SAN FRANCISCO — Dr. Paul Turek was on his way to speak to employees at a cryptocurrency investment firm one recent afternoon about a growing anxiety for the men in the office: what’s going on with their sperm?
Is there enough? Is the existing supply satisfactory? Are we men enough?
“They’re worried, right?” Dr. Turek said. “And we’re O.K. with the worry.”
Last summer, a meta-analysis of 185 studies in which semen was collected over the past 40 years indicated that sperm concentration seemed to have consistently and remarkably declined in the course of a generation.
Different clusters of people — urologists, anthropologists, men’s rights activists and start-up founders — became quietly concerned about the state of sperm. Quiet, probably, because Americans are more used to talking about women and fecundity. And also quiet because there has not been much research aimed at discovering if anything is actually happening.
Still, the study has had social impact. Some men’s rights communities are gathering around the idea that sperm counts are dropping because men are being feminized by society. There is now growing interest in testosterone replacement therapy, which some believe boosts sperm count. At the same time, smartphone-enabled at-home sperm tests are entering a heated market.
“We’ve been looking for this for years,” Dr. Turek said. “We were hoping it existed.” He hopes to turn sperm panic into a tool for preventive health. He sees a moment in which we can convince young men to take better care of their health overall to see their sperm quickly improve.
“As we dive deep into sperm,” he said, “we find that lifestyle matters most.”
The End of Men (Again)
The study has become a foundational text for an online community that believes men are being emasculated by modern culture. In this manosphere — digital spaces created to discuss and sometimes profit from a counternarrative to feminism — commenters see this as scientific evidence that modern society is bad for men.
“Betas make no sperm,” a Red Pill blogger announced.
Daryush Valizadeh, who runs The Return of Kings, a men’s rights site, called the situation “a biological crisis” and one that women struggle to understand.
“Tell your editor to stop being an idiot and reassign the article to a man,” he wrote in a direct message on Twitter. “Then get in touch with me.”
Rollo Tomassi, another leader in the manosphere, who runs a site called The Rational Male, said the sperm count study last year was a watershed moment. To his mind, it showed definitively that modern society was weakening men.
“For guys in the ’sphere, there’s finally some sort of barometer to test their overall health from a historical perspective,” Mr. Tomassi said.
He said men who believe this cite the idea that there could be trace amounts of birth control in the water supply and also cite myths about foods like soy. He, however, prefers to blame egalitarian socialization. “We don’t teach boys to be competitive anymore,” Mr. Tomassi said.
A common derogatory term in the manosphere is “soy boy.”
“Everybody thinks there’s a soy link,” he said.
According to Mr. Tomassi, many men are starting to look into testosterone replacement therapy (T.R.T.).
“T.R.T. — it’s a big deal in the manosphere right now,” Mr. Tomassi said. “That’s the real health news: There’s this sudden revelation and guys are saying, ‘Oh man, my sperm count is hella low, how can I fix this?’ Then they realize their testosterone is lower than it should be.”
Now Busy Men Can Measure, Grade and Freeze Their Sperm
Companies are popping up with at-home sperm tests, sperm health scores and sperm cryobanking services.
Greg Sommer, a biodefense researcher at Sandia National Labs, was developing a small portable centrifuge for testing blood after a chemical attack when he realized it could have a consumer application. But he wasn’t sure what.
“Early in the company, we were like, ‘What are we going to build?’” Mr. Sommer said.
Well, what liquid would people want or need to swirl in a small centrifuge? “Semen! It was a game changer,” he said. “It’s a whole new approach to semen testing that we’ve invented.”
Sandstone Diagnostics, the company he and his colleagues founded in Pleasanton, Calif., has raised $ 8 million in funding to bring these mini-sperm-spinning centrifuges into homes across America. The device costs $ 200, runs on AA batteries and includes four tests. A two test refill pack is $ 49.99.
“The way it works is, you collect your sample, you put a few drops in, and it spins,” Mr. Sommer said. “We spin your semen sample at 7,500 r.p.m., and when it’s done it gives you a reading of your sperm count.”
A competitor, the Yo Home Sperm Test, which was introduced in April 2017, bills itself as, essentially, a sperm microscope for smartphones. First, the guy collects his sample, then there is a 10 minute wait in the process.
“We have a very nice sperm trivia challenge on the phone during that time,” said Marcia Deutsch, the C.E.O. of Medical Electronic Systems, which created Yo. “I wanted something to keep the guys occupied and not worrying.”
Next, using the pipette from the Yo kit (“the sperm does not touch your phone”), the customer places a drop of the sample on a slide that slips into the “Yo Clip,” which is basically a mini-microscope. Then the clip slides onto the smartphone, which uses its camera and light to take a high-resolution video.
Test results and the sperm video should show up in about two minutes. The company advertises 97 percent accuracy and has been cleared by the Food and Drug Administration. The Yo kit costs $ 59.95 and includes two tests, in case a low reading is just from a weekend binge.
“Ours tests moving sperm,” said Ms. Deutsch, adding that some competitors “test just the number of sperm, and they could be dead.”
“Guys are concerned about their fertility from the time they reach puberty,” she said. “Part of their basic biological role in life is to impregnate and they’re not sure that’s going to work, and there’s fear of testing to find out.”
Gabriel del Rio, a 35-year-old publicist in Los Angeles, and his wife were having trouble getting pregnant, but it took a year of fertility doctors for them to consider that he could be the cause.
Mr. del Rio took the Yo test and found he had low motility (which can mean not enough of the overall sperm are swimming, or are not swimming quickly enough, or are not swimming in the right manner), which he said felt like a commentary on his masculinity.
“It was just really embarrassing,” he said.
The solution turned out to be pretty simple (skip the Jacuzzi, buy loose underwear). Three weeks later, he took the test again and watched his now healthy sperm live-streamed onto his phone.
“It went from like a graveyard to a rave,” he said. “It’s an interactive movie. You can zoom in, zoom out, you can focus in on one of the sperm and see how far it’s traveling.”
Within two months, his wife was pregnant.
“We’re seeing huge level of interest around male fertility,” said Claire Tomkins, the co-founder of Future Family, a fertility care start-up that sells a Sperm Activity Test for $ 599. “When we look at the difference between men and women on our website, men actually have longer sessions.”
“Now that sperm counts are dropping, it’s important to be informed about your fertility profile so that you can plan ahead,” the website for Future Family reads.
And for men who do have good sperm, some start-ups are suggesting it should be frozen when one is young and healthy.
“Exactly zero men I know under 35 had talked about freezing their sperm before, but we are at the very beginning of a shift in conversation among men,” said Khaled Kteily, 29, the founder of the sperm cryobanking service Legacy, which started in January and is part of the Harvard Innovation Lab’s program for start-ups.
It bills itself as “the Swiss private bank for your most valuable assets.”
But Where Is All the Sperm?
Sperm panic began in July 2017, with a headline-grabbing finding: Sperm counts in Western men had dropped 59 percent between 1973 and 2011. Researchers had analyzed 185 studies involving 42,935 men who had provided semen samples.
A collaboration between researchers in the United States, Israel, Brazil, Denmark, and Spain, it opened a huge conversation about sperm and what might be happening to it.
And then, in terms of research, not much happened.
“The National Institutes of Health has been focused on males for so long, but reproduction was never considered a male problem,” said Shanna Swan, one of the study’s authors and a professor at the Icahn School of Medicine at Mount Sinai’s department of environmental medicine and public health. Of the research community in general, she said, “They don’t want to know what they’re going to find.”
“It’s an area that makes people uncomfortable. It’s about sex. It’s about men,” Dr. Swan said. “You can get a lot further if you have a nice finding on autism or obesity.”
“There is a general feeling of ‘My God, there’s too many people in the world already, who cares?’” Dr. Swan said. “One of our answers to ‘who cares?’ is to point out men with low semen quality die earlier than other men. They have more cardiovascular disease, they have more diabetes, they have more cancer.”
The study’s lead author, Dr. Hagai Levine, a former Israeli military epidemiologist now with Hebrew University-Hadassah School of Public Health, said sperm decline shows no sign of slowing down and stigma around male fertility could threaten the human species.
“We tend to think when there are changes, they will be small changes, but from time to time there are suddenly major shifts,” he said. “This is a symbol of our inability to look at the future of mankind, and for what? We may be like the Titanic approaching an iceberg.”
Dr. Levine said that it seems exposure to pesticides, obesity and smoking could contribute to low sperm count.
He also suggested something more complex. “Social factors could definitely influence this,” he said. “We are animals. The social rank, the socioeconomic position, is important.”
There are also a few studies that show there may be decreasing testosterone levels over the last 20 years, and this trend line may be related to sperm counts, Dr. Levine said.
“Our culture affects our reproductive behavior,” he said. “After a World Cup game, the winning team testosterone levels go up and those who lose, testosterone levels go down.”
He suggested I talk to Margaret Atwood, the author of “The Handmaid’s Tale,” a novel in which declining fecundity leads to authoritarianism and where sperm health is a taboo topic.
“We tend to think when there are changes, they will be small changes, but from time to time there are shifts,” he said. “Margaret Atwood could imagine if such a shift happened.” (Ms. Atwood did not return a request for comment.)
Clinicians are split on how grave the situation is. Sperm tests are notoriously fickle, with counts swinging widely depending on behaviors like an evening in a hot tub or a weekend of heavy drinking.
Doctors and researchers who are skeptical of the findings argue that infertility would already be rising if sperm counts were really dropping so precipitously.
“If you had a decrease in sperm count in the 50 to 60 percent range, we would expect the proportion of men with severe male infertility to be going up astronomically,” said Dr. Peter Schlegel, the chair of urology at Weill Cornell Medicine and NewYork-Presbyterian. “And we don’t see that.”
Others say the study’s science was sound and that it should be sounding an alarm.
“I do believe the meta-analysis,” said Dr. Michael Eisenberg, a urologist at Stanford Medical School who advises the at-home sperm test company Trak. “And we should be paying more attention.”
We, apparently, are not.
“There’s no funding. There’s none,” said Dr. Sarah Vij, who specializes in male infertility and andrology at the Cleveland Clinic. “When we try to develop a study, there just are not a lot of foundations out there looking to fund male fertility projects.”
For men today, Dr. Levine advises something simple. “Take a sperm check,” he said.
“Every 18-year-old at some point takes blood tests — why not your sperm?” he said. “If you have a problem, you change your life accordingly. If you don’t, maybe you freeze it.”
One group of researchers — Janice L. Bailey, Jacquetta Trasler and Sarah Kimmins — is working on a study to look at environmental contaminants and sperm in Greenland and South Africa, as well as lifestyle factors like body mass index in Canada.
“Oddly enough there’s a lot of women in the field,” Dr. Bailey said. “We sometimes call ourselves Gals for Guys.”
Dr. Bailey began studying human sperm after working on farm animal reproduction and noticing that almost all interventions focused on the female animals.
“Whenever there was a problem, they always blamed the female, and I said, ‘For crying out loud, we have to do something to the male,’” she said.
A World of Betas
To Dr. Turek, who is also an adviser to Future Family, people waking up to the importance of sperm as a measure of health is good news — it means men will finally start thinking about preventive care. Low sperm counts and low motility could be a sign of bigger current or future health problems, he said.
“Men with low sperm counts don’t live as long,” Dr. Turek said. “Something wicked this way comes.”
Business is growing. He has opened a new satellite office in San Jose and has started a series of Facebook Live talks. He blogs regularly (recent posts include “Are You Going Extinct?” and “Is Bigger Better When It Comes to Testicles?”).
At his clinic, sports are on TV in the waiting room, and the walls are painted dark. The room Dr. Turek calls the “masturbatorium” has a lava lamp, framed Playboy magazines and a photo of a vintage Maserati (his own).
Dr. Turek thinks the decline in sperm count and quality may be related to relatively inactive, physically noncompetitive modern life, but to him that is probably just fine since he said fecundity seems stable.
“Our sperm look terrible compared to most animal species, land or marine. That’s real alpha stuff. Ours looks like crap,” he said. “If you’re married and you’re a captive audience, demand is low, and maybe don’t need it. Maybe that’s what the drop is adjusting for. Maybe it’s evolutionarily fine. Maybe the drop plateaus here.”
“Over the last 100 years of industrialization, we’re living better, longer, and we’re certainly fatter,” Dr. Turek said. “We’re not cave men anymore. We’ve industrialized ourselves. We probably need less sperm.”