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Re: Using Social Media for Patient-Reported Outcomes: A Study of Genital Appearance and Sexual Function in Adult Bladder Exstrophy Patients.

Editorial Comment: Accumulating evidence points toward the role general health has in male fertility, including the metabolic syndrome and its ill effect on male reproduction. But how early in a man’s life does overall health affect his fertility down the road? These investigators analyzed a database containing health data of 1,454 boys since their birth in 1989 to 1991 and observed that males at age 17 years with increased cardiometabolic risk factors had lower testosterone and inhibin B than their peers. They also observed that males with evidence of nonalcoholic fatty liver disease had lower sperm counts, testosterone and inhibin B, and those with a high concentration of tumor necrosis factor receptor 1, a marker of the metabolic syndrome, had lower sperm counts and inhhibin B, and elevated luteinizing hormone and follicle-stimulating hormone. It is sobering to think that poor health in adolescence can play out in early adulthood as reduced fertility but these findings point to exactly that.