn’t want any responsibility but still ends up paying child support. Who here has more of a motive to lie about birth control use?

      • Lynn

        It’s a whole new time now that there are so many boy-men who don’t work. Women are paying child support more and more.

      • LizinNC

        Unless you’re a professional athlete, it’s unlikely a court-ordered child support check comes close to covering the cost of raising a child. Who bears the burden of pregnancy, childbirth, and 18-plus years of single parenthood in your scenario two?

        The poor father trapped by his lack of impulse control gets to enjoy his child every other weekend with very little effort or responsibility. If you’re so convinced women are lining up to “trap” you and continue the glorious reign of your gene pool, you do have options. I’d encourage you to use them all.

        • Hibernia86

          Again, this is just slut-shaming. You lecture the father about having “a lack of impulse control” as if only he is responsible for the sex and not the mother. Also there are plenty of fathers fighting for more visitation time and more responsibility in child raising, but often face an uphill battle in the courts against their ex-wives who don’t want to share time with the child.

    • Jamie Presley

      Then don’t have sex with douchebags. Why is it women are always the blameless victims here? Why is it that if a man doesn’t want a child he is a “deadbeat” or a “loser” or a “Man-boy” yet a woman who goes and has an abortion because she doesn’t want to be a parent is “Empowered”?

      The hypocrisy of the so called “Modern woman” is appalling, woen wanted to be equals well you got it. Being a man sucks ladies and we aren’t going back to the way things were. Women can die of hypertension working crappy jobs raising kids who hate them. Women can go fight our wars and die for some else s profit now, women can stay unmarried (because really who wants some used up 30+ woman who has screwed half the phone book under the foolish notion that she is being “Empowered”?) So go ahead ladies whine and bitch that men will have access to the male birth control pill, whine and bitch that men will soon have “Paper abortion” legal paternal surrender. You where the ones screaming “I am woman hear me roar” well ladies you asked for it you got it.

      • LizinNC

        Bitter much?

        • Jamie Presley

          Deflect much? Simple fact is I speak the truth and there is nothing that can disprove what I have stated.

  • ulisesvelez


  • Lynn

    What a great idea. An unplanned pregnancy could mean 18+ years of child support. A man should have the option to prevent pregnancy as well as a woman.

    • LizinNC

      He has that option every day of his life. Many women do not.

  • Imaginascience

    Saying that Big Pharma don’t do this or that because of something which does not relate to money (not even safety…) is RIDICULOUS. If there is a BIG money to be made with a male contraceptive, don’t doubt ONE second that they will put the product on the market.

    I mean their marketing departement is making all relevant studies about the acceptance of a male contraceptives. Don’t make them appear stupid and conservatives. There’s no place for that in these cash machines.

  • Ryan Fielding

    I find myself feeling a little disappointed that the method that, in my inexpert opinion, seems to be the most promising potential method in development.

    Called RISUG, or Vasalgel, it acts like a non surgical, entirely reversible vasectomy. I won’t risk butchering the explanation, but it utilizes pseudo-magnetic/irradiated properties that so radically challenge sperm’s acceptable conditions, that it shreds them into pulp.

    Market forces do indeed matter tremendously, and they often fail when effective products fail to promise massive profit margins. In this case the gel used costs less than the syringe used to deliver it. It also only needs to be reapplied once every 8 years.

    Please check it out for yourselves, on both wikis and the Parsemus Foundation website for full details. They are a not for profit org that is leading the charge.

  • Chae

    Can’t wait for male contraceptive pills/shots/patches/suppositories–you name it! As a female who was on hormonal BC for years, it would be nice for men to take some share in this as well.

    • Buddy199

      Don’t hold your breath.

      • Chae

        If it happens after I die, I will celebrate my butt off from my grave when that day comes.

  • Buddy199

    Men don’t have to worry about getting pregnant. Birth control costs money and must be utilized contientiously. Three big reasons I don’t think this will be a success in the real world.

    • Hibernia86

      Men have to worry about having children though. And men don’t have access to abortion.

  • Jamie Presley

    Nice that this site is deleting comments that point out the truth and don’t tow the bs feminist agenda

  • teapartydoc

    That’s not the actual pill in the picture. It’s actually quite a bit bigger. The way it works is you put one in your shoe and it makes you limp.

  • JoyceB

    Aside from STI and prevention issues. If you met someone, and you’re consenting adults, contraception question comes up.. Would you be ok if he said “Its ok, I’m on the pill” ?
    (he can’t get pregnant)

  • Duude

    The testosterone path is fraught with peril. The last thing society needs is more men amping their testosterone. If acne were all we had to worry about it would be manageable. But the long term side effects include premature balding, liver and kidney disease. No thank you.


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