Dr Manorama Bakshi
There are moments in science that quietly demand our attention-not with the clamour of headlines, but with the soft thud of something deeper shifting beneath the surface.
Today, as I scrolled through the Economic Times Health section, one such moment emerged. A headline on a shrinking Y chromosome. A quote by Dr. Shubhada Sharma, a senior gynaecologist, cautioning about the quiet decline in male fertility and the overlooked erosion of men’s hormonal health. It wasn’t just a genetics story-it was a mirror held up to the blind spots in our public health system.For me, it wasn’t just about biology-it was about silence.
Men’s Health: A Silent Casualty of Skewed Priorities
The 2017 meta-analysis led by Dr. Hagai Levine showed that sperm counts among men in North America, Europe, and Australia have declined by nearly 60% in just four decades. Testosterone levels, too, have shown a sustained drop of 1% per year since the 1980s. While these trends have often been viewed as the price of modern life-obesity, sedentary behavior, exposure to hormone-disrupting chemicals-they remain alarmingly under-addressed in mainstream health policies.
The silence around men’s preventive care. The absence of structured dialogues on sperm health, testosterone levels, and endocrine resilience. The way we’ve built public health around certain priorities-vital ones, like maternal and child health-while leaving other narratives to drift.
This article is not an argument against those priorities. They remain crucial, unfinished, and deserve continued focus. But it is a call to widen our lens. To notice the quiet trends that rarely make headlines. And to ask: what are we missing by not listening?
The Vanishing Chromosome: Not Just Genetics, But a Signal
The 2017 meta-analysis led by Dr. Hagai Levine showed that sperm counts among men in North America, Europe, and Australia have declined by nearly 60% in just four decades. Testosterone levels, too, have shown a sustained drop of 1% per year since the 1980s. While these trends have often been viewed as the price of modern life-obesity, sedentary behaviour, exposure to hormone-disrupting chemicals-they remain alarmingly under-addressed in mainstream health policies.
There are indications of attrition in the Y chromosome, which is little yet critical.Over years , scientists around the world have started to warn about its declining size and gene activity, which has sparked discussions about everything from evolutionary biology to the social implications of gender.The drop in testosterone levels, sperm quality, and other measures of male reproductive health, particularly in the Indian subcontinent, is a more serious issue than the headlines.
Male fertility rates appear to be declining, according to recent epidemiological observations, and an increasing number of instances have been connected to metabolic disorders related to lifestyle, and stress-induced hormonal dysregulation. Yet these issues remain buried in clinic corridors, rarely surfacing in public discourse or policy frameworks.
Why Men’s Health Lacks a Policy Pulse
In India, our reproductive and child health narrative has understandably revolved around maternal mortality, antenatal care, and immunization. This prioritization has been instrumental in saving lives and improving the quality of care for women and children.
However, this framework has inadvertently sidelined male reproductive and hormonal health. Unlike maternal health-which is institutionalized into primary care delivery-men’s health lacks systemic entry points. Sperm health, endocrine disruption, mental well-being, and substance dependence are seen as “private” matters, addressed in silos, often too late.
Environmental and Metabolic Pressures: A Double Hit
Hormonal health is now known to be threatened by endocrinedisrupting chemicals (EDCs), which are found in plastics, herbicides, and industrial pollutants.Men are exposed to high concentrations of phthalates, BPA, and persistent organic pollutants, which disrupt sperm viability and testosterone production, especially in urban and rural areas.This is accompanied by the metabolic crisis.Inflammation and hormone imbalance have been exacerbated by the rise in obesity, type2 diabetes, and gut dysbiosis.The immune system and testosterone metabolism are significantly impacted by gut health, which is frequently disregarded in males.An growing field of study links male vitality and fertility to the health of the gut-brain-gonadal axis.
Breaking the Silence: Reframing Men’s Health in Public Policy.
We need a reframed conversation-one that does not view men’s health as a threat to women-centric health programming but as a complementary priority. Here’s what that might look like:
Public Awareness Campaigns: We need campaigns to normalize sperm testing, testosterone screening, and mental health support for men, particularly young adults and newlywed men, just as we demythologized menstruation and maternal health. o Occupational and Environmental Health Surveillance: Focused monitoring for hormone imbalance in workers in highexposure industries (such as manufacturing, plastics, and agricultural) with follow-up care paths.
Integration with the Ayushman Bharat and RMNCHA+ Platforms: Ensuring health seeking behavior by integrating male reproductive health into family planning, adolescent health, and wellness centers. o Microbiome & Lifestyle Interventions: Research and scalable interventions that connect food, hormone resilience, and gut health, especially in highrisk areas and socioeconomically poor populations.
A Gender-Just Health System Includes Everyone
Prioritizing maternal and child health was-and remains-a necessary correction in public health. But equity does not mean exclusion. It means balance. A truly gender-just health system listens to all bodies under pressure-whether due to social neglect, economic stress, or evolutionary shifts.
The shrinking Y chromosome, symbolic as it is, offers us a moment to introspect. It asks whether we are ready to create a health system that acknowledges the silent decline in male vitality as not just a personal crisis, but a public one.Let’s not lose the plot. And in doing so, let’s not lose more time.
(The author is the Director & Head of Healthcare & Advocacy at Consocia Advisory, Founder of the Triloki Raj Foundation, senior visiting Fellow IMPRI. )
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