A Perspective on the Evolving Landscape in Male Reproductive Medicine

Context: Men's health and aging are emerging as important areas of research opportunity because of advances in reproductive biology and the recognition of men's health as a unique and important aspect of public health. Evidence Acquisition: A perspective of the evolving landscape in male reproductive medicine. Evidence Synthesis: Remarkable discoveries in reproductive biology have greatly advanced the treatment of erectile dysfunction, androgen deficiency, infertility, hormone sensitive cancers, and prostate diseases. Although the off-label use of testosterone in middle-aged and older men has grown, the management of androgen deficiency syndromes remains suboptimal. There is a pressing need for wider adoption of accurate testosterone assays and harmonized reference ranges and large randomized trials of testosterone's efficacy and cardiovascular and prostate safety. The transformation in idealized body image towards greater muscularity has contributed to increasing prevalence of body image disorders and the use of muscle building drugs in men. Therapeutic options for fertility regulation in men remain limited, the pathophysiologic basis of infertility in a vast majority of infertile men remains unknown, and assisted reproductive technologies remain inaccessible to many infertile men. Much of the dogma on testosterone's binding to its binding proteins remains inaccurate, and the role of free and albumin-bound testosterone poorly understood. The reproductive health of cancer survivors and the availability of wider contraceptive choices for men are other areas of unmet need. Suboptimal care of transgender persons has framed transgender medicine as an important healthcare disparities issue. Conclusions: Transformative changes in societal attitudes towards men's sexual health, body image, and gender identity, and in the economics of reproductive healthcare services, offer extraordinary opportunities for translational science that is patient focused, mechanism based, and integrated with healthcare.