Future Prospects

The concept that male reproductive dysfunction in adulthood may have its origins in fetal or neonatal life is in line with the evolution in thinking about the origins of other common medical disorders, such as cardiovascular disease and type 2 diabetes. This concept is poised to grow and to embrace more aspects of male reproductive health. For example, it is notable that some ethnic groups with a low risk of developing testis cancer have a correspondingly higher risk of developing prostate cancer—this applies both to American blacks and to Finnish men (121). Because androgen exposure is implicated in both disorders, low exposure equating to increased risk of testis cancer and high exposure to increased risk of prostate cancer, the notion that androgen exposure of the developing male fetus (this exposure remaining to be defined) may predetermine susceptibility to reproductive dysfunction becomes attractive. This is not to imply that all male reproductive dysfunction has its origins in fetal life, but rather to indicate that susceptibilities are put in place that may then predispose to effects by other genetic, environmental, or lifestyle factors—these may exert their effects at various stages in life or throughout long periods of life. There is nothing remotely controversial in such thinking, because all human health disorders ultimately result from an interaction between genetic and environmental/lifestyle factors.

An important (and overlooked) aspect of the environmental/lifestyle components is that they are intrinsically preventable. However, before this possibility can be realized, the causative factor has to be identified and its mechanism established. As this chapter has hopefully demonstrated, we are a long way from achieving this for most environmental and lifestyle factors that affect male reproductive health. The exception is time spent seated and scrotal heating, and methods and studies are now in place that are defining precisely the risk to sperm counts and whether this affects fertility, sperm DNA damage, and so on. Once this is completed, a proper risk assessment can be made and appropriate action recommended—whether it will be taken or enforced remains to be seen.

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