Not Even On the Radar Screen

Ask a Science Blogger asks:

UPDATE:
THIS IS SUPPOSED TO BE THE OCT. 27TH ASK A SCIENCE BLOGGER ANSWER

What's the most underfunded scientific field that shouldn't be underfunded?...

I can't presume to know the definitive answer. But I can give you one answer: a field that's not even on the radar screen for nearly everyone. We all know women routinely go to see their gynecologist, and women's reproductive health is an important issue. What's the equivalent for men? Do you hear of men routinely going to see their andrologist? The closest thing they have is a urologist, and that's just not the same thing. Mr. Zuska gets fine care for his kidney stones from his urologist but what does that do for his reproductive health?

Cynthia R. Daniels writes in Exposing Men: The Science and Politics of Male Reproduction :

In 1992, a team of Danish researchers reported a drop of more than 40% in sperm count rates worldwide over the previous fifty years. They noted as well an almost fourfold increase in rates of testicular cancer in men and a doubling of genital birth defects in baby boys. Others noted a decrease in the male-to-female birth rate; it seemed that fewer baby boys were being born. In the ten years to follow, these claims would be among the most highly disputed in both science and politics. It would seem that these measures would be simple to assess: Had testicular cancers increased or declined? Had sperm counts risen or fallen? Had the proportion of baby boys gone up or down? How was it possible that we didn't know or hadn't noticed? But no one seemed certain about the state of men's reproductive health. The lack of historical attention to male reproductive health meant that there were fewer baseline measurements to recall, little information about the extent to which such reproductive ailments had afflicted men in the past. Neglect throughout the twentieth century meant that there were few tracking systems to assess the simplest measures of male reproductive health.

When such issues spilled over into public consciousness, as they did in the ten years following the Danish team's initial report, the response displayed many of the elements of public panic, with deeply conflicted responses in the scientific community, the media, government agencies worldwide, and the general public. Some declared a crisis of epic proportions - the "feminization" of "chemical castration" of men and the potential end of the human race. Others denied such claims as social and scientific hysteria. At one extreme, claims of a monumental health crisis appeared to eclipse scientific reason. At the other, the doubts with which these measures were met appeared to exceed reasonable scientific skepticism. [pp. 31-32]

Daniels notes that the first andrology medical journal, Andrologie, was established just in 1969, and the American Society of Andrology was founded in 1975. Andrology is still a small and marginal profession, especially in comparison to gynecology. We lack basic, and baseline, knowledge about how the male reproductive system functions. There seems to a general assumption that it's sort of an on/off system; it either works, or it doesn't, and that's all there is to it. Not very complicated, not much to know, not worth bothering about. After all, reproduction is women's business, and they are the ones with the complicated systems that are subject to breakdown and mess-ups. They are the ones that are...well...fragile. Men are virile and strong. They are not vulnerable, they are not at risk, they do not transmit reproductive damage to their children; exposure to noxious chemicals and other reproductive risks is only an issue for women. What's there to learn about men and reproductive health?

And furthermore, what's at risk, sociologically speaking, if we assume there is indeed something worth knowing about men and reproductive health? Daniels says:

What was at stake, it seemed, was more than just male reproductive health but masculinity itself. This failure to agree on even the simplest measures of male reproductive health is evidence not only of the difficulty of tracking rates of disease or disability but also of cultural barriers to the recognition of the potential reproductive vulnerabilities of men and the volatile nature of any suggestion of male reproductive failure. [p. 32]

Men who are not completely virile, men who are subject to reproductive risk and damage, men who have reproductive health issues...well...are they still men?

To ask real, serious, difficult questions about male reproductive health requires challenging ingrained assumptions about what it means to be a man. Daniels outlines the four assumptions of reproductive masculinity:

• Men are assumed to be secondary in biological reproduction
• Men are assumed to be less vulnerable to reproductive harm than women
• Men are assumed to be virile
• Men are assumed to be relatively distant from the health problems of children

These four assumptions get in the way of serious and sensible study of male reproductive health. Thus, in this case of an underfunded field of scientific study, it is our own cultural blinders that keep us from funding an area of research that in which we desperately need to be asking more, and better, questions. Or even any questions. Daniels rightly notes that the so-called "privileges" of masculinity are a double-edged sword, privileges that allow us to "neglect ailments like male infertility in the interest of maintaining illusions of male virility", or allowing men to be separated from their children toiling in dreary work so that they may maintain the image of providers, or to go to the front lines of war while women stay home and care for the children.

But hey, men are virile and invulnerable. Let's not mess with the image. At least we're saving money.