How fast can your swimmers go?

At-home semen testing could be the key to unlocking men’s health.

At 17, Eric Zhu is equal parts high school kid and boardroom prodigy.

Not long ago he would sneak off from class to take investor calls from a Carmel, Indiana high school bathroom stall, framed by a janky green screen and ring light (this was his backup office after being kicked out of the janitor’s closet).

Those investors listened. He raised $2.3 million for Aviato, his startup analyzing private market data, dubbed “PitchBook on steroids.” Now he’s got an eye towards the next big idea, and it is no less likely than the first.

One night, over a casual conversation with fellow entrepreneurs, the topic turned to biohacking. Then the topic turned to sperm. “As someone in high school, normally when my friends talk about sperm it’s them being degenerates,” he told me. “But these people were talking about it as a biomarker.”

Sperm matters for fertility but there are other reasons to care about sperm too. Sperm are highly sensitive to metabolism (bad diet = bad sperm), toxic exposures like alcohol and pot, and other lifestyle factors that contribute to overall health. Many of these factors are within our control.

Eric found himself thinking: what if we treated sperm health more like a sport? What if it became something you could train for and triumph in against a competitor? In April, he debuted the natural conclusion of this thinking to the world: Sperm Racing.

Two legends, one microscopic race track

Eric is aware of how outlandish his idea is. In fact, he leaned into the absurdity to raise $1 million for the first race alone, produced as a one-on-one match between students at USC and UCLA, with all the hype, theatrics and fanfare of a celebrity UFC fight.

Under moody purple lights amid hum of downtown Los Angeles, a large crowd clustered around a massive screen where sperm—yes, real sperm—raced across a digital track in real time.

Each “racer” was given $1,000 to train for maximum health and sperm speed. Spectators watched a best of three match between two competitors that, as one journalist put it, “felt briefly like watching the final stretch of the Kentucky Derby—if the horses were microscopic and had long flagellating tails.”

“Our winner quit alcohol and drugs for 30 days,” he said. “He started working out, and optimizing his health. He felt so much better, and now he isn’t even drinking anymore at all. That’s pretty sick.”

Competitors produced their samples in the green room, an hour before showtime. Then, their sperm was warmed, filtered, and transformed via computer vision into an animated race. Each race was extremely close, (even exponentially-magnified sperm can only swim so fast) and lasted about two minutes. Ultimately, USC’s Tristan Milker took home the title, plus a $10,000 cash prize.

For Eric, it feels like the start of something momentous. “Our winner quit alcohol and drugs for 30 days,” he said. “He started working out, and optimizing his health. He felt so much better, and now he isn’t even drinking anymore at all. That’s pretty sick.”

Therein is the big idea: to Eric, sperm racing isn't just about racing sperm–it's about turning health into a competition, and using a familiar (if unconventional) entertainment format to inform.

It's about making male fertility something people actually want to talk about, track, and improve.

Testing made easy

Reproductive urologist Dr. James Smith is so enthusiastic about men’s health that every conversation with him makes me feel that few causes could be more worthy of my attention. He is a Professor of Urology at the University of San Francisco, California, and also Chief Medical Officer of Fellow, a company that offers clinical-grade and “patient-friendly” semen tests.

Men who test with Fellow produce their samples at home and then mail them in for analysis. Since founding the company, men have been mailing them in by the thousands. And today, Dr. Smith is sitting on one of the world’s largest repositories of longitudinal semen analysis data. This means that men not only send him their tests, but many test themselves repeatedly.

Medical testing is rarely regarded as fun, particularly when it involves something as personal as reproductive health. Yet a colleague of mine once observed that in comparison to many of the tests women are subjected to such as pap smears and mammograms, a semen analysis is actually “easy to perform, cheap, and pleasurable.”

According to Dr. Smith, a significant number of men are testing not because they are struggling to conceive, or because they have been asked to by a doctor, but solely because they want to. Because they’re curious.

As a medical student, originally Dr. Smith planned to become an infectious diseases doctor. While studying dengue fever in Nicaragua he saw firsthand that “the reason children died from dengue fever was simply that the farther away you were from medical care, the less likely you were to get it.”

It wasn’t a groundbreaking conclusion (“I didn’t even write it up,” he says), but it galvanized an intense focus on breaking down barriers to care. In ultimately choosing to become a reproductive urologist, it did not escape him that he picked one of the rarest specialties in medicine.

According to Dr. Smith, a significant number of men are testing not because they are struggling to conceive, or because they have been asked to by a doctor, but solely because they want to. Because they’re curious.

As Dr. Smith ascended the academic ranks of UCSF, becoming a prolific researcher, professor, and eventual director of their Male Reproductive Health program, he came to observe a pattern: his patients did want to talk about their sperm—they just were blocked by a system that made getting answers unnecessarily challenging.

“There are a lot of hoops that somebody has to jump through to get to me,” he said. “They go to their primary care doctor and the primary care doctor doesn't know how to order a semen analysis, let alone interpret it. Or maybe their wife is plugged into her ob-gyn, who doesn’t feel comfortable ordering it for someone who isn’t her patient. Maybe they end up with an REI, who is still mostly dedicated to caring for women.”

At Maven, the appetite for at-home testing over the first half of this year has already been remarkable, with three times more requested tests than our initial projections.

The gold standard for semen analysis remains an in-person test, where men produce a sample in a clinic that gets examined within an hour. Sperm quality degrades over time and the results can be strongly influenced by handling and temperature. But Dr. Smith tells me that Fellow’s test is unique in accounting for the time-lag to analysis, giving men accurate results, even if it takes days for their samples to arrive in the mail.

The convenience–and the ability to receive results directly–is potentially game changing. At Maven, the appetite for at-home testing over the first half of this year has already been remarkable, with three times more requested tests than our initial projections.

Curiosity and stigma

Of course men are as diverse as we are complex, no more easily summarized than women. Still, surprisingly little is known about how men think about their own reproductive health. The reason is because we are seldom asked.

This Men’s Health Awareness Month, Maven released a first-of-its-kind national survey with our partner Posterity Health, a digital male fertility clinic. The findings explore how men ages 25-49 feel about their fertility:

• Men were most likely to test their semen out of pure curiosity (57%), versus if they’re having difficulty conceiving (50%), if a doctor recommended it (48%), they’re preparing to conceive (46%), or if a partner recommended it (34%).

• Among men currently trying to conceive or planning to: 55% would make lifestyle changes if they believed it would help, and nearly half have already cut back on alcohol, eaten healthier, or become more active.

• Overall, 91% of men would be interested in digital health resources to support their fertility.

But at the same time:

• Many men still believe infertility is mostly a women’s issue, with nearly 1 in 3 men believing that male infertility contributes 30% or less of the time when couples have trouble conceiving. In reality, it's closer to 50%.

• 57% of men think there is a stigma associated with male fertility testing—especially non-Hispanic white men (62%). Interestingly, this stigma increased with socioeconomic status, with lower-income men least likely to feel it (46%).

• 39% of men say they’d avoid semen testing because it feels awkward or inconvenient. When asked why they might not test the top reasons included: feeling confident in their fertility (39%), and fear of the results (29%)

Posterity’s Chief Scientific Officer Dr. Joshua Halpern is a reproductive urologist who helped lead the study. Few people have a better command of the scientific literature. He tells me, “This is probably one of the first surveys of its time, which sounds crazy, but goes to the point that our field is really early in trying to answer some of these basic questions about how men feel.”

“This is probably one of the first surveys of its time, which sounds crazy, but goes to the point that our field is really early in trying to answer some of these basic questions about how men feel.”

Dr. Halpern sees this hesitance in his patients firsthand: “When you're a woman and you graduate from your pediatrician, they say you have to go see a gynecologist once a year, you need a pap smear and birth control,” he said. “When you’re 18 years old, as a guy, you go to the frat house and then you spend the next 15 years never seeing a primary care doctor until you have a serious problem. And that first serious problem these days is often fertility and erections.”

This in essence means Dr. Halpern functions as a primary care doctor: “I'm often the first person that individual is coming to see after having very limited experience with the health care apparatus and a lot of discomfort around doctors.”

From awkward to empowered

I asked Dr. Halpern to help me reconcile that discomfort with all the latent curiosity. He told me, frankly, that while the survey indicates that both stigma and acceptance co-exist, the degree of male curiosity surprised him.

Most men find the idea of tracking their sperm as a biomarker compelling. Most men that Dr. Halpern sees in the office tell him that they wish they had tested sooner. Yet in the office setting, getting them to test in the first place is a struggle. “My team has to text them or call them between three to four times just to get them to pick up the phone,” he said.

A marketer would represent that challenge as a funnel. The traditional system has created a narrow funnel, requiring clinical referrals, complex scheduling and potentially awkward office visits to find and engage men. Meanwhile, new solutions like those created by Posterity Health and Fellow are stretching the funnel, enabling at-home tests and virtual visits with urologists that may precede necessary in-person care.

And of course Eric is now aiming to blow the top of the funnel wide open, taking on the potential stigma head-on with a mix of spectacle and intrigue, that is at once ridiculous and surprisingly earnest.

He tells me the next sperm race will take place this October in Las Vegas, with potential celebrity competitors with generation-straddling appeal. (Eric tells me he had no idea who Nick Cannon is until recently, but the folks around him have suggested that the notoriously prolific father of 12 should be at the top of the list.)

I wonder if a rising generation of men may be poised to engage in their reproductive health more openly. Much like the rising generation of women who’ve helped reduce the stigma associated with periods and menopause, perhaps routine semen testing will be a normal thing that men do. Maybe for sport. But hopefully also for better health.

When Fellow was a smaller operation, Dr. Smith enlisted his own teenage son to help with the supply chain—packaging and shipping kits from the founder’s house. To Dr. Smith’s surprise, his son was hounded by his friends. “They all wanted to know if they could have a kit, if they could test,” he laughed, “because they were curious!”

What my team is reading, considering, and building against:

• If you want proof Sperm Racing is reaching its intended audience…look no further than this clip of David Spade riffing on the concept on Theo Von’s podcast.

• My pal Dr. Paul Turek was one of the first people to ever frame sperm as a biomarker to me. His recent episode on Peter Attia’s podcast is an awesome step towards mainstreaming this idea, and is not unlike my experience learning about this work for the first time.

• Very often media coverage of health influencers on the Internet tends to suggest the audience are women. But male health influencers are equally inescapable, and well worth studying for their effectiveness at reaching and engaging men. One survey from the UK found that over 60% of young men interacted with masculinity influencers online, that 35% had taken direct advice from them, and that across the board those who did were more likely to take steroids, supplements, etc.

• Dr. Brian Levine (a terrific REI and even more terrific person) has a well-timed op-ed in STAT this week calling for greater regulation of the fertility industry to better protect patients—a call that is only more urgent as even the bare minimum regulations are worn away.

• My college classmate Anna Louise Sussman has a wonderful piece in the NYT this weekend about an issue near and dear to my heart: tactical policy recommendations to make parenting less burdensome. I am eagerly anticipating her new book on the same topic.