Matt dives into a specific healthcare topic to help those in the industry, and those outside of it, better understand the market drivers causing today’s healthcare challenges.

I pushed for a sperm test after a year of watching my wife blame herself.

The result: zero sperm count.

The cause: testosterone therapy I'd been prescribed with zero conversation about what it would do to my fertility. My doctor treating my hormones never mentioned children. My wife's OBGYN never asked about my medical history.

We got our daughter through IVF because we could afford it. The WHO just released guidelines calling infertility a public health crisis affecting one in six people.

Where were they when I was that statistic?

Eleven million men in the United States are currently prescribed testosterone. Research shows 90% of men on testosterone can drop their sperm counts to zero. Yet in a 2010 survey, 25% of urologists incorrectly believed testosterone therapy would improve male fertility.

The math is brutal.

Between 2018 and 2022, testosterone prescriptions increased 27%—with a 58% jump among men aged 35-44. Prime reproductive years. Less than 2% of these men underwent semen analysis before starting treatment.

Men are trading future fertility for present performance without informed consent. The doctor prescribing testosterone isn't the one discussing pregnancy. That conversation happens with women at the OBGYN.

The system fragments care, and patients pay the price.

Stop testosterone, and 64-84% of men see sperm production resume within about 110 days. But 30% of men cannot achieve viable sperm counts even after 12 months of recovery treatment.

I wish someone had told me that before I started therapy.

The WHO's new guidelines emphasize male diagnosis and education. They acknowledge what patients already know: infertility isn't just a female issue. But guidelines mean nothing if primary care doctors don't order fertility hormone panels as standard practice.

The gap isn't in the recommendations. The gap is in the exam room.

The U.S. fertility rate dropped to 1.599 children per woman in 2024—far below the 2.1 replacement rate needed to sustain population levels. Most couples believe technology will save them when they're ready.

It won't.

Female ovarian quality and quantity begin declining in the mid-20s. By the time couples reach their 30s and decide to start trying, the conversations about donor eggs and surrogates come too late.

We're facing collapsing birth rates that threaten Social Security, Medicare, and Medicaid. Elon Musk has been shouting about this for years. President Trump pushed for employer coverage of infertility care.

The WHO's 40 recommendations won't change anything without patient-driven awareness.

WHO guidelines are paper that won't reach the exam room. What gives me hope is the patient population making this a story.

We need public awareness campaigns and high school education programs. Social media influencers normalizing conversations about fertility. Primary care doctors ordering hormone panels before prescribing treatments that destroy reproductive capacity.

Young couples need to hear this in their twenties: Your fertility years are limited.

Men need to discuss fatherhood potential with their doctors before starting hormone therapy. Women need hormone level evaluations before turning 30. These conversations matter as much as diet and exercise if we care about the human race.

My daughter exists because I could afford IVF and because I pushed for testing when the system failed me. WHO Director-General Dr. Tedros calls infertility "one of the most overlooked public health challenges of our time," noting that in some settings, a single IVF round costs double the average annual household income.

Millions are priced out of care or forced to choose between having children and financial security.

Vanguard just projected public markets may return only 5% annually over the next decade. In a 2024 report, Goldman Sachs forecasted the S&P 500 may return just 3% annually for the same time frame—stats that put current valuations in the 7th percentile of history.

Translation? The gains we’ve seen over the past few years might not continue for quite a while.

Meanwhile, another asset class—almost entirely uncorrelated to the S&P 500 historically—has overall outpaced it for decades (1995-2024), according to Masterworks data.

Masterworks lets everyday investors invest in shares of multimillion-dollar artworks by legends like Banksy, Basquiat, and Picasso.

And they’re not just buying. They’re exiting—with net annualized returns like 17.6%, 17.8%, and 21.5% among their 23 sales.*

Wall Street won’t talk about this. But the wealthy already are. Shares in new offerings can sell quickly but…

👉 My subscribers skip the waitlist

_{*Past performance is not indicative of future returns. Important Reg A disclosures: masterworks.com/cd.}

Have the conversation with your spouse early in your relationship. If you love each other, see the doctor together after you get married. Then make whatever plans you have for your life.

Children are too important to put off.

The WHO finally admits what patients already knew. Infertility is a public health crisis. But recognition without action is just more paper.

The change happens when you demand better from your healthcare provider. When you ask about fertility before accepting prescriptions. When you refuse to wait until crisis forces discovery.

The system won't fix itself. Patients have to make this matter.