should men freeze their sperm?
Thanks to Tucker Carlson’s homoerotic egg-white-chugging-trailer for a weird episode of his show called “The End of Men,” I spent way too much time researching sperm this week.
It’s easy to laugh at a cable news host promoting “testicle-tanning,” but when we let right-wing buffoons’ performances overshadow the legitimate concerns they are tapping into, we end up with pretty scary stuff.
Tucker is picking up on something that’s true. Testosterone levels are dwindling, but it’s not because men are drinking soy lattes and taking paternity leave. It’s because of an ever growing presence of endocrine disruptors like phthalates and bisphenol. These chemicals are found in everyday products like plastic containers and cleaning products, which are associated with decreased sperm counts and even penis size. Climate change and rising sea levels may also negatively affect spermatogenesis in all kinds of males species. So while Carlson has called climate change a conspiracy to shrink babies, it’s probably more accurate to say it’s contributing to shrinking men’s manhood.
The good news is that if we take his premise of male concern about testosterone seriously, it actually leads to progressive solutions like more regulation around the environment and corporate governance. Thank you Tucker Carlson for giving men one more reason to join the fight against climate change!
After all, male fertility is a valid topic of interest. It’s fundamentally strange that women are hounded with advice and products to help manage their reproductive health while men often get left out of those conversations entirely. If you’re a woman, you’ve probably been incessantly reminded that your biological clock is ticking. Whether it’s coming from movies, tv shows, or complete strangers, it seems like everyone is invested in the idea that fertility is woman’s responsibility, when in fact, men are part of the equation too. Because of misogyny, men don’t lose as much societal value as they age, but this patriarchal programing has given us a distorted view of men’s invulnerability when it comes to fertility. The focus on preserving female youth is not just sexist towards women, it’s unhelpful for men too.
A few weeks ago I met an intrepid entrepreneur who is trying to revolutionize the way men think about their bodies. Khaled Kteily is the founder of Legacy, a male fertility service that offers affordable sperm testing and freezing. After he spilled an entire tray of hot drinks on his lap in a fast-moving car and ended up in the ER being asked if he wanted to freeze his sperm, he realized the entire experience was pretty crummy. As he did more research and realized how little he knew about his own fertility, he filed the market with a service that helps men get proactive about it. Kteily agreed to answer a few questions for our community and I formatted some of his answers to have bullet points for ease of reading. Let me know what you think in the comments!
LP: Do men have a biological clock?
Khaled Kteily: Yes! In many ways, Mick Jagger is our greatest enemy, because he had kids into his 70s. Many men think that sperm quality is eternal, but we know that's not the case. While men typically never stop producing sperm, there is a measurable decline in sperm quality every year they get older.
The World Health Organization (WHO) has a set of benchmarks, known as semen parameters, for healthy sperm, including count, morphology (shape), and motility (movement). The Centers for Disease Control and Prevention (CDC) reports that most men experience significant age-related fertility decline after they reach the age of 40. Other studies show that the decline begins around age 35—in one study, men over the age of 35 had fertility rates of 25%, compared to men under 35 who had fertility rates of 52%. Another study that evaluated the relationship between age and semen parameters also concluded that male fertility decline begins at 35
Paternal age is among the most significant factors affecting a couple’s chance of conceiving and their pregnancy outcomes. Men over the age of 35–40 typically experience a decrease in sperm health, which affects:
Pregnancy rates. Pregnancy rates decrease with paternal age. Men will generally see a 52% decrease in fertility rate between their early 30s and their mid-to-late 30s.
Time to conception. Compared to men 25 years or younger, men 45 years or older are 12.5 times more likely to take over two years to conceive.
Miscarriage risk. Pregnancy loss between the 6- and 20-week gestation period increases by 27% in fathers 35 years or older. That risk doubles when fathers reach 50.
Adverse pregnancy outcomes. Pregnancies that involve a male over the age of 45 see an increased risk of birthing complications, and their offspring have an increased risk for adverse birth outcomes.
Offspring health risks. The probability is still generally low, but studies show that older fathers may be more likely to have children with schizophrenia, bipolar disorder, autism, Down syndrome, or childhood leukemia. A study of over 130,000 men found that fathers over 40 were 6x as likely to have children born with Autism Spectrum Disorder (ASD) It is believed that random mutations in a man's sperm pile up over the years, which can pass genetic mutations to a child and increase their chances of developing a psychological or neurocognitive disorder.
LP: As a woman in my thirties, I get hounded left and right to freeze my eggs. Why are women the only ones who get this kind of pressure?
Khaled Kteily: Every woman in my life has heard some variation of the following: "When are you going to meet the right guy? When are you going to get married? When are you going to have kids? The clock is ticking..." And if the pressure doesn’t come from your own parents, it’s from society, or movies.
But what has become increasingly clear is that for a heterosexual couple - BABY = Egg + SPERM! We know that sperm is just as important as eggs to having a healthy baby, and infertility is just as likely to come from the male partner as a female partner. Infertility is actually one third male factor, one third female factor, and one third joint or unexplained. That seems like a pretty even split to me. So these thoughts that women have been having about our biological clocks for decades are also thoughts that guys should be talking about, too. We're working hard on changing this.
Part of this is that the science didn't really exist. We focused so much on female fertility that men were sidelined (which is the opposite of what happens for most healthcare funding). Until not that long ago, we were still using hamster eggs to test sperm's ability to fertilize — the NYT even did a write-up on this. Today, we know about sperm declines, we know about the effect of advanced paternal age, we're beginning to understand DNA damage in the sperm. And as we learn more, the responsibilities around family planning begin to shift. But nothing will change until we can meaningfully destigmatize the topic. And as we do, then our goal is to change the outdated view that fertility is a "women's issue" and rebalance the responsibilities of family planning.
LP: Why is male fertility so taboo?
Khaled Kteily: It's interesting because it's difficult for us to even publicly talk about it. Sperm, the male reproductive cell, is a biological and anatomical word that doctors, fertility companies, and educational institutions use to speak about male health, conception, and the challenges that our patients experience.
And yet, when we're trying to talk about this medical issue publicly, we are prohibited from using the word (even variations of it, like sp*rm). We can't show graphical elements within key advertising locations, no matter how tastefully, thoughtfully, or carefully designed. We even get shut down for "adult content" if we use the word sperm or semen for Facebook, Google, or Reddit ads.
Some of it comes from Puritanical norms, and some of it comes from a discomfort with talking about anything that is associated with sexual organs, even for non-sexual reasons. But the fact is: we can't change anything as long as this topic remains taboo.
LP: How do ideals of masculinity prevent men from taking their reproductive health under control?
Khaled Kteily: Men are afraid of "shooting blanks" -- we hear this all the time. For many men, masculinity = virility. Implicit in these views is that if you are not producing sperm, or if you're not fertile, then you're less of a man. That's silly. And in fact, 99% of men are producing sperm. Of the 1% who face azoospermia (an absence of sperm in the semen), about half of the case it's treatable. So for 99.5% of the population - you will be just fine. But most men don't know that.
Part of it is also broader views around healthcare. We know that in 80% of cases, women are the primary healthcare decision makers in a household. Men simply are not as good at taking care of themselves and being proactive about their health, and this extends to their reproductive health.
But then you have harmful calls from individuals like Tucker Carlson, talking about things like testicular tanning. Not only can you NOT tan an internal organ, not only is there no science behind it, but just as importantly, it will also make you look very silly. These are from a misguided idea that we need to "make men manly again". Instead, we should focus on understanding WHY sperm counts are dropping, WHY testosterone levels are dropping, and focus on fixing the root causes.
LP: Where can men start when it comes to taking care of their fertility and reproductive health?
Khaled Kteily: Step one is understanding where you're at. If you produce sperm, you should be testing it to understand how healthy it is. If you’re thinking about having kids in the future, you should consider freezing your sperm, while your sperm is younger and healthier.
This matters because sperm is the “canary in the coal mine” for other health issues, because it's a biomarker for your overall health. A study that tracked 40,000 men over 40 years - found that the worse your sperm, the higher your mortality rates. In fact, the worse your sperm, the higher your likelihood to have cancer, diabetes, or cardiovascular disease.
Fertility issues like azoospermia - or an inability to produce sperm - can help diagnose genetic issues like cystic fibrosis. And men with two or more abnormalities in their semen were more than twice as likely to die over a roughly eight-year period as men who had normal semen, Your sperm quality is literally a predictor of how long you will live.
Now, aging is a natural process. You can't stop the effects of age on male fertility completely, but you can take steps to improve your fertility.
The best way to improve your sperm health is by improving your lifestyle. This can look like:
Eating a healthier, nutrient-rich diet; the Mediterranean diet, for example, is a great option.
Exercising regularly and moderately - don't over-exert your body, and stay away from the long bike rides, which keep your testicles close to your body and can affect spermatogenesis.
Cut down on smoking, drinking, and 4/20 and its related activities
Staying away from hot tubs and saunas -- we're looking at you, Finnish people.
I am so sick of being a man today, thanks to Carlson.