The End of Male
The real masculinity crisis is more biological than cultural.
Zak Stone is caught up in all of it.Kathryn Garcia is an artist (and taco aficionado) born and raised in Los Angeles.
On a Thursday in August, I walk into a budget health clinic in downtown Los Angeles. At the end of a maze of pistachio-colored hallways, I find a room marked LabCorp—it’s essentially a storage closet full of folded cardboard boxes, a jumble of plastic tubs, a bin marked “Dry Ice,” and a few desks and chairs. It’s reminiscent of where the janitors at elementary school would hang out, only with microscopes. I’ve paid $129 to have a test done: “Semen Analysis, Basic.”
There is no waiting room. I stand in the doorway until Maria—a lab-tech with a sweet-looking face, long black hair, and a pink shirt sprinkled with fine black polka dots under a white coat—acknowledges me. She hands over some forms and a plastic cup.
“You have to ejaculate everything inside, and when you’re finished put it in here,” Maria says, pointing at a box next to me crowded with plastic cups in baggies. “The bathroom’s out the door, a quick left.”
I enter the handicap-accessible bathroom. The walls are a chalky shade of blue. A knot of toilet paper drifts around the toilet bowl. An overworked plunger sits in the corner. I can hear someone unfurling a roll of duct tape beyond the door. There is no porn. There is no chair. I do my thing. I return to the office and put the cup into the box. I avoid Maria.
In my rush to leave, I forget to hand in my paperwork. When I revisit Maria, she tells me they’ll measure volume and concentration here on the spot. Then the sperm will travel south, to another lab in San Diego, where a technician will analyze their shape and size, and how well they swim. I’ll get the results—a password-protected PDF—a few days later.
I signed up for a fertility test not because I’m trying to have a kid (please) but as a barometer of my maleness, in its most medieval, distilled sense. Admittedly, it was a ridiculous thing to do. But I was curious. As you may have heard, male anxiety is on the rise in 21st-century America. Employers no longer value our strength to lift or make things (we sent those jobs overseas). Society is sick of our risk-taking bravado (that’s what crashed the economy). Women don’t need our financial support (matriarchy is the new patriarchy). Every week there’s a new think piece or cover story ripping holes in the trappings of traditional manhood.
As a gay man, I welcome the growing irrelevance of old-school masculinity. I’m less likely now than at any point in history to be impeded by my failure to conform to traditional notions of manhood. I can be the CEO of Apple. I can be a drag queen. Whatever I choose, I’m still a man.
But a creeping masculinity crisis, one that’s biological, affects me just as much as any frat boy or military officer. Around the world, male fertility is sharply declining. Birth defects afflicting the penis and testicles are on the rise. So is testicular cancer. Scientists expect that these problems will plague future generations even more than ours.
Whether you’re RuPaul or Paul Ryan, functional genitals matter—and contribute to an understanding of your maleness. “When you boil it down to it, the essence of masculinity might be a hard penis and semen,” says Lisa Jean Moore, professor of gender studies at Purchase College-SUNY. Specifically, semen dense with healthy, tail-wagging sperm.
It’s a reductive idea, but maybe that’s why it’s valuable. Cultural understandings of masculinity are always shifting, after all. They’re temporary. Cock and balls are forever. Or at least they’re supposed to be.
Since the 1990s endocrinologists have issued warnings on the future of male reproductive health—“penis and semen,” in Moore’s words. In 1992, Danish scientists published a meta-analysis of 61 studies on semen quality from around the world, concluding that the average sperm concentration had declined by nearly 50 percent over a 50-year period, from 113 million to 66 million sperm per milliliter. “Every man sitting in this room today is half the man his grandfather was,” reproductive biologist Lou Guillette told Congress in 1993. “Are our children going to be half the men we are?’ ”
An increasingly solid—but by no means conclusive—body of evidence links low sperm density and other problems in male reproductive health with a class of chemicals called endocrine disruptors, which are present in everything from pesticides to plastics to beauty products. First identified in the 1990s, endocrine disruptors are named for the way they mimic hormones and tinker with the signals sent between cells. These include news-making plastic components like bisphenol-A and phthalates, recently banned from use in baby bottles and children’s toys, respectively, but still present at low levels in the blood and urine samples of more than 90 percent of the U.S. population.
“They’re not all identical and they have different actions. Some interfere with estrogen; some with androgen, the male hormone,” explains Philip Landrigan, an epidemiologist at Mount Sinai Hospital in New York. “It’s a mixed lot, and very complex.” Wildlife biologists first identified them in connection with birth defects and decreasing populations of birds and fish. “For the first few years, the concept of endocrine disruption was treated with a lot of skepticism outside of environmental circles. But in the last four or five years it’s moved very much into mainstream medicine,” says Landrigan, particularly as study after study suggests connections to the contemporary decline in male reproductive health.
In 2000, American researchers not only confirmed results from the original Danish semen quality study, they found sperm density in the United States and Europe to be falling at an even faster clip: by 1.5 to 3 percent per year. (The Danes had only pinned the decline at 1 percent per year.) And this summer, an Israeli study noted a steady decline in semen quality at one local bank over the past 15 years. A full 38 percent of all sperm-donation applicants are now rejected, up from one-third prior to 2004. That year, the bank lowered its minimum sperm count for acceptance to widen its net for donors. Under those more stringent standards, 88 percent of contemporary samples would have been rejected.
Sperm-bank rejects aren’t necessarily infertile. “Semen donors could be viewed as a unique group of young fertile men at the prime of sperm production”—the A-team—as Israeli researchers write in their study. But if the downward trend continues, by 2030 the researchers predict that even above-average men will reach “subfertility” levels. Not all the data send a consistent message. A recent follow-up study by the original Danish group found that sperm quality was slightly less rotten in the state of Denmark. But the researchers noted, “Only one in four men had optimal semen quality.” Globally, an average of 15 percent of men are considered infertile, up from 10 percent 20 years ago.
Psychologists have shown that men who get an infertility diagnosis “feel isolated, they feel lost,” says William Petok, a psychologist who specializes in treating infertility. “One of the things we often see is a feeling that in some ways they are a failure sexually, because there’s a conflation between being fertile and being potent.” Indeed, two-thirds of infertile men say they worry about their “physical potency.” This conflation is especially visible in non-Western cultures, or ones where structural economic disadvantages mean men are unable to fill traditional roles like provider or protector— which is where Hanna Rosin, in her book The End of Men, says we’re headed. “I think a man considers his sperm far more an annunciation of his identity than a woman considers her egg,” Petok says. “It’s visible. Every time a guy has an ejaculation it’s evidence of his capacity to produce a child.”
Cock and balls are forever. Or at least they are supposed to be.
The masculinity-fertility relationship is reified in the sperm bank industry. When I called up the Cryobank in Los Angeles, California’s largest sperm bank, director of client experience Scott Brown told me what an accepted donor looks like. He’s a “college graduate or student. Average age is probably 22 to 25. Altruistic in nature, successful in life. Healthy. Tall.” A real catch, but only for the ladies: he can’t have had sex with another man in the past five years. Like the FDA prohibition on blood from gay donors, it’s “a leftover prejudice from the days of HIV and not understanding how it’s transmitted,” conjectures Brown, even though all sperm is tested for disease.
Unlike the Israeli sperm bank, Brown says Cryobank hasn’t had more trouble finding quality donors. “Less that 1 percent of our applicants actually qualify to become donors, which is why our numbers haven’t dropped significantly,” Brown says, “because it was so hard to get in in the first place.”
How does one man end up making more, better sperm than another? Endocrinologists believe a man’s capacity for sperm production is capped by the time he leaves the womb—so, maybe he’s born with it? But with an increasing body of evidence implicating chemicals found in everything from carpeting to cosmetics, the more crucial question becomes: Maybe it’s Maybelline?
It’s a relief when I get my lab results back the next week: I’m fertile. This shouldn’t come as a surprise. I’m 25; I don’t regularly take drugs, linger in the sauna, ride a bike, or huff gasoline fumes. But my sperm count shows up on the low side of normal: with just 33 million sperm per milliliter, it’s right above the lab’s cutoff of 20 million per milliliter.
I am guilty of certain lifestyle choices that could lower my count: I spend my days at a desk; I’m prone to stress; I’ve recently experimented with tighter underwear styles. But it’s possible the explanation goes back much further, to the chemicals that infiltrated my mother’s womb.
It was the ‘80s. My mom applied hairspray liberally. She didn’t seek out pesticide-free food or use glass instead of plastic. Yet there’s no way to prove that endocrine disruptors affected my or anyone else’s development, according to Niels Skakkebaek, a pediatric endocrinologist in Copenhagen. “You can’t do experimentation in humans.”
You can document the patterns, though. Skakkebaek was one of the first researchers to highlight the connection between endocrine disruptors and a variety of problems in male reproductive health, starting with testicular cancer. The disease became commonplace in the 20th century—1 in 100 Danish men were getting it—and as a young doctor in the 1970s, Skakkebaek set out to determine why. “You can’t see such an increase in one or two generations just due to genetic factors alone,” Skakkebaek says. “It had to be an environmental problem.”
Skakkebaek's research showed that the signs of testicular cancer—which strikes after puberty—are present in the womb. In the testes of miscarried fetuses, he found cells similar to precursor testicular cancer cells. In his clinical practice, he observed a spate of birth defects like undescended testes. Meanwhile, semen-quality studies in the 1980s revealed surprisingly low sperm counts among working-class Danes.
Skakkebaek started to connect the dots. “I noticed that infertile men—they more often had undescended testes and other childhood abnormalities,” and were at a greater risk for testicular cancer, he says. Another observation: The precursor cancer cells were more often found in men with birth defects. He started reviewing semen-quality studies, which led to his landmark meta-analysis in 1992 that found sperm density was half as high as it was 50 years ago. "What could explain such a rapid change both in semen quality and testes cancer?" he wondered.
His work coincided with environmentalists’ growing concerns about endocrine disruptors. In 1991, World Wildlife Federation zoologist Theo Colborn held the first major symposium about the possible effects of environmental toxins on animals’ sexual organs and behavior. Researchers presented data showing how pesticides in Florida swamps appeared to raise the levels of estrogen in male alligators to unusually high levels, shrinking their penises to three-quarters the usual size. Lesbian seagulls had been outed in Southern California. Later, fish turned intersex in the Potomac.
The evidence was starting to pile up that “we all might be—without knowing it, unintentionally—exposed to chemicals that had hormonal effects,” Skakkebaek says, “which at that time was completely new for me.” And it posed a possible explanation for the problems he was finding among men.
Researchers began replicating these environmental conditions in the lab, exposing rodents to a variety of endocrine disruptors, including phthalates. Male rodents exhibited malformed prostates, undescended testes, and other problems. In 2010, male frogs introduced to the herbicide atrazine started producing eggs, copulating with other male frogs, and giving birth to healthy young. They were seven times as likely as the un-exposed frogs to display homosexual behavior.
Why would all of these problems affect males more than females? The answer is sexual differentiation: Before hormones kick in, male and female fetuses are pretty much indistinguishable. If left alone, gonads become ovaries—it takes androgens to command them to morph into testes. During gestation, “the reproductive organs and other organs are undergoing rapid development,” says Landrigan. “The price of that rapid development is extreme vulnerability.” In lab animals, the tiniest difference in hormones or hormone-mimicking chemicals—a teaspoon-sized drop in an Olympic-sized pool—can permanently undervirilize the male reproductive system and brain. The testes may not fully descend. The urethra might not reach the tip of the penis. The sperm count could be permanently lowered.
In 1993, Skakkebaek co-authored a paper advancing an environmental theory for the decline in semen quality he discovered the previous year. And over the course of the next decade, he built an argument about the relationships between testicular cancer, birth defects, and infertility. “Not that they always go together. Sometimes they do. But the risk that there’s one or two or three of these conditions together with the fourth is quite significant,” he explains.
Recent research has shown a strong association between these conditions in men and one type of endocrine disruptor in particular: phthalates, the anti-androgen chemical used to soften plastics and found in the food we eat, water we drink, and dust we inhale. Male rats whose pregnant mothers were fed a diet of phthalates were shown to be at risk for reproductive problems, “undescended testes and so on,” explains Shanna Swan, a biostatistician at the University of Rochester. Moreover, the distance between the anus and the genitals—normally twice as long in male as in female rats, and longer in human males as well—was shorter in the exposed rats, a sign of prenatal feminization.
“This measure of ano-genital distance”—AGD, as it’s called—“has been used in animal studies for a long time, but almost never in human studies,” Swan says. She decided to measure it in children.
Swan’s approach was clever. Looking at urine samples from pregnant woman gave her a window into the chemical environment in the womb. And in a groundbreaking paper in 2005, she made a significant reveal: Boys whose mothers had higher levels of phthalates had shorter AGDs than normal, not to mention impaired testicular descent. The paper is perhaps the strongest evidence we have that “phthalates may undervirilize humans as well as rodents.”
“After our paper came out, one of the questions we got was, ‘Well who cares, why do you care if AGD is shorter a little bit in boys?’ ” Swan says. “Because these boys didn’t look weird.” But under their shorts, some of them do.
A shortened AGD has been linked with the birth defect hypospadias, when the urethra opens on the penis’s underside. Data cited by the Centers for Disease Control showed hypospadias doubled in frequency between the 1970s and the 1990s. Affecting about one out of every 100 men, it’s among the most common abnormalities males are born with. But unlike autism or cleft palates, it’s rarely discussed.
“My biggest struggle is not having found any other people with hypospadias in my age group who I can talk to,” Tom, a 45-year-old Australian man I met in the comments section of a blog post about hypospadias, wrote me in an email. As a boy, Tom went through a series of painful operations to correct the condition, which forced him to pee sitting down. His classmates, who could see his sneakers poking out under the stall, hurled at him the expected set of insults. “I was confused whether I was a boy or a girl,” Tom told me. “I always saw myself as a freak.”
“People are very interested in trying to determine the psychological outcomes in these boys,” says Michael Hsieh, a pediatric urologist at Stanford School of Medicine. “Certainly most of us believe that if you fix the hypospadias while the boy’s still an infant, there are no more problems.”
But in some cases, hypospadias never gets completely fixed. One surgery after another forced Tom back into the hospital. At age 12, his doctor inserted a rod into his urethra to clear the urinary tract. The incident was so painful it was “like sexual abuse,” Tom says. “It was after that guy that I decided—I’m not going back to any doctor or hospital or anything ever again. And I never have.”
In the decades since Skakkebaek started asking questions about declining fertility in Denmark, research has coalesced around the association between fetal exposure to endocrine disruptors and feminized male genitals. Now a few researchers are starting to ask: Do these toxins also affect men’s brains?
In 2009, Swan studied 145 preschoolers whose mothers had relatively high levels of phthalates in their urine. Parents were asked to fill out surveys about how their children played. Did the boys gravitate toward gender-typical toys like trucks and guns? Were they “rough and tumble”?
“Now, I have to stress that these studies are small. They were the first studies,” Swan says. “And you know we can’t obviously randomize people to be exposed to phthalates or not, so we have a lot of limitations.” But initial results showed that boys exposed to higher levels of phthalates were more likely to exhibit feminized behavior—a correlation, not conclusively a cause.
Still, I can’t help but ask if the study implies something bigger. “I actually don’t know the answer to that question,” Swan responds. “Behind your question is the question I get a lot: ‘What does it have to do with gender identity?’ ”
It’s probably unanswerable. And it feels offensively reductive—a vestige of the tired nature-versus-nurture debate that seeks to find a cause for complicated differences in gender and sexuality. Scientists take seriously the hypothesis that endocrine disruption affects behavior, but when I asked them about gender, one by one the experts steered the conversation toward other studies linking the toxins with ADHD or autism—behaviors that are more diagnosable and less controversial.
If endocrine disruptors are indeed feminizing males, it’s a health problem in humans only insofar as it affects fertility and the functioning of sex organs. Feminine and gay men obviously still reproduce. Will the feminized boys in Swan’s study end up infertile? Will they end up with testicular cancer? Or will they just end up gay? It’s certainly possible that this type of research will pathologize male differences, lumping in gender variation with real health concerns. But it could also push the question of gender identity to the foreground, forcing a broader dialogue about the need for more accommodating notions of maleness (at a time when male reproductive organs seem to be changing, nonetheless).
Swan is gearing up for another study with a bigger sample size of about 800 children. “If we see this again in the second study, then I think it will be really convincing,” she says. “I think the fact that we took animal data, we formed a hypothesis, went to test it in a human population, and found what we had predicted also strengthens our original findings. But it’s not conclusive.” And perhaps that’s a good thing. Plenty of experts, whether they’re scientists or psychologists or queer theorists, deny linkages between sex, gender, and the role of hormones. Gender isn’t something someone has; it’s something someone does. There are all sorts of people—those who are transgender, say, or intersex—who don’t map onto one set of norms.
How—and why—we “do maleness” is incredibly complicated, and seems to be getting more so. Phthalates are among the most common chemicals on earth; billions of tons continue to be produced annually. What does manhood look like in a future where men are less likely to be able to reproduce naturally and far more likely to be born with imperfect sex organs? The questions will linger in our minds, just as long as the chemicals permeate our bodies.