Opinion: U.S. government must invest more in research around men’s sexual and reproductive health

STAT News · Feb 27, 2026 · Collected from RSS

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Every day, there are 1 million new cases of potentially curable sexually transmitted infections (STIs). In the past year, half of the 250 million pregnancies across the world were unplanned. At the clinic where I work in Boston, we see increasing numbers of infections every day. Yet many programs and policies that seek to address these issues overlook men, neglecting half of the planet. It’s high time to change this and focus on sexual and reproductive health for men. 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. In fact, no new male contraceptive methods have entered the market in more than 100 years. This gross oversight, which is largely due to a lack of financial backing, impedes reproductive health for everyone. As a doctor and professor who has been working to prevent HIV and other STIs for the last 40 years, I have seen firsthand how this gap impacts us all. My colleagues and I see young men who come into our clinic unaware of the risks, not knowing that most STIs are asymptomatic, or that many are readily treatable and easily diagnosed. While many efforts to prevent STI transmission have focused on men, this is all the more essential because men tend to have more sexual partners than women. This means they are more likely to transmit frequently asymptomatic STIs to more partners. This is particularly important for men who have sex with men (MSM). Despite making up around 5% of the U.S. population, MSM accounted for over 30% of syphilis cases in 2023. These differences are not just because of having more sexual partners. Sexual and gender minority people 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 finally stop STIs, we must find solutions for all populations. The good news is, medical science is making significant progress in recent years. Doctors have had some understanding of how hormonal male contraception could potentially work for 85 years and have been conducting research since the 1970s. These contraceptive methods work by mimicking the body’s natural feedback loops to reduce spermatogenesis. When the hormone regimen is stopped, the body’s functions return to normal and sperm counts increase once again. Now, numerous products are in late testing stages. NES/T is a gel combining progestin and testosterone that is applied daily and has shown no serious side effects. Synthetic testosterone derivatives that can be taken orally are also now undergoing clinical trials. With sufficient testing, it’s possible we could have a viable hormonal male birth control on the market before 2030. This is vital for everyone’s reproductive health. Of course, women often bear more of the burden of unwanted pregnancy, but men are affected too. And without sufficient contraceptive options, their own choice has been limited. For every new method that’s introduced, there has been a 12% increase in overall contraceptive use. So as men are given new contraceptive options, it should reduce unplanned pregnancies. Similarly, science is evolving for STI prevention options. The developments of the last decade in antiretroviral therapy (ART) to fight HIV have been monumental. We have reached the point where, medically, we have the tools to ensure no one dies from AIDS and that HIV is not transmitted. But new cases persist, especially for men. In 2023, men made up over 80% of the 39,000 newly diagnosed HIV cases in the U.S., and two-thirds of these were attributed to male-to-male sexual contact. That’s because even in developed nations, it can be difficult for some people to adhere to daily regimens, keeping up with the cost and complexity of appointments and prescriptions. Moreover, not everyone is aware that they may be living with the virus, and some people who could benefit from pre-exposure prophylaxis (PrEP) are not using it. To address these challenges, researchers have been working on new options that fit better into people’s lives. Last July, the Food and Drug Administration approved biannual injections of Lenacapavir for PrEP. This joins cabotegravir, which is already on the market as a PrEP injection every two months. Now, research is underway to make yearly injections or monthly pills available as PrEP. However, the efficacy of HIV prevention and treatment from ART has likely contributed to more lax condom use and increasing STI rates, reinforcing the need for longer-lasting solutions for other STIs. This is especially crucial for gonorrhea, as antibiotic resistant strains continue to emerge, raising concerns about untreatable superbugs. While data show heterosexual men and women contract gonorrhea at similar rates, MSM made up around 40% of all gonorrhea cases in the U.S. in 2022. For this, vaccines may be the answer and the science is developing. The bacteria that causes meningitis has significant genetic similarities with gonorrhea, so one approach to create a gonorrhea vaccine has been to adopt the meningococcal serogroup B (MenB) vaccine. This vaccine has already been approved in many countries, and while clinical trial results have been mixed, data from larger definitive trials should be forthcoming soon. And STI vaccines don’t stop at gonorrhea: While in earlier stages, scientists are also working on vaccines for syphilis, chlamydia, and herpes simplex, Type 2. For yet another STI disproportionately affecting men, and especially MSM, the recent mpox outbreak shows how to effectively respond, and how vaccines can help. After emerging in the summer of 2022, the disease has declined sharply in developed countries. This accomplishment offers a roadmap for how we can invest in, and better protect, men into the future. Most crucially, it requires committing sufficient funding to develop strategies to protect those most at risk. For example, at Fenway Health, we jumped in to address mpox right after the first cases of were reported among MSM. We began educational programs for the MSM most at risk, treating those impacted and offering preventative vaccines. Less than five months after our first case, we had administered more than 6,000 doses of the Jynneos vaccine, helping to protect the Boston-area community against transmission. By working quickly, using existing research, recognizing those most in need, and committing the needed funds, organizations like Fenway Health around the country were able to control the outbreak quickly. Unfortunately, we are at a point where funding for research and public health programs is being cut, not expanded. The Trump administration is proposing to slash budgets for the National Institutes of Health that is the major funder for new research, and has already dismantled U.S. Agency for International Development programs that supported sexual and reproductive health for men and others around the world. Other governments are disappointingly on the same path. This is a crucial loss. The answer to ensuring men’s health is not to redirect funding from women, and it’s certainly not the elimination of funding entirely. Sexual and reproductive health is intertwined — between men and women, between hetero- and homosexual communities, and across different countries. Resurgent mpox flaring in Eastern and Central Africa still leads to infections in the U.S. HIV continues to spread not just among MSM and transgender people but to heterosexual communities as well. And every single unplanned pregnancy involves a man. The only way forward is to enlarge the pool of those who can access state-of-the-art medical approaches, to provide training for culturally competent care, and to ensure that everyone has their sexual and reproductive health needs met. We need governments to reinvest in research and programs, doubling down on the recent scientific breakthroughs and expanding access. Without focusing on long-overlooked men, we’ll never succeed. Kenneth Mayer is medical research director and co-chair of The Fenway Institute as well as a professor of medicine at Harvard Medical School. He has been studying HIV prevention and men’s sexual health since the 1980s. STAT’s coverage of health challenges facing men and boys is supported by Rise Together, a donor advised fund sponsored and administered by National Philanthropic Trust and established by Richard Reeves, founding president of the American Institute for Boys and Men; and by the Boston Foundation. Our financial supporters are not involved in any decisions about our journalism.