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Male fertility-related disorders: cause for concern or a stalking horse?
  1. Mireille B Toledano,
  2. Paul D Nelson
  1. Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College London, London, UK
  1. Correspondence to:
    Mireille B Toledano
    Department of Epidemiology and Public Health, Faculty of Medicine, Imperial College London, London, UK; m.toledano{at}

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Perspective on the papers by Abdullah et al and Nassar et al (see pages 576 and 580)

In this issue, Abdullah et al examine routine Hospital Episode Statistics (HES) from the 1990s for northern England and report a decreasing birth prevalence of cryptorchidism and orchidopexy. In addition, they report a small increase in birth prevalence of hypospadias but no change in the rate of hypospadias surgical repair (corrective procedure rates). The latter is more likely to reflect true prevalence as the vast majority of cases are referred for surgery. In contrast, Nassar et al, also in this issue, report on a population-based study to determine trends in hypospadias in the Australian population, 1980–2000. Data were obtained from a congenital anomaly registry (with multiple sources of notification) for aborted and still births and for live births up to 6 years old. Overall birth prevalence was found to be 3.5 over the 20-year study period with birth prevalence rates increasing significantly by 2% per annum.

Both these papers reporting contrasting trends in male fertility-related disorders are part of a wider series of publications examining the evidence for adverse trends in male reproductive health, in particular, in association with exposure to ubiquitous environmental chemicals mimicking oestrogen.

Much public interest in this body of research came from popular science, most notably Carson’s Silent spring in 1962 warning us of the dangers posed by man-made pesticides. This was followed in 1996 by Colborn et al’s scientific detective story Our stolen future, which suggested that we were still ignoring the danger of man-made chemicals and thereby threatening our fertility and human survival. In the academic domain, these ideas were formalised into the controversial “endocrine disruptor hypothesis” notably by Skakkebaek, Sharpe and colleagues. Much evidence of chemical-hormonal activity in vitro is available, together …

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  • Competing interests: None.

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