With Father’s Day here yet again, it’s time to address the question on everyone’s mind: What is the health impact of being a father?
As with all critical questions relating to life and death, there is medical literature to help guide us. First, the epidemiologic: The proportion of adults who choose not to be parents is growing and sits at 20 percent or so. Most of the data is from women and for good reason—females have a shorter, more knowable duration of fertility. Plus they always know when they are a parent.
A guy, however, may impregnate and run, never knowing of the child he left behind (see: 1,001 traveling salesman and milkman jokes). Plus, he can remain potent a long while: Strom Thurmond fathered several children in his seventies while Saul Bellow last became a father at age 84.
Given the vagueness of the starting and stopping point for men, it is unsurprising that I could find no report that estimated the proportion of childless men. There is however a mature vocabulary for men and women alike: Childlessness can be voluntary or involuntary, has an upbeat newish name—“child-free”—countless blogs and spirited books, and a political slant around the notion that reproducing is somehow self-adoring and short-sighted.
The medical side of fatherhood (or its lack) has mostly focused on that group of men who are involuntarily fatherless—i.e., those who have tried but never successfully fathered children. The group that prefers not to procreate represents an unknowable proportion in the various studies but likely sits in the minority.
Various outcomes have been examined. These include cancer, heart disease, and overall mortality. Each article, though, carries the same extremely important caveat: The causal link between offspring number and medical condition is uncertain at best. Most investigators hypothesize that a subtle hormonal derangement such as too much or too little estrogen or androgen (the hormones involved in determining sexual characteristics) is known to affect the risk of heart disease and stroke and also may render a person less fertile. Therefore the medical problem and the childless state may be consequences of the same physiology and not a linear cause and effect.
Therefore, a well-performed study of more 137,000 men recruited to an AARP cohort found that “married men who have no children have a higher risk of dying from cardiovascular disease… than men with two or more children,” which might be explained by the fact that the same hormone imbalance that was reducing fertility also was increasing risk for cardiovascular disease. These authors, from leading institutions across the U.S., including Stanford and the National Cancer Institute, concluded that their findings agreed with more than a half-dozen similar studies finding an uptick in heart disease among the childless.
Ditto for prostate cancer, though in the other direction. Prostate cancer, like heart disease, appears related to subtle hormone imbalances; that is why the disease is often treated by using feminizing hormones. Several studies have sought to correlate risk of prostate cancer with number of offspring; most but not all show a lower risk among childless men. Perhaps, authors have speculated, the men who are not able to father because of a touch too much feminizing hormone are protected from some risk for prostate cancer risk by the same imbalance.
A large Danish study addressing these issues made quite a flurry at the end of 2012 (here, here, and here for example). Any study on population-based disease rates from Denmark should make the news—they lead the world in well-performed, dispassionate, and statistically balanced inquiry.
This exploration found that, compared to the childless, the risk of premature mortality for those who had children was sharply reduced: Men with children had half the rate and women, one-fourth. The fine lines of the article (which were not so fine at all but loudly trumpeted) were not read carefully by some. Thankfully, a watchdog group of unskewers at the Science Media Centre examined the actual facts. The group studied was an altogether skewed collection of 21,276 Danish couples who had sought help in an infertility clinic. The researchers then compared the health outcomes of those who successfully did or did not successfully become pregnant—and the difference in rates was startling.
Yet the actual number of premature deaths, as the Science Media group (and the authors themselves) pointed out, went from a really really really small number to just a really really small one. And more importantly, the group studied—those already seeking help for infertility—was not representative of the adults who have children without difficulty or those who opt for the child-free life.
Perhaps then it is time for a new tradition: the Father’s Day resolution, an annual promise dads everywhere should make to embrace the acuteness of the male condition, its fragility in modern life. After all, Father’s Day is the lone moment in the year that celebrates being, well, just a guy. Oh sure, the Super Bowl and all its macho imitators are commemorations of some repulsive male urge best ignored. But being a son or a father or both is its own glorious reward and, man, that’s something worth celebrating.