‘GUYnecology’: Why men’s reproductive health matters

In the introduction to her latest book, “GUYnecology: The Missing Science of Men’s Reproductive Health,” Yale sociologist Rene Almeling describes a day in the life of “John,” a regular guy who is trying to have a baby with his wife. 

John carefully considers how his every activity — showering, eating lunch, attending a happy hour, etc. — might affect his future child, concerned that his health and exposures might cause miscarriage, birth defects, or childhood illnesses. (He orders a juice at that happy hour) 

John isn’t a real person, and his diligence does not represent reality. Almeling created the hypothetical aspiring dad to illustrate a point: Men today know very little about their reproductive health, including how their decisions and environment can affect the condition of their sperm, which, in turn, can impact their children’s wellbeing. 

Her book, published by the University of California Press, explains why. She traces how the medical profession has historically paid little attention to men's reproductive health and discusses the implications of this gap for men, women, and society. 

Almeling, an associate professor of sociology, public health, and medicine, recently spoke to YaleNews about her research. The interview was condensed and edited. 

What sparked your interest in researching the missing science of men’s reproductive health? 

I wanted to understand why we pay so little attention to men’s reproductive health relative to women’s and how that disparity affects everything from health care to gender norms and reproductive politics. In researching the book, I started with the history of medicine to figure out why we have two large specialties devoted to women’s reproductive health — obstetrics and gynecology — with no truly comparable specialty focused solely on men’s reproductive health. Then I created a 50-year sample of scientific studies and media reports to pinpoint if and when researchers and journalists focused on how men’s health matters for reproductive outcomes. For the last part of the book, I turned to men from the general public, interviewing them about how they think about their role in reproduction. 

Why is this issue important?

Recent research shows that a man’s health before conception can damage sperm in such a way that it can affect his children’s health. This includes the father’s own age, his behavior — alcohol and drug use, smoking — as well as his exposure to chemicals at home, work, and in the environment. There is increasing evidence that damaged sperm can affect pregnancy outcomes, from miscarriage and birth weight to birth defects and childhood illnesses.

Yet, this message has not made its way to the broader public. So I think it’s important to pay more attention to men’s reproductive health because it has the potential to improve men’s lives and the lives of their children. I also want to call attention to these issues so that scientists and clinicians make it a point to include men in their research on reproductive outcomes. If they continue to concentrate solely on women’s health and women’s behaviors, then we are missing some unknown amount of reproductive risk associated with men’s bodies. And on a broader level, reproduction has long been portrayed as a “women’s issue.” Adding a discussion about the significance of men’s reproductive health might shift some of our most contentious debates around reproductive politics. 

How did the medical profession come to largely ignore men’s reproductive health?

The answer to that question stretches back to the 19th century when medicine became a formal profession and began the process of specialization. The American Medical Association was founded in 1847, and specialties soon followed, including obstetrics and gynecology. So it was fairly early on that women’s reproductive bodies were cordoned off as a separate realm of medical knowledge. 

The first chapter in the book tells a forgotten history of an attempt in the 1880s to launch a parallel specialty for men’s reproduction called “andrology.” The founders were ridiculed at medical conferences, mostly because men’s reproductive health at the time was dominated by highly stigmatized sexually transmitted diseases, and they quickly gave up their efforts to focus attention on the male reproductive body. I argue that we’re still living with the consequences today. 

What are some of those consequences?

For one, we still don’t have a male birth control pill. Men’s contraceptive options have not really changed since the late 19th century. They have condoms and vasectomies, and that’s all. In contrast, the early emergence of obstetrics and gynecology generated robust research agendas around women and reproduction all through the 20^th century. As a result, there are numerous interventions and technologies for women’s contraception, women’s infertility, pregnancy, and birth.  

What are some of the gaps in knowledge as a result of this lack of emphasis on male reproductive health?

One of the most important knowledge gaps is among the general public. Doctors don’t talk to men about reproduction, and there are no public health campaigns about the significance of sperm health. The effects of this inattention became clear when I interviewed 40 men about reproduction and sperm. They had not heard that their age and health can affect sperm and, in turn, their children’s health. Most didn’t know that sperm takes two to three months to grow in the male body, which is the key window before conception when their behaviors and exposures probably matter most. They didn’t know that with every passing year, older men are more likely to develop new mutations in their sperm, which have been linked to an increased risk of autism and schizophrenia in their children. In fact, most of the men I spoke with said the last time they heard anything about their own reproductive systems was in high school. 

I think it’s important for men to learn this new information about how their health matters for reproduction, but I don’t want to take the anxiety and stress that women feel about every bite they eat and every breath they take during pregnancy and just spread it around. I believe the “newness” of men’s reproductive health offers us a chance to recalibrate public health messaging around reproduction. In addition to emphasizing that both women’s and men’s age and health matters, we can also move away from stigmatizing and blaming individuals for reproductive outcomes. COVID-19 is providing us with a deadly reminder that any one person’s health is not solely a matter of their individual choices. It is also shaped profoundly by structural and environmental conditions, including rampant racism and deep economic inequalities.

What would you recommend as next steps? 

Focusing attention on men’s reproductive health can happen in a number of ways. Health care providers can disrupt the implicit association of reproductive health with women’s health by offering patients information about the importance of sperm health. Biomedical researchers can work to identify the precise levels of risk posed by men’s age, behaviors, and exposures. Federal health agencies and professional medical associations can develop materials to educate the public about how men’s health can affect children’s health. Those who engineer fertility apps could add notices about the significance of men’s health for reproductive outcomes. And high school teachers responsible for health classes or sex education can incorporate this information into the curriculum.

On a societal level, we should be making structural investments in health by ensuring that all individuals have access to high-quality and affordable health care, and that there are sidewalks and green spaces and good food to eat in neighborhoods that are safe. Health also requires tackling environmental pollution, making sure the air we all breathe and the water we all drink is clean. These measures would improve the health of all bodies, whether they are reproducing or not. 

It is not possible to reduce reproductive risk to zero. But paying more attention to men’s reproductive health has the potential to improve life for this generation and for generations to come.