Environmental pollution, hormone-disrupting chemicals and maternal health factors during pregnancy are increasingly coming under scientific scrutiny as researchers seek to better understand hypospadias, one of the most common congenital conditions affecting male newborns.

Hypospadias occurs when the urethral opening develops on the underside of the penis instead of at the tip during fetal growth.

Though the condition is generally treatable through surgery, experts say identifying possible environmental contributors has emerged as an important public health concern.

Globally, hypospadias affects roughly one in every 150-200 male births. Based on India's annual birth rate, specialists estimate that close to one lakh boys may be born with the condition every year.

"Hypospadias is usually easy to diagnose because the urethral opening is not located at the tip of the penis," said Dr Shandip Kumar Sinha, director of pediatric surgery and pediatric urology at Medanta-The Medicity, Gurugram.

"The foreskin may be underdeveloped and the penis may show a downward curvature in many cases," he said.

Early diagnosis helps ensure timely treatment, which generally involves reconstructive surgery aimed at straightening the penis and repositioning the urethral opening to the tip.

"The success rate of surgery is usually high, particularly when performed at an early age," Dr Sinha said, adding that most procedures are carried out between nine months and two years of age, although complex cases may require staged operations.

Dr Prabudh Goel, professor of paediatric surgery (PhD in genomics of hypospadias) at AIIMS, Delhi said that every day in India, roughly 800 boys are born with this condition. Affecting one in every 125 live male births, it is among the most common birth defects globally, and its incidence is quietly but steadily rising, Dr Goel told PTI.

Most cases are treatable through surgery, but the growing numbers are prompting doctors to ask an uncomfortable question -- is the world we have built making our children sick before they are even born? Doctors identify three broad causes of hypospadias. The first is genetics, where inherited gene variants disrupt normal genital development.

The second is inadequate exposure to male hormones (androgens) during a critical period between the eighth and sixteenth weeks of pregnancy, when the baby's genitalia are forming.

The third, and increasingly concerning, is exposure to endocrine-disrupting chemicals (EDCs) in the environment.

"Our bodies are regulated by hormones, and EDCs can mimic or block these chemical messengers," said Dr Goel. "They are found in everyday sources such as plastics used to heat food, pesticide residues, industrial pollutants and contaminated water and heavy traffic corridors," he said.

According to him, these chemicals can cross the placenta and reach the developing fetus, where they not only interfere with hormones but also alter epigenetics - the process that determines how genes function.

"Think of DNA as the text of a book, and epigenetics as the notes telling the body which chapters to read," Dr Goel said. "EDCs can switch off genes crucial for normal hormonal development, and some of these changes may even be passed on to future generations," he explained.

Beyond hypospadias, prenatal exposure to EDCs has been linked to undescended testes, reduced sperm quality and a higher risk of testicular cancer in adulthood - conditions collectively known as testicular dysgenesis syndrome, he stated.

Emerging research also suggests possible links to hormonal imbalances and developmental disorders.

Dr Goel said prenatal EDC exposure may also affect girls, with studies linking it to early puberty, menstrual disorders, polycystic ovarian syndrome, reduced fertility and possibly endometriosis and hormone-sensitive cancers.

The societal implications are hard to ignore, Dr Goel said. Rising hypospadias rates are, in a sense, a biological signal or a warning that our food systems, urban air quality, industrial regulation, and plastic dependency deserve far greater scrutiny than they currently receive.

Prevention is imperfect but not impossible. Expectant mothers are advised to avoid heating food in plastic containers, choose organic produce where feasible, stay away from pesticide-heavy environments, and seek early and regular prenatal care.

Policy changes such as stricter regulation of EDCs in consumer products and better industrial waste management are equally necessary, Dr Goel stressed.

Sudies published in Environmental Health Perspectives and Human Reproduction Update have reported associations between prenatal exposure to some EDCs and male reproductive abnormalities, including hypospadias, although direct causation has not been established.

Dr Sinha said hormonal exposure during pregnancy may influence risk in some cases.

"Maternal exposure to progesterone during pregnancy may increase the risk of hypospadias in a male fetus," he said, noting that the condition can also run in families. "If a biological relative such as the father or a brother has had hypospadias, the chances may be slightly higher," he said.

Some scientists consider hypospadias part of a broader spectrum of male reproductive disorders known as Testicular Dysgenesis Syndrome, which also includes undescended testes and impaired reproductive function later in life.

Dr Raman Kumar, chairman of the Academy of Family Physicians of India, said congenital disorders linked to environmental exposure required greater public health attention and long-term monitoring.

"Family physicians are increasingly seeing concerns around pollution, lifestyle factors and reproductive health. Strengthening awareness about environmental risks and integrating preventive counselling into primary healthcare can help families make informed choices during pregnancy," he said.

Despite concerns over environmental exposures, doctors emphasise that outcomes for children with hypospadias are generally excellent when the condition is diagnosed and treated early.

"Healthcare providers usually identify the condition soon after birth during routine examination by a pediatrician," Dr Sinha said. "Early evaluation allows proper surgical planning and helps ensure the best outcomes."

Published on June 28, 2026