It has been reported that surgical face masks contain harmful chemicals to men and their reproductive systems. It has also been reported that they are polluting the environment. This sounds alarming, so I looked into the facts. First, I want to give a little background on surgical face mask manufacturing.

Surgical face masks are typically three-ply. The inner layer is a fibrous material designed to absorb moisture. The middle layer is the filter medium, and finally, there is the water-resistant outer layer. The materials are manufactured from polypropylene, polyurethane, polyacrylonitrile, polystyrene, polycarbonate, polyethylene, or polyester. These materials are all forms of plastics and are known to emit microparticles (MP), especially when decomposing or with heat exposure. Some of the potentially harmful microparticles are classified as phthalates ( pronounced thal-ates). (1)

Phthalates are in many products, including:

We All Have Detectable Phthalates

 The National Health and Nutrition Examination Survey (NHANES) and the Centers for Disease Control and Prevention (CDC) have found that phthalates are almost always detectible in humans. (3) Phthalates can cross the placenta, have been measured in amniotic fluid in human studies, are present in breast milk, and can be measured in urine at all ages. (2) Several human studies have reported associations of some phthalates with adverse reproductive outcomes and developmental effects similar to those in rats. (4) 

The Science and Regulation

Phthalate exposures (mostly in alb animals) have been linked to male reproductive system damage, including infertility, decreased sperm count, undescended testes, and malformation of the penis. (3) The widespread human exposure to phthalates coupled with its ability to induce male reproductive toxicity in laboratory animals has prompted the European Union and the United States to pass legislation restricting phthalates in children's toys. The European Union has also banned several phthalates from cosmetics. (5)

The Poor State of Men's Virility and Fertility

 It is plausible that phthalates reaching the developing human fetus at the appropriate concentration and in the precise developmental stage will cause damage to developing male testes. (6) It is undeniable that male sperm counts and testosterone levels have been significantly declining over the last several decades. A 2017 study found a 37% drop in mean sperm count in just the previous ten years. (7) Another paper looked at several studies and reported a 50-60% decline in sperm counts between 1973 and 2011. (8) Travison et al. reported in 2007 that testosterone levels fell 22% over 15 years. (9) 

Widespread Mask wearing is new. If we are to believe that the phthalates in masks are a problem, why have low sperm counts and testosterone been getting lower for decades? Masks may be adding to the total phthalate burden in humans, but no definitive studies have been done on the subject so far. Also, The animal studies gave very high doses at precise times to lab animals to observe the damage. Finally, in the paper by Tadele Assefa Aragaw that created the buzz over face masks, the materials were burned to release the phthalates. The paper also claims that phthalates are released when they degrade but do not indicate the timeframe or conditions that cause degradation. 

My Take

Phthalates may very well be a cause of male virility and fertility problems. Nobody knows for sure, but the animal models, coupled with their presence in most of us, lend plausibility. Enough that they have been limited in some products. Another competing theory is that the fall in testosterone and sperm counts is from soy products. Soy contains phytoestrogen that mimics natural estrogen. Testosterone levels were significantly lower in the animals fed the phytoestrogen-rich diet than animals fed the phytoestrogen-free diet, according to a 2001 paper. (10)

Finally, the critical time to avoid them is during pregnancy, so I would caution all expectant mothers to extra careful.

The Environmental Impact

The environmental impact of phthalates and other plastics cannot be denied. They have made their way into most environments. They are man-made and are therefore only present because we make them. Oluniyi O. Fadare and Tadele Assefa Aragaw have covered the subject in recent papers. If you wish to read their reports, click on their names. They point out that single-use plastic packaging materials, drinking bottles, and fast food containers have been identified as significant pollution sources in the environment. Disposable face masks could break down into smaller particles under environmental conditions and add to the overall burden. (11, 12) They both note that masks are becoming a common item found both on land and in aquatic environments. I challenge you to look around outside today; you will find masks strewn about your town. It stands to reason that when they degrade, they will add to the phthalate problem.

What Can We Do To Mitigate The Effects of Phthalates (and Masks)

• Don't reuse surgical masks; better yet, use cloth ones.

• Look for phthalate-free products.

• Stay away from fragrance. (The phthalate is less toxic than others) 

• Plastic products with recycling codes 3 and 7 may contain phthalates or BPA. Look for plastic with recycling codes 1, 2, or 5.

• Opt for glass food storage containers.

• Never heat your food in plastic.

• Avoid pesticides.

• Look for phthalate-free products.

Conclusion

As with many new chemical compounds, science does not present a clear picture of their true nature. Phthalates are no exception. Caution is certainly recommended because we have no evolutionary experience with them and most man-made chemicals. We simply have no innate mechanism to metabolize them efficiently. To be practical, we need to see the complete picture. We don't have one in this case. Luckily, cloth masks are acceptable everywhere as far as I understand. Polluting the environment, on the other hand, is unacceptable. Protecting the environment is a reasonable expectation. One final word; don't dig yourself a giant rabbit hole. I see too many people in my practice worrying over every potential toxin to the point where they develop severe anxiety issues and can't enjoy life the way it's meant to be. Don't be that person!