GUYnecology: The Missing Science of Men's Reproductive Health by Rene Almeling (review)

Why is there so little professional attention to men's reproductive health in the United States? In GUYnecology, Rene Almeling sets herself a difficult task: to explain the reasons for the absence of a specific medical field and to outline the impact of that absence on men's knowledge and behavior.

One of the book's main arguments is that men's bodies have been the default model for medical understandings of the body, and that the study and treatment of women's bodies have often been reduced to reproductive functions: "The relationality of gender results in extensive knowledge-making about women and reproduction and non-knowledge-making about men and reproduction" (p. 17). Thus, as medical science became professionalized starting in the mid-nineteenth-century United States, fertility became the center of medical attention to women and was absent in medical care for men. Due to the association of men's fertility with venereal disease (and with sex generally) at the turn of the last century, the medical profession often ignored men's reproductive care. In turn, this perspective on men's reproductive health has had lasting consequences for the development of medical knowledge, especially for men's knowledge about the factors that affect their own health and that of their potential future children.

The book is divided into two parts, each using a different scholarly technique. The first part, "Medical Specialization and the Making of Biomedical Knowledge," uses historical methods to identify the two times that American physicians attempted to delineate andrology as a specific field. First in 1886, Edward Lawrence Keyes and colleagues established a society (initially the Association of Genito-Urinary Surgeons) and journal (initially the Journal of Cutaneous and Genito-Urinary Diseases). Their effort to establish this medical specialty failed because other physicians thought that "men's genitals were never seen as core to their health and physiology like women's genitals were," and that venereal disease treatment was the domain of quacks (p. 43). Second, in the late 1960s and 1970s, a new initiative to organize the field of andrology, the American Society of Andrology, took inspiration from second-wave feminism and patients' rights movements. This initiative succeeded in part, leading to a present-day membership of over six hundred specialists, but the study of men's reproductive health remains fragmented across multiple medical specialties. A lack of intellectual and organizational structure around andrology continues to affect the production, circulation, and reception of men's reproductive health information.

The second part, "Circulating Knowledge about Men's Reproductive Health," shifts to sociological methods to pinpoint how this lack of knowledge affects individual men and the broader public health initiatives that target them. Almeling investigates the creation and dissemination of information regarding paternal effects—a subfield of andrology—in academic journals, newspapers, and public health messaging. She also interviewed forty men about their general knowledge of conception and reproductive health. Perhaps without knowing it, interviewees drew on ancient ideas of zygote formation (active sperm and passive egg) and articulated ideas of fatherhood with much more conviction than ideas about reproduction. The book concludes with possibilities for overcoming knowledge gaps through better medical research–community building, public health messaging, and doctor-patient information sharing during routine check-ups. Not only should men's reproductive health "be more deeply incorporated into preexisting biomedical infrastructure," but also the scope of reproductive health research should broaden to include trans and nonbinary individuals (p. 174).

Unfortunately, the focus of the book's first half, the development of andrology as an indicator of professional attention to men's reproductive health, is too narrow to illustrate the wide scientific and public interest in genetics and heredity from the late nineteenth century to the present. It pays scant attention to the role of American eugenicists in structuring research in men's and women's reproductive health—namely, how traits such as alcoholism...